The e-Health literacy among young and middle-aged hypertensive patients still needs improvement : a qualitative study

doi:10.21203/rs.3.rs-4849477/v1

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Research Article

The e-Health literacy among young and middle-aged hypertensive patients still needs improvement : a qualitative study

https://doi.org/10.21203/rs.3.rs-4849477/v1

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Introduction: Although there is a marked trend of hypertension becoming increasingly prevalent among younger age groups, young and middle-aged individuals are the primary users of mainstream media and information technology. However, their level of e-health literacy still requires significant improvement. Therefore, this study aims to explore the experiences and perceptions of using e-health information and services among young and middle-aged hypertensive patients, providing more tailored e-health guidance for this patient population.

Objective: This study aims to explore how young and middle-aged hypertensive patients acquire, understand, evaluate, discriminate, share, and utilize e-health information and online health services. It also highlights the importance for healthcare professionals to focus on digital health, thereby providing better e-health management for this demographic.

Methods: Using a qualitative descriptive approach, we conducted semi-structured, in-depth interviews with 14 young and middle-aged hypertensive patients. Data collection took place during December 2023 to January 2024 via one-on-one interviews. All interviews were audio-recorded and transcribed verbatim, and interview data were analyzed using the colaizzi seven-step analysis method.

Results: We found that the e-health literacy among participants still needed improvement. However, a few young and middle-aged hypertensive patients showed significant interest in electronic health and believed that they could benefit from it. Data were grouped into four themes: (1)e-health literacy still needs improvement; (2)online medical services operation skills need further promotion; (3)the influence of the e-health information or online medical services; and (4)the expectations for electronic health information or online medical services. Participants expressed a desire for more professional and technical support to learn authoritative medical knowledge and fully utilize e-health services for daily self-management.

Conclusions: Patients have access to a wide range of sources for electronic health information and online medical services, but they often lack the scientific standards to accurately assess this information. Therefore, healthcare professionals should educate patients on how to discriminate the authenticity of electronic health information. Additionally, they need to inform patients about current authoritative and reliable information sources, and teach them how to use reputable health websites, health-oriented social media, and health management applications.

E-health literacy

Qualitative

Hypertension with young and middle-aged

Among adults aged 18 years and older, only 35.0% had normal blood pressure. About 50.9% of those without a hypertension diagnosis had high-normal blood pressure, and the prevalence of hypertension was as high as 27.5%^[1]. In a 15-year cohort study, the team revealed that 65% of individuals aged 35 to 59 with stage 1 hypertension, characterized by systolic blood pressure (SBP) of 130-139 mm Hg or diastolic blood pressure (DBP) of 80-89 mm Hg,would eventually develop hypertension. Compared to individuals maintaining blood pressure within 130/80 mm Hg, those with higher levels had a threefold increased risk of developing cerebrovascular disease^[2,3].

The hypertension population surveys conducted in 1991, 2002, 2012, and 2012-2015 showed the hypertension prevalence rate were 11.26%, 17.7%, 24%, and 27.9%, respectively^[4]. The increasing prevalence of hypertension among younger individuals will not only impose significant life pressure on patients and their families but also place a substantial burden on our healthcare systems and medical resources^[5].

E-health literacy is a kind of ability, which is refer to seek, evaluate, discriminate, understand, share and make use of the online information or electronic devices via the internet to maintain and improve health^[6].

According to The 53rd Statistical Report on China’s Internet Development posted by China Internet Network Information Center, by December 2023, the number of internet users in China had reached 1.092 billion, with an internet penetration rate of approximately 77.5%^[7]. At present, most middle-aged and young individuals have mastered the skills required to use mainstream media and information technology, making them the primary users of online medical service platforms^[7,8^]. However, their e-health literacy still needs to be improved^[9], despite its importance for improving self-management abilities^[10]. Studies have shown that higher e-health literacy is associated with greater health-related knowledge acquisition and increased self-efficacy in using e-health resources, which can positively influence health behaviors and result in better blood pressure control^[11].

