--- title: "Digital health literacy, proactive behaviours and quality of life in older adults with type 2 diab" id: "bmj-open-6-digital-health-literacy-proactive-health-behaviours-the-digital-healthcare" canonical_url: "https://medichelpline.com/clinical-feed/bmj-open-6-digital-health-literacy-proactive-health-behaviours-the-digital-healthcare" content_type: "clinical_feed_article" specialty: "Endocrinology" source_name: "BMJ Open" source_url: "http://bmjopen.bmj.com/cgi/content/short/16/10/e120615?rss=1" published_at: "2026-10-06T11:59:03.000Z" evidence_level: "Journal Feed" license: "CC-BY-NC-4.0 / Informational Use" --- # Digital health literacy, proactive behaviours and quality of life in older adults with type 2 diab ## Provenance & Clinical Metadata - **Canonical URL:** https://medichelpline.com/clinical-feed/bmj-open-6-digital-health-literacy-proactive-health-behaviours-the-digital-healthcare - **Specialty:** [Endocrinology](https://medichelpline.com/clinical-feed/endocrinology.md) - **Primary Source:** BMJ Open - **Source URL:** [Original Journal Publication](http://bmjopen.bmj.com/cgi/content/short/16/10/e120615?rss=1) - **Published At:** 2026-10-06T11:59:03.000Z - **Evidence Rating:** Journal Feed ## Executive GIST (TL;DR) - This cross-sectional study examined associations between **digital health literacy (DHL)** and health-related quality of life (**HRQoL**) in 1,053 older adults with **type 2 diabetes** recruited from primary care registries in Huai'an, China. - Measures included DHL, **proactive health behaviours (PHB)**, four single-item digital healthcare environment indicators, EQ-5D-3L utility score, and EQ-VAS. Mean scores: DHL 21.24 ± 10.43; PHB 76.75 ± 9.88; EQ-5D-3L utility 0.968 ± 0.069. - The adjusted total association between DHL and EQ-5D-3L utility was statistically significant (B = 0.000569; 95% CI 0.000228 to 0.000910), but the direct association was not (B = 0.000152; p = 0.338). - A significant indirect association was observed: DHL → **PHB** → HRQoL (B = 0.000418; bias-corrected 95% CI 0.000260 to 0.000619), accounting for 73.5% of the total association. - Effect modification by the digital healthcare environment showed no robust evidence for the primary EQ-5D-3L outcome; some interactions (remote service use, online health management) reached significance only under HC3 inference and were not confirmed in sensitivity analyses. - An exploratory positive interaction between PHB and remote-service use was noted for EQ-VAS but is described as exploratory. - Authors conclude higher **DHL** is associated with better HRQoL largely via increased **proactive health behaviours**, and they recommend further longitudinal and interventional research to clarify causality and mechanisms. - All numerical results, instruments, analytic approach (5000 bias-corrected bootstrap resamples; heteroscedasticity-consistent type 3 (HC3) standard errors) are reported as in the source. ## Clinical Analysis & Structured Key Points Background Digital health literacy (DHL) may be associated with health-related quality of life (HRQoL) in older adults with type 2 diabetes, but the behavioural and contextual correlates of this association remain unclear. This study examined that association, the indirect association through proactive health behaviours (PHB), and potential effect modification by the digital healthcare environment. Methods A cross-sectional survey was conducted from July to August 2025 among older adults with type 2 diabetes recruited by convenience sampling from primary healthcare chronic disease management registries in Huai'an, China. DHL, PHB and four single-item digital healthcare environment indicators were assessed using structured instruments, and HRQoL using the EuroQol five-dimensional three-level questionnaire (EQ-5D-3L) and EuroQol Visual Analogue Scale (EQ-VAS). Adjusted indirect-association (5000 bias-corrected bootstrap resamples) and effect-modification analyses used heteroscedasticity-consistent type 3 (HC3) standard errors. Results Among 1053 participants, the mean DHL score was 21.24±10.43, the mean PHB score 76.75±9.88 and the mean EQ-5D-3L utility score 0.968±0.069. The adjusted total association between DHL and utility was significant (B=0.000569, 95% CI 0.000228 to 0.000910), whereas the direct association was not (B=0.000152; p=0.338). The indirect association through PHB was significant (B=0.000418, bias-corrected 95% CI 0.000260 to 0.000619) and accounted for 73.5% of the total. There was no robust evidence of effect modification for EQ-5D-3L utility: interactions with remote service use and online health management use reached significance only under HC3 inference and were not reproduced in sensitivity analyses. An exploratory positive PHB-by-remote-service-use interaction was observed for the supplementary EQ-VAS outcome. Conclusions Higher digital health literacy was associated with better HRQoL among older adults with type 2 diabetes, with a significant cross-sectional indirect association observed through proactive health behaviours. No robust effect modification was identified for the primary EQ-5D-3L outcome. 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