Factors Influencing eHealth Literacy in Maintenance Hemodialysis and Its Relationship with Emotional Status and Quality of Life.

BACKGROUND: eHealth literacy (eHL) has emerged as an important determinant of health outcomes in chronic disease management. However, its role among patients undergoing maintenance hemodialysis (MHD) remains insufficiently explored. This study aimed to assess the level of eHL in MHD patients, identify associated sociodemographic and clinical factors, and examine the relationship between eHL, emotional status, and quality of life (QoL).

METHODS: A total of 229 patients receiving MHD were recruited in a single-center cross-sectional study. Data were collected using validated questionnaires assessing eHL, emotional status (anxiety and depression), and quality of life (SF-36). Binary logistic regression and linear regression analyses were conducted to identify factors associated with eHL. Spearman correlation analysis was used to evaluate the associations between eHL, emotional status, and QoL.

RESULTS: The mean age of participants was 57.36 ± 13.98 years, and 66.38% were male. The median dialysis duration was 4.00 years. Approximately half of the patients (50.66%) demonstrated high eHL. Patients with low eHL were significantly older, Patients with low eHL were significantly older, had lower educational attainment, and had a higher burden of multimorbidity. Patients with low eHL had significantly higher anxiety and depression scores and a higher prevalence of anxiety and depressive symptoms than those with high eHL (all P < 0.01). They also had poorer QoL across all eight domains of the SF-36 (all P < 0.05). eHEALS scores were positively correlated with overall QoL (r = 0.382, P < 0.0001) and negatively correlated with depression scores (r = -0.182, P = 0.0057), whereas the correlation with anxiety scores was not statistically significant (r = -0.124, P = 0.0613). In multivariable analyses, older age and lower educational attainment were independently associated with lower odds of high eHL, while higher comorbidity burden, widowed/divorced marital status, and longer dialysis duration were associated with continuous eHEALS scores.

CONCLUSION: eHL was significantly associated with emotional well-being and QoL in patients undergoing MHD. Lower eHL was more common among older and less educated patients, suggesting that these groups may benefit from targeted, patient-centered support for digital health engagement. However, whether improving eHL can reduce psychological distress or improve QoL remains uncertain and requires evaluation in longitudinal and intervention studies.