A Multidimensional Analysis of eHealth Literacy Skills and Chronic Disease Self-Management Among U.S. Adults with Chronic Conditions

Abstract

Background: More than 140 million adults in the U.S. live with one or more chronic conditions and must engage in ongoing chronic disease self-management, increasingly within an electronic health (eHealth) environment. Effective use of eHealth tools depends on eHealth literacy skills, yet little is known about how specific eHealth literacy domains relate to health behaviors among U.S. adults living with chronic conditions. This dissertation examined the role of eHealth literacy skills in supporting chronic disease self-management behaviors among adults with common chronic conditions.Methods: This study involved a secondary analysis of 2022 Health Information National Trends Survey data (HINTS Cycle 6) among internet-using adults with at least one chronic condition (n = 2,888). Guided by theory from public health, health communication, and information science, variables approximating six domains of eHealth literacy—basic, computer, scientific, information, health, and media literacy—were identified and operationalized. Four study aims were addressed using survey-weighted descriptive statistics, bivariate analyses, and regression models. Results: Overall, in Aim 1, eHealth literacy skill levels varied across domains, with higher reported levels of basic and health literacy and lower levels of scientific and media literacy. In Aim 2, an eHealth use composite score showed its strongest and most consistent associations with computer, information, and health literacy, supporting the validity of these skill measures. In Aim 3, higher levels of several eHealth literacy domains were independently associated with select chronic disease self-management behaviors, although patterns varied by domain and behavior. In Aim 4, the composite eHealth literacy index was positively and significantly associated with greater engagement in chronic disease self-management behaviors after adjustment for sociodemographic factors. Self-efficacy emerged as the strongest independent predictor of chronic disease self-management behaviors but did not eliminate the association between eHealth literacy and self-management. Conclusions: This study demonstrated that eHealth literacy skills can be meaningfully approximated using population surveillance data and that higher eHealth literacy is associated with greater engagement in chronic disease self-management behaviors among U.S. adults with chronic conditions. Findings support a multidimensional conceptualization of eHealth literacy and suggest that eHealth literacy and self-efficacy together represent important behavioral skills for effective self-management. These results have implications for theory, measurement, and the design of digital health interventions for adults living with chronic disease.