In China, research on e-health literacy began relatively late, and few intervention studies have been reported. Most research has focused on the usage of internet health information, popular types of e-health information, and the localization and expansion of e-health literacy scales. In other countries, e-health literacy has advanced more rapidly than in China^[12]. Over the past 10 years, medical professionals have increasingly developed and used e-health technologies and health websites. This trend became particularly evident during the COVID-19 pandemic^[13]. For example, Guven, S.T^[14]and Xie, B^[15]both improved patients’ e-health literacy through the online health knowledge resources and online health education project. Blakemore, L.M^[16]and Xie, B^[17]both improved patients' e-health literacy and refined their self-management strategies by developing online health education videos. Kim, H^[18]and Sobko, T^[19]both increased patients' e-health literacy by providing online personalized health information and medical care services.

Currently, the online sources of health information available to patients are complex and lack accuracy^[20]. In an increasingly diverse information environment, evaluating the accuracy of health information has become a challenging task^[21],even some online health information that contains medical terminology can be difficult for patients to understand^[22].

This study used qualitative interviews to explore patients' experiences and perceptions of accessing, understanding, evaluating, discriminating, sharing, and using electronic health information or services. Qualitative research can provide an in-depth, comprehensive and targeted understanding of the health information needs among young and middle-aged hypertensive patients^[23]. The conclusions of this study can help similar health platforms and apps to enrich health information, optimize recommendation algorithms, and provide more appropriate health guidance for middle-aged and young hypertensive patients.

Study design

We used a qualitative descriptive approach^[24]. Through qualitative research, we can understand patients' perspectives, perceptions, and value systems, and how these beliefs and values are influenced by the circumstances in which they live^[25,23]. Qualitative methods can help researchers gain a deeper understanding of the complex dynamic mechanisms, behaviors, and processes that generate and exacerbate inequalities in e-health^[26,27]. Therefore,we aimed to guide the young and middle-aged hypertensive patients to discuss their perceptions and similar experiences in our research.

Participant selection

Participants were purposively selected from two community Health Service Centers in Hengyang City, Hunan Province, based on similar medical conditions, the organizational structures of the medical staff, and hospital levels. The inclusion criteria were as follows: (1)young and middle-aged people aged 18 to 59 years^[28]; (2)a diagnosis of primary hypertension; (3)a good communication skill.

Purposive sampling was used to recruit respondents,including young and middle-aged hypertensive patients with varying years of work experience, education, titles, and positions to facilitate saturation in the analysis of interview data. When the information obtained from the interview began to repeat itself and no new and important topics emerged, 1-2 additional interviews were conducted to ensure the sample size was saturated.

Data collection

All patients were interviewed, allowing us to gain insight into their experiences and key needs^[29]. Semi-structured interviews were usually conducted in person or on a mobile phone, which could guarantee patient privacy and get rich verbal and non-verbal information^[30]. The interview outline was developed with six questions based on the study's purpose and previous qualitative research on digital healthcare(see Multimedia Appendix 1). The frameworks and questions can be used during each interview to ensure neutrality and validity.

Prior to the formal interviews, we conducted pre-interviews with two participants to refine and revise the interview outline. We also avoided giving any hints to the interviewees such as expressions and words during the interview process to ensure the objectivity of the interview data. As the interviews progressed, we adjusted the way we asked questions and the scope of our questions.

Finally, 14 participants were included in the analysis. We recorded the interviews using a voice recorder. The duration of the interviews ranged from 26 to 38 minutes, with an average length of 30 minutes. In addition, we also collected demographic information(see Table 1).

