Health literacy among older adults in selected states of Malaysia and its associated factors

Abstract

As Malaysia approaches the status of an aging nation by 2030, understanding health literacy (HL) among older adults becomes increasingly critical for public health policy. In recent years, the rapid digitalisation of health information and services has further underscored the importance of eHealth literacy (eHL). However, empirical evidence on HL among older adults in Malaysia remains fragmented, and the role of eHL in shaping HL has not been adequately examined. In addition, findings from a systematic review of 18 Malaysia-based studies indicate that health literacy is influenced by multiple sociodemographic and contextual factors, including education, ethnicity, income, and access to health information, highlighting the need for updated empirical investigation. This study aimed to assess the level of health literacy among Malaysian older adults, identify its key determinants, and examine the relationship between eHL and HL within a multi-ethnic context. A cross-sectional survey was conducted among 377 older adults aged 60 years and above in three Malaysian states representing different socioeconomic contexts: Kuala Lumpur, Johor, and Kedah. Eligible participants were Malaysian citizens aged ≥60 years with normal cognitive function. A multistage sampling method was employed to ensure adequate representation across regions and ethnic groups. HL was assessed using an adapted HL Questionnaire, while eHL was measured using the eHealth Literacy Scale (eHEALS). Sociodemographic information was collected. Descriptive statistics, correlation analyses, and multiple linear regression were employed to examine associations and identify independent predictors of HL. The study sample comprised 377 participants with a mean age of 68.21 years (SD = 5.75). Through descriptive statistics, there were 214 women (56.8%) and 163 men (43.2%), of whom 209 (55.4%) were Chinese, 157 (41.6%) were Malay, and 11 (2.9%) were Indian. Overall HL and eHL levels are relatively low, with scores of 10.44 (SD = 3.576) out of 20 and 23.14 (SD = 12.155) out of 40. Correlation analysis revealed significant associations between HL and eHL, education, age, income, ethnicity, and living arrangement (p < 0.01). The multiple regression analysis revealed three key predictive factors that independently contributed to health literacy outcomes: eHL (β = 0.260, p < 0.001), educational attainment (β = 0.257, p < 0.001), and ethnicity (β = –0.288, p < 0.001). The final regression model was statistically significant and accounted for 30.6% of the total variance in health literacy scores. This study demonstrates that HL among Malaysian older adults remains suboptimal and is shaped by both traditional sociodemographic factors and digital competencies. eHL emerged as a significant and independent predictor of HL, highlighting its growing importance in an increasingly digital health environment. Persistent ethnic, educational, and regional disparities point to the need for culturally sensitive, digitally inclusive, and regionally targeted interventions. Strengthening eHL among older adults may serve as a key strategy for improving overall HL and promoting healthy aging in Malaysia.