Global Health & Medicine 2026;8(4):274-284.

Factors associated with digital health literacy among community-dwelling older adults in Japan: An in-person cross-sectional study

Kimoto R, Mano T, Kawano Y

Digital health literacy (DHL) is increasingly important as health information, appointment systems, patient portals, and other services move online. However, evidence in older adults remains limited and is often based on online surveys that may underrepresent digitally disadvantaged groups. This in-person cross-sectional study examined factors associated with DHL among 91 community-dwelling older adults in Japan. Participants completed paper-based questionnaires and performance-based assessments, including a modified 15-item score from the Japanese Digital Health Literacy Instrument (DHLI-J), the Japanese version of the Montreal Cognitive Assessment (MoCA-J), and the Nine-Hole Peg Test (NHPT). Group comparisons, bivariate correlations, and hierarchical multiple regression analyses were performed, with structural equation modeling (SEM) as a supplementary analysis. Higher modified DHLI-J scores were associated with younger age, longer personal computer use, better cognitive function, better manual dexterity, greater digital confidence and interest, and better well-being. In the final regression model (adjusted R² = 0.37), older age was independently associated with lower modified DHLI-J scores, whereas better cognitive function and greater confidence in using digital devices were independently associated with higher scores. The exploratory supplementary SEM showed acceptable fit (χ²(11) = 13.96, p = 0.24; χ²/df = 1.27; comparative fit index (CFI) = 0.97; root mean square error of approximation (RMSEA) = 0.06) and indicated positive cross-sectional associations between digital attitudes and DHL and between DHL and well-being; these associations should not be interpreted as causal. These findings may inform user- and system-level strategies intended to reduce digital exclusion and support more equitable digital health access, although access to digital health services and equity outcomes were not measured.

DOI: 10.35772/ghm.2026.01050

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