Abstract
Background: The mechanisms through which information and communication technology (ICT) use influences chronic disease self-management remain unclear. Method: This cross-sectional investigation examined the mediating effects of health literacy, social support, and self-efficacy on the association between ICT use and self-management behaviors among older adults (≥60 years) with comorbidities in China (n = 520). The participants were recruited from a tertiary hospital in Shanghai (July 2023-June 2024), and data on sociodemographics, self-management, health literacy, social support, self-efficacy, and ICT use were collected via structured questionnaires. Results: Pearson's correlation analysis revealed a significant association between ICT use, health literacy, social support, self-efficacy, and chronic disease self-management (p < 0.001). Multiple mediation modeling revealed a direct positive effect of ICT use on self-management (b = 1.3314, 95% CI = 0.6629, 2.0002). Furthermore, significant indirect effects were observed, mediated independently by both health literacy and social support. Additional serial mediation pathways included health literacy → social support, health literacy → self-efficacy, social support → self-efficacy, and a comprehensive pathway from health literacy through social support to self-efficacy. Conclusions: These findings collectively indicate that ICT use directly enhances chronic disease self-management among older adults with comorbidities. Moreover, ICT use indirectly improves self-management by enhancing health literacy, augmenting social support, and bolstering self-efficacy.