Abstract
BACKGROUND: The rapid advancement of Internet technologies has become deeply integrated into multiple aspects of social life, providing an intelligent and diversified platform for information acquisition, social interaction and civic participation. Within the context of accelerated digitalisation and urbanisation, the association between Internet use and health among rural-to-urban migrants, as well as the potential pathways that link them, remains insufficiently explored. METHODS: This study utilized data from the China Family Panel Studies conducted between 2014 and 2022, focusing on a sample of 18,302 rural-to-urban migrants. Ordered logit and probit models were primarily used to examine the relationship between Internet use and self-rated health. Chronic disease status and mental health were treated as alternative health outcomes, analyzed using binary logit and OLS regressions, respectively. The instrumental variable (IV) method and propensity score matching (PSM) were adopted to address endogeneity and selection bias. Additionally, the Karlson–Holm–Breen (KHB) and an IV-based mediation method were applied to evaluate the mediating role of social integration across relational, structural, and institutional dimensions. Finally, stratified analyses were performed to explore heterogeneity across demographic subgroups and Internet use patterns, and to assess potential non-linear relationships of usage duration on health. RESULTS: The findings indicated that Internet use was positively associated with better self-rated health, lower chronic disease risk, and reduced psychological distress among rural-to-urban migrants. Social integration mediated this relationship by enhancing interpersonal interactions, fostering a sense of community belonging, and increasing institutional trust. IV-adjusted decomposition results show that, after instrumenting Internet use, the indirect associations via relational, structural, and institutional integration were 0.051 (p < 0.01), 0.022 (p < 0.01), and 0.036 (p < 0.05), respectively. The study also identified demographic heterogeneity, with stronger associations observed among men, middle-aged individuals, those with higher educational attainment and intraprovincial migrants. Additionally, compared to non-users, multi-type and low-frequency Internet users showed stronger positive associations with self-rated health. Finally, a nonlinear, inverted U-shaped relationship was found between Internet use duration and self-rated health, with an optimal threshold of approximately 2.69 h per day. CONCLUSIONS: Improving digital accessibility and narrowing the digital divide are critical for maximizing the health benefits of Internet use among rural-to-urban migrants. Policy efforts should prioritize digital inclusivity by integrating migrants into local “Digital China” initiatives. First, digital literacy should be strengthened through accessible formats like community-based education and short videos, encouraging migrants to leverage the Internet for learning, social interaction, and healthcare. Second, inclusive digital design is essential; policies should promote age-friendly and simplified adaptations for vulnerable subgroups, such as older adults and those with lower educational attainment. Finally, promoting healthy digital habits is crucial through community-based programs that balance online engagement with offline interaction to mitigate risks of information overload and social isolation. Together, these measures will foster a health-oriented digital environment, enabling migrants to better navigate an increasingly urbanized and digitized society.