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Research Article: E-health literacy is associated with better medication adherence in older adults with chronic comorbidities: the mediating role of information overload and the moderating effect of family care on the anxiety-adherence link

Date Published: 2026-07-10

Abstract:
Using the Stimulus-Organism-Response and stress buffering models, this study explores how e-health literacy is associated with medication adherence in older adults with chronic comorbidities, focusing on the chained mediation of information overload/anxiety and the moderation of family care on anxiety-adherence. A cross-sectional survey was conducted (October 2025–March 2026) on 428 eligible adults (conveniently sampled from 3 Grade A tertiary hospitals in Northwest China). Assessments used 5 scales (Electronic Health Literacy, Information Overload Severity, Self-Rating Anxiety, Family Care Index, Morisky Medication Adherence). We performed analyses (correlation, stratified regression, structural equation modeling) using SPSS 29.0 and AMOS 26.0. Medication adherence was poor (80.8% non-adherent), with good model fit. E-health literacy was directly associated with adherence ( ? =?0.234, p <?0.001) and indirectly associated via information overload ( ? =?0.022, p <?0.05). However, the chained mediation through both information overload and anxiety was not statistically significant; only the single mediation via information overload was significant. Family care moderated the anxiety-adherence association ( ? =?0.102, p <?0.001), such that higher care buffered anxiety’s negative impact. E-health literacy is associated with better adherence in older adults with chronic comorbidities (directly or through reduced information overload), while family care is associated with a weaker negative impact of anxiety on medication behavior. This “moderated mediation” model suggests future interventions may benefit from improving elderly e-health literacy and integrate family care for targeted multi-level strategies.

Introduction:
Chronic disease co-morbidity poses a significant health challenge for the older population, and for older adults with chronic comorbidities (OACCs), adherence to complex medication regimens has become even more critical for disease management ( 1 ). The internet is currently reshaping how health information is accessed, and e-health literacy (e-HL)—the ability of individuals to locate, understand, and evaluate online health information—has become a vital tool for personal health self-management ( 2 ). However,…

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