Data analysis

The two authors (Ziyi Mi, Bingxue Zhang) used NVivo 11 software which was developed by the Australian QSR international company to independently code the research data^[31]. NVivo guarantees straightforward, efficient, and effective coding, simplifying the retrieval process. It can help save our time and allow us spend more time exploring trends,defining the theme and drawing a conclusion. In addition, this program can also widely facilitate accuracy of qualitative studies and the analysis progress of transparent research data^[28,32].

The data were stored in a password-protected computer folder, and all identifying information, including names of people, places, and institutions, was removed from the text. Instead, codes were used to identify relevant information about the cases. To ensure the authenticity and objectivity of the information, the questionable sections were returned to the participants to verify that the narratives reflected their true experiences. The interview data were transcribed verbatim and coded chronologically. After coding, any dissenting parts were discussed, and four themes were ultimately identified.

Demographic information

We interviewed 14 young and middle-aged hypertensive patients. The interviews ranged from 26 to 38 minutes in length. Seven were female(50％) and the mean age was 52 years with a range of 44-58 years. There were also 7 males, accounting for 50%, which was a balanced proportion of men and women. The average age of the men was 47 years old, ranging from 35 to 58 years. Participants’ characteristics are further described in Table 1.

Table 1. Sample Characteristics (n=14)

Patient	Sex	Age (years)	Occupation	Education Level	Marital Status	Any Systematic Learning of Medical Knowledge
P01	Male	35	Salesman	Undergraduate degree	Yes	No
P02	Male	40	Delivery person	Junior high school	Yes	No
P03	Male	56	Driver	High school	Yes	No
P04	Female	54	Vendor	Primary school	Yes	No
P05	Female	57	Laborer	Junior high school	Yes	No
P06	Female	44	Accountant	Junior college	Yes	No
P07	Male	54	Medical worker	Undergraduate degree	Yes	Yes
P08	Female	58	Laborer	Junior high school	Yes	No
P09	Female	51	Factory worker	High school	Yes	No
P10	Female	53	Primary school teacher	Undergraduate degree	Yes	No
P11	Female	50	Waitress	Undergraduate degree	Yes	No
P12	Male	58	Freelancer	High school	Yes	No
P13	Male	43	Stock transaction	Junior college	Yes	No
P14	Male	43	Truck driver	High school	Yes	No

Themes that emerged

The hypertensive patients participating in the interview described their experiences,feelings,influence and expectations about acquiring health information or using online medical services by the internet. Our findings were divided into four themes: (1)e-health literacy still needs improvement; (2)Online medical services operation skills need further promotion; (3)the influence of the e-health information or online medical services; and (4)the expectations for electronic health information or online medical services. Participants expressed a desire for more professional and technical support to learn authoritative medical knowledge and fully utilize e-health services for daily self-management.

Theme 1:electronic health literacy still needs improvement

The theme encompasses the acquisition and utilization of e-health information and online medical services. It includes access to digital health information and online medical treatments, evaluation of the quality of e-health information and services, and the intelligibility of obtaining and using e-health information and online medical services.

Subtheme 1a: the use of electronic health information or services

Most patients didn’t regularly use electronic health information or services because they only accessed them when experiencing symptoms of discomfort or requiring a follow-up examination:

For example,I get hypertension,when my blood pressure get high,what medicine should I take? I can find this information on Baidu.(Participant 13)

If there is suddenly an emergency related to hypertension or if I encounter a health knowledge gap, I will consider getting information online. For minor issues, I might search the internet for a general idea, then determine what kind of information is suitable for me.(Participant 6)

I usually search the internet for the reexamination time or precautions when I receive my medical examination results.(Participant 10)

I normally ask the doctor on health-oriented social media when my families are illness or when i receive the medical examination report.[...]I consult other doctor’s advice to find out if there’s a more optimized therapeutic schedule.(Participant 11)

Subtheme 1b: patient's ability to discriminate electronic health information or services

The majority of participants evaluated the quality of e-health information and online medical services based on subjective feelings, while very few assessed it using scientific standards:

