Urban-Rural Differences in the Association of Ehealth Literacy with Medication Adherence among Older People with Frailty and Prefrailty: Cross-Sectional Study

Abstract Background With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82‐1.63), less evaluation (AOR 1.29, 95% CI 0.92‐1.81), and less decision ability (AOR 1.20, 95% CI 0.86‐1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56‐2.13), less evaluation (AOR 1.05, 95% CI 0.61‐1.79), and less decision ability (AOR 1.10, 95% CI 0.64‐1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48‐1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47‐1.54), evaluation (AOR 0.89, 95% CI 0.50‐1.57), and decision ability (AOR 0.99, 95% CI 0.55‐1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48‐1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62‐2.44), evaluation (AOR 0.98, 95% CI 0.53‐1.82), and decision ability (AOR 0.90, 95% CI 0.49‐1.67), were associated with medication adherence in rural areas. Conclusions The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.