The relationship between digital health literacy and health anxiety among Chinese older adults: the role of aging attitudes and physical activity.

Objective Against the backdrop of rapid population aging and increasing digitalization, health anxiety has emerged as a significant public health concern affecting the physical and psychological well-being of older adults in China. Digital health literacy, defined as an individual's ability to access, understand, and evaluate health-related information in digital environments, may play a crucial role in shaping health anxiety. However, the underlying mechanisms linking digital health literacy to health anxiety remain insufficiently examined. Therefore, this study aimed to investigate the association between digital health literacy and health anxiety among Chinese older adults, with particular attention to the mediating roles of aging attitudes and physical activity.

Methods A total of 535 Chinese older adults were recruited using a convenience sampling strategy. Validated standardized questionnaires were used to assess digital health literacy, aging attitudes, physical activity levels, and health anxiety. Correlation and regression analyses were conducted, and the mediating effects of aging attitudes and physical activity, as well as their chain mediation effect, were tested using the Bootstrap method.

Results Digital health literacy was significantly and negatively associated with health anxiety (β = -0.239, p < 0.01). Aging attitudes [95% CI (-0.080, -0.025)] and physical activity [95% CI (-0.029, -0.002)] independently mediated the relationship between digital health literacy and health anxiety. Furthermore, a significant chain mediation effect of aging attitudes and physical activity was observed [95% CI (-0.008, -0.001)].

Conclusion Digital health literacy not only directly alleviates health anxiety among older adults but also indirectly reduces anxiety by fostering more positive aging attitudes and promoting higher levels of physical activity. These findings elucidate key psychological and behavioral mechanisms underlying health anxiety in digital contexts and provide important implications for public health interventions. Integrated strategies combining digital skills training, positive aging education, and physical activity promotion may be effective in enhancing the mental and physical health of older adults.