Sense of coherence mediates the relationship between digital health literacy and anxiety about the future in aging population during the COVID-19 pandemic: a path analysis

Abstract

Objectives: During the COVID-19 pandemic, older adults experience various challenges, including information uncertainties, financial pressure, and visit restrictions, which may lead to anxiety about the future. As a protective factor, sense of coherence (SOC) may play a role to reduce some psychological discomfort. This study aimed to analyze the relationships of SOC with anxiety, digital health literacy (DHL), information, and financial satisfaction among older adults during the outbreak.

Methods: This is part of a large-scale DHL study with a cross-sectional survey across 41 countries. This study extracted data from three Asian countries (China, the Philippines, and Singapore) and included people aged ≥60. Structural equation modeling with path analysis was utilized to examine the relationships of SOC with anxiety about the future and other variables.

Results: A total of 266 older adults were included, with 43.2% expressed anxiety about the future. DHL (β=–0.13, p < 0.05) and SOC (β=–0.26, p = 0.01) were negatively associated with anxiety, while financial and information satisfaction were not. However, financial satisfaction (β = 0.34, p < 0.01) and DHL (β = 0.32, p = 0.01) were positively associated with SOC. Higher SOC further mediated the negative relationships of DHL (β= −0.11, p = 0.004) and financial satisfaction (β= −0.12, p = 0.004) on anxiety of older adults.

Conclusions: SOC had direct negative effect on anxiety and mediated the relationships between anxiety and DHL/financial satisfaction. Strategies should be developed to enhance SOC and DHL among older adults, as these capacities may help to manage anxiety during the pandemic.

Keywords:

• Anxiety
• COVID-19 pandemic
• digital health literacy
• sense of coherence

Acknowledgements

We sincerely thank the participants who joined this study in amidst of the pandemic.

Disclosure statement

No potential conflict of interest was reported by the authors.

Ethical statement

The ethical approval was obtained from the Hong Kong Polytechnic University. The research team compiled with all of the requirements of a study involving human subjects as stated in the Helsinki Declaration and subsequent updates (World Medical Association, 2013).

All authors have contributed significantly, and they are in agreement with the content of the manuscript. Authors have no relationships that may pose any conflict of interest. The list of authors is as follows:

1. *Dr. Angela Yee Man LEUNG, RN, PhD, Associate Professor, Centre for Gerontological Nursing; World Health Organization Collaborating Centre for Community Health Services, School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China. ORCID: 0000-0002-9836-1925

2. Mr. Laurence Lloyd PARIAL, RN, MSc, PhD candidate, Centre for Gerontological Nursing, School of Nursing, Hong Kong Polytechnic University, Hong Kong SAR, China; College of Nursing, University of Santo Tomas, Manila, Philippines. ORCID: 0000-0003-3793-9305

3. Prof. Ma. Carmen C. Tolabing, PhD, Professor, Department of Epidemiology and Biostatistics, University of the Philippines College of Public Health, The Philippines. ORCID: 0000-0003-3069-0009

4. Dr. Timothy SIM, PhD, Department of Applied Social Sciences, Hong Kong Polytechnic University, Hong Kong SAR, China, ORCID: 0000-0001-7478-474X

5. Dr. Phoenix Mo, PhD, Jockey Club School of Public Health and Primary Care; Centre for Health Behaviours Research, The Chinese University of Hong Kong, Hong Kong SAR, China. ORCID: 0000-0001-9822-5424

6. Dr. Orkan OKAN, PhD, Research Associate, Bielefeld University, Faculty of Educational Science, Interdisciplinary Centre for Health Literacy Research, Bielefeld, Germany. ORCID: 0000-0003-1714-4783

7. Prof. Kevin DADACZYNSKI, PhD, Professor, Fulda University of Applied Sciences, Public Health Centre Fulda, Fulda, Germany; Leuphana University Lueneburg, Center for Applied Health Science Lueneburg, Germany. ORCID: 0000-0002-7367-5362