How Health Literacy and eHealth Literacy Influence Quality of Life in Older Adults with Chronic Diseases: A Network and Path Analysis

Background Despite existing research on factors influencing quality of life (QOL) in older adults with chronic diseases, the underlying mechanisms by which health literacy (HL) and e-health literacy (eHL) contribute to QOL improvement remain underexplored. This study aimed to elucidate the complex relationships among HL, eHL, health behaviors, psychosocial factors, and QOL, and to identify the driving pathways of HL and eHL in enhancing QOL. Methods A cross-sectional study was conducted between March and June 2025 at a tertiary hospital in Xi’an, China. A total of 304 older adults with chronic diseases participated in the study. Participants completed assessments for HL, eHL, cognitive function, frailty, nutrition, physical activity, sleep quality, family function, depression, and QOL (including Physical and Mental Component Summaries, PCS and MCS). Grip strength was also measured. Multiple linear regression, network analysis, and path analysis were employed to determine influencing factors and structural relationships. Results Higher HL and eHL levels were associated with younger age, higher socioeconomic status, longer daily smartphone usage, and having personal interests; HL was additionally linked to better family function. Network and path analyses revealed that depression, frailty, physical activity, grip strength, and family function were primary direct predictors of QOL, PCS and MCS. Depression and frailty were identified as key risk factors, while sleep quality and nutritional status served as significant mediators. Although HL and eHL did not directly influence QOL, they functioned as upstream variables that indirectly improved QOL by positively influencing these intermediary health behaviors and psychosocial factors. Conclusions HL and eHL indirectly enhance QOL in older adults with chronic diseases by driving improvements in health behaviors and psychological status. Interventions should target depression, frailty, sleep quality, and nutrition as critical modifiable factors. Future programs aiming to improve HL and eHL should prioritize older individuals with low socioeconomic status and limited digital experience, incorporating age-friendly designs, social interaction, and family involvement.