Association of E-Health Literacy with Health and Social Factors in Older Surgical Patients: Cross-sectional study

Association of E-Health Literacy with Health and Social Factors in Older Surgical Patients: Cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association of E-Health Literacy with Health and Social Factors in Older Surgical Patients: Cross-sectional study Pavida Srichant, Yollada Phungsiangdee, Arunotai Siriussawakul, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6668941/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 13 You are reading this latest preprint version Abstract Background Thailand is transitioning into a fully aged society, with older adults increasingly subject to surgical procedures and healthcare-related risks. To support healthy aging and long-term self-reliance, digital competence is essential. eHealth literacy—the ability to seek, comprehend, and evaluate electronic health information—is therefore critical. This study aimed to assess eHealth literacy among Thai older adults undergoing surgery, in order to inform strategies to improve access to health information and optimize the use of eHealth platforms in this population. Methods A cross-sectional study was conducted among patients aged 60 years and older who underwent surgery at a university hospital. Patients who were unable to communicate in Thai or did not complete the questionnaires were excluded. Data collected included sociodemographic characteristics, eHealth literacy (eHEALS), health perception, online health information-seeking behavior, self-efficacy, quality of life (EQ-5D-5L and VAS) and postoperative complications. Descriptive statistics and multiple logistic regression analyses were performed. Results From December 2022 to May 2024, a total of 291 participants were included (mean age 67.4 years, SD = 5.5). The average eHEALS score was 18.93 (SD = 11.14), with 51.5% classified as having low eHealth literacy (cut-off ≤ 20; AUC = 0.638, 95% CI: 0.570–0.706; p = 0.035). Only 35.4% of participants demonstrated high health awareness. In multivariable analysis, factors independently associated with greater health awareness included being single (AOR = 2.41; 95% CI: 1.01–5.74; p = 0.048), having better physical health (ASA classification < 3; AOR = 1.81; 95% CI: 1.00–3.27; p = 0.049), and higher eHealth literacy (AOR = 1.83; 95% CI: 1.04–3.22; p = 0.036). Conclusion Marital status, physical health status and digital health literacy are significant determinants of health awareness among older surgical patients. Interventions to enhance health awareness in this population should include targeted digital literacy training, simplified and accessible eHealth platforms and personalized health education. Strengthening digital engagement among older adults is essential to promote autonomy and improve perioperative outcomes in aging societies. eHealth literacy Older adults Surgery Health awareness Digital Health Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 26 Jan, 2026 Reviews received at journal 03 Jul, 2025 Reviews received at journal 30 Jun, 2025 Reviews received at journal 26 Jun, 2025 Reviewers agreed at journal 23 Jun, 2025 Reviewers agreed at journal 22 Jun, 2025 Reviewers agreed at journal 21 Jun, 2025 Reviewers agreed at journal 16 Jun, 2025 Reviewers invited by journal 12 Jun, 2025 Editor invited by journal 20 May, 2025 Editor assigned by journal 19 May, 2025 Submission checks completed at journal 19 May, 2025 First submitted to journal 15 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6668941","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":471467543,"identity":"9ab02aba-588e-4d77-96ae-77190afbab75","order_by":0,"name":"Pavida Srichant","email":"","orcid":"","institution":"Siriraj Integrated Perioperative Geriatric Excellence Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Pavida","middleName":"","lastName":"Srichant","suffix":""},{"id":471467544,"identity":"44ad73df-a6b6-444f-9a82-3c76418dad56","order_by":1,"name":"Yollada Phungsiangdee","email":"","orcid":"","institution":"Siriraj Integrated Perioperative Geriatric Excellence Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Yollada","middleName":"","lastName":"Phungsiangdee","suffix":""},{"id":471467545,"identity":"a8f83f02-03f0-49cb-8975-072535fa8b50","order_by":2,"name":"Arunotai Siriussawakul","email":"","orcid":"","institution":"Siriraj Integrated Perioperative Geriatric Excellence Research Center, Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":false,"prefix":"","firstName":"Arunotai","middleName":"","lastName":"Siriussawakul","suffix":""},{"id":471467546,"identity":"bf60659c-91fb-430a-98af-18d2725d75f0","order_by":3,"name":"Pawit Somnuke","email":"","orcid":"","institution":"Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol 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Sura-amonrattana","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAuElEQVRIiWNgGAWjYBADORBx4AEpWozBWhJI0ZLYACKJ0mIuffjhY962O+nzww4/BNpiJ6fbQECLZV+asTFv27PcjbfTDIBako3NDhDQYnCGwUw6t+1w7sbZCSAtBxK3EdbC/v03UEu64ez0D8Rq4TFjBmpJkJfOIdIWyx6eYuk/5w4bbpDOKTiQYECEX8x52Dd+nFF2WF5+dvrmDx8q7OQIex/OOIDCJUaLfAMRqkfBKBgFo2BkAgCinEX3QT1UdAAAAABJRU5ErkJggg==","orcid":"","institution":"Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University","correspondingAuthor":true,"prefix":"","firstName":"Unchana","middleName":"","lastName":"Sura-amonrattana","suffix":""}],"badges":[],"createdAt":"2025-05-15 05:23:07","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6668941/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6668941/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84698334,"identity":"1021aa54-d189-414d-9ca3-27be0cae74a2","added_by":"auto","created_at":"2025-06-16 11:01:47","extension":"pdf","order_by":1,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":494293,"visible":true,"origin":"","legend":"","description":"","filename":"MScampEhealthUS01652025Edit.