Digital health literacy moderates the school sports environment and physical activity pathway among Chinese adolescents: a health equity perspective.

BACKGROUND

Physical inactivity among Chinese adolescents remains a pressing public health concern, with pronounced urban-rural disparities. School sports environments serve as a critical determinant of adolescent physical activity (PA), yet the conditions under which this relationship strengthens or weakens remain insufficiently understood. Digital health literacy (DHL) has emerged as a potential moderator that may amplify or buffer environmental influences on PA behavior.

METHODS

A cross-sectional survey was conducted among 2,531 adolescents (Mage = 15.2 ± 1.8 years; 51.3% male) recruited through stratified cluster sampling from 18 secondary schools in Hubei Province, China (9 urban, 9 rural). Participants completed validated Chinese versions of the Questionnaire Assessing School Physical Activity Environment (Q-SPACE-Chi), the eHealth Literacy Scale (eHEALS), and the International Physical Activity Questionnaire-Short Form (IPAQ-SF). Structural equation modeling with a latent interaction term tested the moderating role of DHL, and multigroup analysis examined urban-rural differences. Reporting followed the STROBE guideline.

RESULTS

School sports environment was positively associated with PA levels (β = 0.34, p < 0.001). DHL significantly moderated this pathway (interaction β = 0.12, p = 0.003), such that the environment-PA association was stronger among adolescents with higher DHL. Multigroup analysis revealed a significantly stronger environmental effect in urban (β = 0.38) than in rural schools (β = 0.29; z = 2.87, p = 0.004); the DHL moderation was significant in urban (β = 0.14, p = 0.008) but not rural schools (β = 0.07, p = 0.14), and the between-group difference in the moderation effect was not significant (z = 0.99, p = 0.32). The model demonstrated acceptable fit (χ 2/df = 3.12, CFI = 0.94, TLI = 0.93, RMSEA = 0.045, SRMR = 0.041).

CONCLUSION

DHL amplifies the translation of favorable school sports environments into actual PA engagement, and the environment-PA association was stronger in urban schools. These findings suggest a potential pathway through which digital inequities may contribute to PA disparities, a possibility that requires longitudinal confirmation, and underscore the need for integrated school-based and digital literacy interventions to advance health equity.