Background While social media theoretically democratizes health information, achieving actual equity in health outcomes remains a challenge, largely due to a “capacity gap”—disparities in individuals’ abilities to critically evaluate and use information—rather than merely an “access gap.” This research moves beyond the conventional narrative of the “access gap” to instead scrutinize the emerging “capacity gap” within the Chinese context. Specifically, we investigate whether critical eHealth literacy, potentially bolstered by community-level interventions, can transform routine social media usage into tangible health empowerment for vulnerable populations with lower socioeconomic status (SES). Methods We surveyed 430 adult social media users in China using a network-based snowball sampling approach, a method chosen for its effectiveness in reaching diverse online communities, though we acknowledge its potential limitations in generalizability. The study utilized a validated, multi-dimensional instrument, including an expanded Critical eHealth Literacy Scale (eHEALS), to assess SES, usage patterns, and critical evaluation skills. Our analytic strategy employed hierarchical regression and PROCESS-based mediation and moderation analysis to test the proposed associations and the “resource substitution” hypothesis. Results The data revealed a nuanced reality: the frequency of social media use showed no direct effect on health empowerment when accounting for other factors. Instead, critical eHealth literacy acted as a crucial mediator in this relationship (<InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(Effect=0.27,SE = \text{0.03,95}\%CI\left[\text{0.22,0.33}\right]\)</EquationSource> </InlineEquation>), suggesting that usage translates to empowerment primarily through active cognitive processing. Latent profile analysis further identified a “Vulnerable Engagers” group (high use, low literacy) with the lowest empowerment scores. Moreover, participants who reported engagement in community-based workshops exhibited significantly higher critical literacy skills. Crucially, moderation analysis confirmed a “compensatory effect”: robust critical eHealth literacy was associated with a weakened link between low SES and lower empowerment, enabling these individuals to achieve empowerment levels comparable to their higher-SES counterparts. Conclusion Our findings suggest that the digital divide has evolved from a barrier of infrastructure to one of cognition and capability. Social media functions as an equalizer solely when users are equipped with the critical literacy to navigate complex digital ecosystems. These findings highlight the value of community-based interventions as a practical policy tool for reducing health disparities, shifting the focus from solely content regulation to also include demand-side skill development.

Social media use and health empowerment among Chinese adults: the critical role of eHealth literacy and community interventions

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2026年4月28日

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Kaimeng Guo,
Tianying Wang

摘要

Background

While social media theoretically democratizes health information, achieving actual equity in health outcomes remains a challenge, largely due to a “capacity gap”—disparities in individuals’ abilities to critically evaluate and use information—rather than merely an “access gap.” This research moves beyond the conventional narrative of the “access gap” to instead scrutinize the emerging “capacity gap” within the Chinese context. Specifically, we investigate whether critical eHealth literacy, potentially bolstered by community-level interventions, can transform routine social media usage into tangible health empowerment for vulnerable populations with lower socioeconomic status (SES).

Methods

We surveyed 430 adult social media users in China using a network-based snowball sampling approach, a method chosen for its effectiveness in reaching diverse online communities, though we acknowledge its potential limitations in generalizability. The study utilized a validated, multi-dimensional instrument, including an expanded Critical eHealth Literacy Scale (eHEALS), to assess SES, usage patterns, and critical evaluation skills. Our analytic strategy employed hierarchical regression and PROCESS-based mediation and moderation analysis to test the proposed associations and the “resource substitution” hypothesis.

Results

The data revealed a nuanced reality: the frequency of social media use showed no direct effect on health empowerment when accounting for other factors. Instead, critical eHealth literacy acted as a crucial mediator in this relationship ( \(Effect=0.27,SE = \text{0.03,95}\%CI\left[\text{0.22,0.33}\right]\) ), suggesting that usage translates to empowerment primarily through active cognitive processing. Latent profile analysis further identified a “Vulnerable Engagers” group (high use, low literacy) with the lowest empowerment scores. Moreover, participants who reported engagement in community-based workshops exhibited significantly higher critical literacy skills. Crucially, moderation analysis confirmed a “compensatory effect”: robust critical eHealth literacy was associated with a weakened link between low SES and lower empowerment, enabling these individuals to achieve empowerment levels comparable to their higher-SES counterparts.

Conclusion

Our findings suggest that the digital divide has evolved from a barrier of infrastructure to one of cognition and capability. Social media functions as an equalizer solely when users are equipped with the critical literacy to navigate complex digital ecosystems. These findings highlight the value of community-based interventions as a practical policy tool for reducing health disparities, shifting the focus from solely content regulation to also include demand-side skill development.