Digital health literacy and attitudes toward aging among older adults in China: evidence of a U-shaped association based on CLASS data

Abstract

Digital health literacy (DHL) is increasingly important for older adults amid population aging and digital transformation. However, its association with attitudes toward aging and the underlying psychological mechanisms remain unclear. Methods This study used pooled cross-sectional data from the 2020 and 2023 waves of the China Longitudinal Aging Social Survey, including 15,196 adults aged 60 years and older. DHL was measured using a PCA-based composite index. Quantile regression and mediation analyses were conducted to examine its association with positive attitudes toward aging and the mediating roles of digital access anxiety and digital usage anxiety. Results DHL showed a significant U-shaped association with positive attitudes toward aging, and a formal U-test supported this non-linear pattern. The U-shaped association was more evident among rural residents, less-educated older adults, and adults aged 70 years or younger, but less pronounced among urban residents and more-educated older adults. No significant association was observed among adults aged over 70 years. Mediation analyses showed that digital health literacy was associated with lower digital access anxiety, which was linked to more positive attitudes toward aging. In contrast, digital health literacy was associated with higher digital usage anxiety, which partly weakened its beneficial association. Conclusions DHL has a complex, non-linear association with older adults’ attitudes toward aging. The findings suggest that digital inclusion strategies may benefit from tailored approaches that reduce access anxiety, address usage-related concerns, and provide assisted digital support for adults in advanced old age.