Objective
To examine the association between digital health literacy and self-care behaviors and to test whether self-efficacy statistically mediates this association, after adjusting for relevant covariates, among older adults with cancer undergoing chemotherapy.
Methods
A descriptive cross-sectional study was conducted with 117 older adults with cancer undergoing chemotherapy at a tertiary hospital in the Republic of Korea. Participants completed validated measures of digital health literacy (eHEALS), self-efficacy (CSSES-K), and self-care behaviors. Data were analyzed using regression-based mediation analysis (Hayes‘ PROCESS macro Model 4) with 5000 bootstrap samples, adjusting for sex, age, educational level, cancer diagnosis, and Eastern Cooperative Oncology Group (ECOG) performance status.
Results
Digital health literacy was positively associated with self-efficacy (B = 0.55, 95% confidence interval (CI) [0.26, 0.84], P < 0.001). In the total effect model, digital health literacy was positively associated with self-care behaviors (B = 0.36, 95% CI [0.09, 0.62], P = 0.009). After self-efficacy was included, self-efficacy remained positively associated with self-care behaviors (B = 0.51, 95% CI [0.36, 0.66], P < 0.001), whereas the direct association between digital health literacy and self-care behaviors was not statistically significant (B = 0.08, 95% CI [-0.16, 0.31], P = 0.530). The indirect effect was significant (B = 0.28, 95% bootstrap CI [0.13, 0.51]).
Conclusions
The findings were compatible with an indirect-only mediation pattern, suggesting that digital health literacy may be linked to self-care behaviors primarily through self-efficacy among older adults undergoing chemotherapy. Interventions to promote self-care during chemotherapy may benefit from combining digital health literacy support with strategies that strengthen self-efficacy.