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

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.