Understanding the factors influencing intergenerational back-feeding on digital health literacy of Chinese older adults: Qualitative interview study

Objective As China faces digitization and aging, despite efforts to improve older adults’ digital health literacy across domains, research lacks examination of the impact of intergenerational back-feeding. This study aims to investigate the effects of intergenerational back-feeding, defined as the transfer of digital knowledge from younger to older generations, on digital health literacy among older adults. Methods Semi-structured interviews were conducted with 20 adults aged ≥60 years from three provinces in China. Thematic analysis was guided by the three-stage back-feeding model (access, skills, literacy) and key individual factors (e.g. perceived usefulness and perceived ease of use). Results The enhancement of digital health literacy among older adults was shaped by a dynamic interplay between individual factors and intergenerational back-feeding. At the access stage, although younger generations frequently provided digital health devices, interface complexity or a preference for traditional care led some older adults to discontinue use. Skill development was significantly influenced by teaching methods: heuristic and face-to-face guidance improved operational competence, whereas remote, proxy, and directive approaches fostered dependency. At the literacy stage, some younger generations’ risk-averse strategies limited older adults’ autonomy, while only a minority proactively engaged in cross-verifying online health information with offline sources. Conclusion This study extended the three-stage back-feeding model to health contexts by incorporating individual factors. These findings confirmed the pivotal role of intergenerational back-feeding in enhancing the digital health literacy of older adults in China. Future efforts should integrate family support with national-level policy implementation, which is significant for advancing healthy aging.