By intuition.[...]Even if the medicine is fake,if you take one or two pills and it doesn’t work,you wouldn’t take it again,would you? It's simple, that’s how i can identify it.(Participant 13)

For Baidu,it can retrieve many results,and you can make a comparison,then trust the one with the most results.(Participant 2)

Sometimes I consult experts in the comments section, but I find that there are many deceptive individuals.[...]You know what i mean?it’s a scam. He hardly reads your comments below and rarely replies to them.[...]I usually refer to the comments below and then consult a doctor. If they don't respond, I'm certain it's fake.(Participant 9)

Subtheme 1c: patient's ability to understand electronic health information or services

More patients didn’t understand medical terms such as laboratory sheet,medical imaging report on the internet,and most of them usually chose to search the information on Baidu:

I can’t understand some of the terminology used in B-ultrasound and CT. (Participant 5)

First of all,those laboratory sheet and other related things need to be simplified and clarified.[...]I can’t understand some professional words,if you send me such an electronic message, I can’t understand it either.[...]I normally put some professional terms about pathology that I don’t understand into Baidu,then search for the similar explanation.(Participant 6)

I also search for terms on Baidu headlines until I find the relevant information. That’s it.(Participant 8)

Theme 2:online medical services operation skills need further promotion

The theme explains the reasons for the low utilization of online healthcare services among patients. Taking online drug screening as an example, most patients didn’t know the scientific criteria for distinguishing between real and fake drugs, nor did they know how to perform such tasks on a mobile phone.

Subtheme 2a: patient use of electronic health information or services still needs improvement

The majority of patients rarely utilized online medical services because some didn’t trust the authenticity of online medical information. In addition, another group of patients lacked the necessary skills to operate online medical services and needed family members to assist them in accessing online medical care:

First of all,i never purchase items or participate in activities on the internet that are unrelated to me.[...]I don’t consider whether it is authoritative, I just want to get a general idea.(Participant 12)

I don’t use the telephone to register online, consult a doctor, or check inspection results because it seems to require a fee or an appointment. I think it’s too troublesome.[...]No matter which app I use, it requires an appointment, and the answers are not explicit.[...]I don’t approve of it, and it hasn’t convinced me yet, so I still prefer to choose physical stores.(Participant 14)

I don’t share or communicate health information on health-oriented social media or other platforms because I consider it private.(Participant 2)

Subtheme 2b: patients' awareness and ability to distinguish genuine medicines still needs to be improved

Many patients lacked the awareness and habit of distinguishing genuine medications. However, one patient who had previously purchased the drug online and another patient whose family had studied medical knowledge knew how to scientifically differentiate between real and counterfeit drugs:

My daughter helps me to check it(drug).(Participant 4)

I seldom buy or check drugs online. I usually purchase them at the pharmacy because it provides a sense of relief.(Participant 2)

I use the scanning code function in health-oriented social media to check for anti-counterfeiting signs to distinguish real medicines from fake ones, but I am uncertain about the authenticity of these anti-counterfeiting signs.(Participant 5)

I compare it with the drugs prescribed at standard hospitals,such as the First Affiliated Hospital of the University of South China.[...]I check its batch number,manufacturer,dosage,production date and expiration date.(Participant 10)

Theme 3:the influence of the electronic health information or online medical services

The theme covers both the positive and negative impacts of online health information and services on patients, as well as the needs and preferences of the majority of patients in using these electronic health resources.

