The Role of eHealth Literacy and Patient Adherence in Mediating Health Consciousness and Perceived Severity in Quality of Life Among Young Patients With Ischemic Heart Disease: Cross-Sectional Study

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Background: Ischemic heart disease (IHD) is becoming increasingly prevalent, with a rising trend significantly impacting the quality of life (QoL) of young Malaysians. Objective: This study aimed to investigate the direct and indirect relationships between eHealth literacy (eHealth) and patient adherence (PA), as well as their mediating effects on the associations of health consciousness (HC) and perceived severity to chronic disease (PS) with QoL among young patients with IHD. Methods: A cross-sectional study was conducted at 2 hospitals, recruiting eligible patients through consecutive sampling at outpatient cardiology clinics. Data were collected via a validated self-administered questionnaire encompassing sociodemographic and socioeconomic status, medical history, and PS, HC, eHealth, PA, and QoL data. Structural equation modeling analysis was used to evaluate the relationships. The ethics approval was obtained from the Ethical Committee of Universiti Kebangsaan Malaysia Medical Centre (FF-2021-117). Results: A total of 136 young patients with IHD participated in the study. Structural equation modeling analysis revealed that eHealth had the strongest positive effect on QoL (β=0.287, P=.002), followed by PA (β=0.245, P=.02), and HC (β=0.218, P=.02). Two significant mediation models were identified, aligning with the Transactional Model of eHealth Literacy theory. The first model demonstrated parallel mediation, where eHealth (β=0.125, P=.008) and PA (β=0.083, P=.046) significantly mediated the relationship between HC and QoL. The second model indicated serial mediation through eHealth and PA between HC and QoL (β=0.042, P=.049). The parallel mediation model exhibited medium predictive power and was deemed the best-fit model. Conclusions: The parallel model pathway showed significant direct and indirect associations between eHealth, PA, HC, and QoL, with eHealth demonstrating the strongest association. Higher eHealth and PA were associated with QoL among young patients with IHD; interventions to support eHealth warrant further investigation in longitudinal or interventional studies.

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