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6668941/v1_covered_3dc92414-93c0-4ccb-b0d9-826477dd5527.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Association of E-Health Literacy with Health and Social Factors in Older Surgical Patients: Cross-sectional study","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"eHealth literacy, Older adults, Surgery, Health awareness, Digital Health","lastPublishedDoi":"10.21203/rs.3.rs-6668941/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6668941/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThailand is transitioning into a fully aged society, with older adults increasingly subject to surgical procedures and healthcare-related risks. To support healthy aging and long-term self-reliance, digital competence is essential. eHealth literacy\u0026mdash;the ability to seek, comprehend, and evaluate electronic health information\u0026mdash;is therefore critical. This study aimed to assess eHealth literacy among Thai older adults undergoing surgery, in order to inform strategies to improve access to health information and optimize the use of eHealth platforms in this population.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among patients aged 60 years and older who underwent surgery at a university hospital. Patients who were unable to communicate in Thai or did not complete the questionnaires were excluded. Data collected included sociodemographic characteristics, eHealth literacy (eHEALS), health perception, online health information-seeking behavior, self-efficacy, quality of life (EQ-5D-5L and VAS) and postoperative complications. Descriptive statistics and multiple logistic regression analyses were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFrom December 2022 to May 2024, a total of 291 participants were included (mean age 67.4 years, SD\u0026thinsp;=\u0026thinsp;5.5). The average eHEALS score was 18.93 (SD\u0026thinsp;=\u0026thinsp;11.14), with 51.5% classified as having low eHealth literacy (cut-off \u0026le;\u0026thinsp;20; AUC\u0026thinsp;=\u0026thinsp;0.638, 95% CI: 0.570\u0026ndash;0.706; p\u0026thinsp;=\u0026thinsp;0.035). Only 35.4% of participants demonstrated high health awareness. In multivariable analysis, factors independently associated with greater health awareness included being single (AOR\u0026thinsp;=\u0026thinsp;2.41; 95% CI: 1.01\u0026ndash;5.74; p\u0026thinsp;=\u0026thinsp;0.048), having better physical health (ASA classification\u0026thinsp;\u0026lt;\u0026thinsp;3; AOR\u0026thinsp;=\u0026thinsp;1.81; 95% CI: 1.00\u0026ndash;3.27; p\u0026thinsp;=\u0026thinsp;0.049), and higher eHealth literacy (AOR\u0026thinsp;=\u0026thinsp;1.83; 95% CI: 1.04\u0026ndash;3.22; p\u0026thinsp;=\u0026thinsp;0.036).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eMarital status, physical health status and digital health literacy are significant determinants of health awareness among older surgical patients. Interventions to enhance health awareness in this population should include targeted digital literacy training, simplified and accessible eHealth platforms and personalized health education. Strengthening digital engagement among older adults is essential to promote autonomy and improve perioperative outcomes in aging societies.\u003c/p\u003e","manuscriptTitle":"Association of E-Health Literacy with Health and Social Factors in Older Surgical Patients: Cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-16 10:29:31","doi":"10.21203/rs.3.rs-6668941/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-01-26T13:41:15+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-03T15:02:22+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-30T23:23:08+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-26T17:08:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"252786417725677251842786521222464362718","date":"2025-06-23T04:40:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"263049022766719309460190568858824094176","date":"2025-06-23T02:10:58+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"79315917385927664706970508028649524696","date":"2025-06-21T11:13:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"46693109042331986857535854028624323487","date":"2025-06-16T14:14:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-12T06:37:20+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-05-20T07:36:18+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-19T11:31:15+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-19T11:27:44+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Public Health","date":"2025-05-15T05:07:57+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pubh","sideBox":"Learn more about [BMC Public Health](http://bmcpublichealth.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pubh/default.aspx","title":"BMC Public Health","twitterHandle":"@BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"da4679bf-9d0b-4e21-91c5-2b8bf6ca7e0a","owner":[],"postedDate":"June 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-24T14:54:39+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-16 10:29:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6668941","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6668941","identity":"rs-6668941","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}