Subtheme 3a: benefits of e-Health information or services

Using e-health information or enjoying medical services was beneficial for most patients. Some patients highlighted that digital health information was comprehensive, convenient, efficient, and easy to understand. Other patients mentioned that this information also had the function of regulating mood or preventing disease:

When I press the points, I feel comfortable, my mood improves, and I am less depressed, so I really think it helps my emotional state. Every time when I take a half-hour ride to work, I press the acupuncture points on my hands, and I really feel that I have benefited a lot.(Participant 8)

You can read the knowledge and risks about the disease(hypertension),which has the function of prevention and learning.(Participant 9)

It can broaden my knowledge and I can read it repeatedly.(Participant 2)

It may have more or less effect on some of my eating habits and diet structures.(Participant 6)

Subtheme 3b: deficiencies in electronic health information or services

Many patients also discussed the negative impacts of electronic health information or online health services. This group of patients generally believed that electronic information lacked systematization and professionalism. There was even one patient considered it a scam:

Ugh, it's not good anyway, I've only asked the doctor twice, it's all a lie.(Participant 9)

On the one hand, I don’t believe it’s worth trusting,on the other hand,it lacks systematization and professionalism.[...]If I want to use this application properly, I have to trust it first and foremost.(Participant 6)

If I look at my phone for too long, I start to get visual fatigue.(Participant 10)

Subtheme 3c: patients are unclear about the source of authoritative health information

Some patients focused more on self-care,health maintenance,dietary therapy,exercise, and precautions for hypertension, while the majority of patients primarily browsed digital health information in a rather casual manner on platforms such as Baidu and health-oriented social media:

I consult all kinds of health information, and there is no fixed way to access electronic health information. Because I don't know any particularly good websites or applications to read consistently, I read a lot of different sources of information.[...]There are few recommendations on which applications provide quality health information.(Participant 8)

When you search for something on Baidu, it will subsequently push similar information to you.[...]If I search for sports-related activities, it will recommend a series of exercise videos for me to study.[...]I don’t follow any specific bloggers, i simply utilize videos that I find appealing or suitable for my needs.(Participant 11)

At the moment, for me personally, I don't have a particular preference, because I don't think there is a systematic or authoritative medical information website yet. Once you search or look up exercise information, you can usually only find some content about running or other sports, which is not authoritative.[...]And there is no authoritative medical information or health information networks,even some websites that you can refer to.[...]After all, we are not medical professionals and can’t precisely determine which information is beneficial or harmful for us, so our options are very limited.(Participant 6)

Theme 4: The Expectations for Electronic Health Information or Online Medical Services

The theme contains patients’ expectations and recommendations for e-health information or services to support their self-management.

Subtheme 4a: improve the accessibility,simplicity and operability of electronic health information and services

With respect to expectations for e-health information and online health services, most patients mentioned that they valued the prevalence, simplicity, and convenience of e-health information and services:

For app,it should cover the needs of users to foster consumer habits, which is difficult to achieve. Secondly,it’s cumbersome and inconvenient.(Participant 1)

Easy to implement and better to stick to, then not limited by time and space.(Participant 11)

It’s not widespread,especially for the ordinary people,who even don’t understand it. Some people don't even have smartphones, some people are still using 2G phones, and now the technology has evolved to 4G and 5G, isn't it?[...]In many cases,these people need to be accompanied by their children to the hospital, it needs to be simplified so that everyone is familiar with it.(Participant 7)

Subtheme 4b: improve the network information management system to weaken its commercial nature

Many patients expected that the future network information management system would be further improved to reduce its commercial nature:

In China, the service network is a systematic structure that needs to be connected from top to bottom. If a community hospital needs to develop an electronic documentation system, it must establish a communication channel between medical staff and patients, but this channel hasn’t been established in community hospitals yet.[...]Nowadays,if you search for health information when you’re riding the bus,for instance,if you want to search for a doctor in a certain hospital, you'll see a lot of advertisements pop up once you get to the relevant page.[...]If these ads aren't be removed,you may inadvertently click on a bundled package deal.[...]But today, when accessing the service page, which includes scanning QR codes for bill payments,a link automatically appears.(Participant 7)

Just don’t have too many advertisements.(Participant 2)

Subtheme 4c: Strengthen the coherence of medical institutions at different levels

Other patients prioritized the coherence of information between superior and subordinate medical institutions:

