eHealth literacy and doctor-inpatient relationships: The mediating role of eHealth utilization and the moderating role of age.

Background: Information asymmetry remains a critical challenge in doctor-patient relationships. Although the adoption of eHealth technologies has substantially improved patients' access to medical information, the extent of these benefits largely depends on individuals' levels of eHealth literacy. This study aims to investigate the association between inpatients' eHealth literacy and doctor-patient relationships, while exploring the mediating role of eHealth utilization and the moderating effect of age. Methods: In 2023, a cross-sectional study was conducted among 1307 inpatients, selected through simple random sampling from three tertiary hospitals in Jinan, Shandong Province, China. The Patient-Doctor Relationship Questionnaire-9 (PDRQ-9) was employed to assess the quality of doctor-patient relationships, while the eHealth Literacy Scale was used to evaluate participants' levels of eHealth literacy. Stepwise and bootstrap tests were applied to examine the mediation effect, and hierarchical regression analysis combined with bootstrap testing was used to assess the moderating role of age. Results: eHealth literacy was significantly positively correlated with eHealth utilization (β=0.150, p < .001). A significant negative correlation was found between eHealth utilization and PDRQ-9 scores (β = -0.270, p < .001). eHealth utilization acted as a significant suppressor between eHealth literacy and doctor-patient relationships (indirect effect = -0.040, 95% CI [-0.061, -0.022] direct effect = 0.076, 95% CI [0.028, 0.124]). In adults aged 18-59, eHealth utilization played a partial mediating role (indirect effect = 0.333, 95% CI [-0.055, -0.011] direct effect = 0.192, 95% CI [0.129, 0.255]). In older adults aged 60 and above, eHealth utilization played a complete mediating role (indirect effect = -0.038, 95% CI [-0.071, -0.001] direct effect = -0.051, 95% CI [-0.130, 0.027]). Compared to the inpatients under 60 years old (effect = -0.022, 95% CI [-0.045, -0.001]), the negative effect of eHealth utilization on PDRQ-9 scores was more evident in inpatients aged 60 and above (effect = -0.70, 95% CI [-0.103, -0.040]). Conclusion: Bridging the digital divide among elderly patients is essential for mitigating information asymmetry and promoting more harmonious doctor-patient relationships.