I noticed that the community hospital required documentation for patients with high blood pressure. A medical worker assisted me in filing my case. However, rather than relying on my history of hypertension to initiate relevant procedures, I feel unsure about how to proceed with the remaining steps. This indicates a gap in the communication process.[...]For example, I have been taking hypertensive medication for several months or even longer, but if I don’t document my hypertension, the relevant medications, values, and other records remain incomplete.(Participant 6)

Several aspects need improvement. For example, as I mentioned earlier, I believe that the experts recommended online are often not genuine, with minimal elements of truth.[...]I suggest that online experts adopt a real-name system. If they aim to disseminate knowledge and assist people with their problems, they should possess high qualifications.(Participant 9)

This qualitative study evaluates e-health literacy among young and middle-aged hypertensive patients, highlighting the need to improve their e-health literacy and online medical service skills. Four themes emerged from the analysis: Firstly, e-health literacy still needs improvement. Secondly, the operational skills for online medical services need further promotion. Thirdly, this study examines the impacts of electronic health information and online medical services on patients. Lastly, our study explores patients' expectations regarding electronic health information and online medical services. Unlike previous studies that focused on surveying patients' online information needs or testing their perceptions and experiences with e-health technologies^{[33,34,35,36]}, this study explores how young and middle-aged hypertensive patients acquire, understand, evaluate, discriminate, share, and utilize e-health information and online healthcare services. This study expands the applicability of e-health research and breaks down information barriers between populations with different characteristics. Young and middle-aged hypertensive patients expressed a preference for easily accessible information and highly operable online medical services. Additionally, the promotion of electronic health information and related medical services needs to be enhanced. Improving the information coherence between different levels of healthcare institutions is also essential. Finally, the network information management system needs to be further optimized.

We have similar findings with previous studies, such as the premise of e-health popularization is that patients master the basic skills of using Internet technology^[37], the e-health application should be simplified in the subsequent development of online medical procedures^[38]. In addition, patients are trained in operational skills^[39,40]and user habits are cultivated, thus increasing Internet penetration, which is consistent with the findings of Li Nie scholar^[41,42].

In addition,these results corroborate the findings of Ai Tingfang scholar^[43]. By analyzing the implementation of "Internet plus" chronic disease management in China, Ai Tingfang's research team revealed that there were still several issues in China's "Internet plus" management, including the challenge of establishing a data sharing system, the need to improve product design, and insufficient industry supervision. However, this study complements her findings, we demonstrate that the government should provide policy, talent and financial support to community medical institutions, which involves giving full play to its regulatory role in "Internet plus" chronic disease management. The eligibility of online medical workers, advertisements for health products, and links to health services should be thoroughly checked to provide a good network environment for patients^[44], which is consistent with the relevant regulations for internet governance in china.

At the same time, promoting the development of the e-health field requires attracting more high-quality professionals^[45]and enhancing the professionalism of community medical service centers. Experts should be regularly recruited within the community hospital to review and discuss the health information published on affiliated platforms, ensuring its authority, accuracy, and simplicity^[22]. Additionally, China is still in the initial stages of providing individuals access to electronic health records, thus adequate financial investment is also necessary^[46].

Our study aligns with the conclusions of Zuo Qiantao scholar^[47], his research team explored the urban-rural differences in e-health literacy levels among community residents and the factors influencing these differences, they found that community medical service centers should make use of community neighborhood committees to carry out knowledge promotion activities, and put public health service programs such as family doctor into practice. And this study reveals that the future development of e-health should be based on high-level experts and take authoritative medical institutions as platforms, thus increasing the trust of patients, which is also consistent with the findings of Shu Zhenhuai scholar^[37,48].

Strengths and limitations

This study possesses several distinct advantages. Firstly, this study not only examines the theoretical knowledge reserve of patients, but also grasps the needs, preferences and operational skills of patients in using e-health information or services. Secondly, our study objects are young and middle-aged people, because they have the habit and demand for daily use of mobile smartphones, and the patients in this age group have a strong learning ability. Therefore, this study provides an important reference for the design of e-health intervention programs oriented by the needs of young and middle-aged hypertensive population. In addition, our research can provide a complete procedure and sufficient details. For example,data collection and data analysis are clearly described, and participant characteristics, backgrounds, study durations, and study settings are well preserved^[26].

This study possesses certain limitations. First, young and middle-aged hypertensive patients are selected in the community hospitals. Although the participants in this study may have strong self-care abilities, some participants exhibit poor self-care awareness and abilities. In addition, some of the interviews in this study are conducted via smartphones, which may result in the inability to capture non-verbal information from respondents, such as unique speech patterns, facial expressions, and body movements, potentially affecting the authenticity of the study. What’s more, qualitative research method are not statistically representative. However, it is more suitable for this study because it aims to understand the real experiences and potential needs of young and middle-aged hypertensive patients in order to develop appropriate interventions to improve their e-health literacy and self-management.

Recommendations for further research

Future research should provide a reference for developers to design management applications that are convenient, user-friendly, privacy-protected, and optimally tailored to the needs of young and middle-aged hypertensive patients. In addition, future research should aim to better understand the perspectives of other stakeholders and improve interventions based on their feedback to increase the ubiquity, applicability and effectiveness of e-health applications^[49]. What’s more, patients and stakeholders should be involved jointly in the design and development of mobile health applications to better meet their preferences and needs^[36,50]. Finally, the relationship between e-health and cost-effectiveness should be discussed in the future, and the feasibility of incorporating e-health into standard care practice should be explored^[51].

This interview study explores the experiences and conceptions of acquiring,understanding,evaluating,discriminating,sharing and using electronic health information or online health services among young and middle-aged hypertensive patients, which is expected to provide more comprehensive information on the development of e-health interventions for hypertensive patients. The results of this study indicate that patients access electronic health information or online medical services from a variety of sources, but they generally don’t have scientific criteria to evaluate the accuracy of the information. Consequently, healthcare professionals should educate patients on how to assess the authenticity of electronic health information. Furthermore, they should guide patients toward authoritative and reliable information sources, and instruct them on using reputable health websites, health-oriented social media, and health management applications.

Acknowledgments

All the authors wish to express our gratitude to the participants in this study and the anonymous reviewers and the editor for their constructive comments.

Authors’ contributions

Ziyi Mi contributed to this study by collecting data through interviews, analyzing the data, and writing the manuscript, Bingxue Zhang participated in the data analysis, Haidi Liu drafted the interview outlines in this study, Hongjuan Hu and Yanjin Huang supervised the writing process, and all the authors provided valuable writing suggestions, reviewed and approved the final manuscript.

Funding

No funding was received for this project.

Availability of data and materials

The data sets analyzed in this study are available from the corresponding authors on reasonable request.

Ethics approval and consent to participate

The study protocol was reviewed by the Behavioural Research Ethics Board at the University of South China (2023NHHL007). Before conducting the interviews, we ensured that all participants had sufficient time to review the informed consent and that any questions were thoroughly addressed. Afterwards, all study participants were asked to sign an informed consent(see Multimedia Appendix 1),which could expound the study purposes, benefits, and potential risks.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Author details

¹School of Nursing, University of South China, Hengyang, China

²School of Nursing, University of South China, Hengyang, China

³Rehabilitation department, The First Affiliated Hospital of University of South China, Hengyang, China

⁴Department of Public Health, The First Affiliated Hospital of University of South China, Hengyang, China

⁵School of Nursing, University of South China, Hengyang, China

Multimedia Appendix 1

Sample interview topic guide.

[DOCX File , 17 KB-Multimedia Appendix 1.docx]

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No competing interests reported.

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The e-Health literacy among young and middle-aged hypertensive patients still needs improvement : a qualitative study

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