Background: With advances in science and technology and improvements in health literacy, more studies have focused on frailty prevention by promoting medication adherence, emphasizing the role of eHealth literacy. However, the association between eHealth literacy and medication adherence in frail older adults has not been well studied, and it is unknown whether urban-rural differences exist in this relationship. Objective: This study aims to examine the relationship between eHealth literacy and medication adherence in older people with different frailty statuses, emphasizing variations between rural and urban areas. Methods: Between November and December 2020, a total of 4218 urban and rural community members (aged ≥60 years) in China were recruited as participants using a multistage random sampling method. A face-to-face structured questionnaire survey was conducted to collect information on demographic characteristics, eHealth literacy (consisting of application, evaluation, and decision dimensions), and medication adherence. eHealth literacy was assessed using the Chinese version of the eHealth Literacy Scale developed by Norman and Skinner, and medication adherence was measured using the 4-item Morisky scale. We used a general descriptive analysis and stratified logistic regression models to examine how eHealth literacy is linked to medication adherence and urban-rural differences. Results: There were 4218 respondents, of which 2316 (54.9%) lived in urban areas and 1902 (45.1%) in rural areas, respectively. After adjusting for potential confounders, among participants with prefrailty, eHealth literacy was associated with medication adherence in urban areas in terms of less application (adjusted odds ratio [AOR] 1.16, 95% CI 0.82‐1.63), less evaluation (AOR 1.29, 95% CI 0.92‐1.81), and less decision ability (AOR 1.20, 95% CI 0.86‐1.68); eHealth literacy was linked with medication adherence in the rural areas in terms of less application (AOR 1.10, 95% CI 0.56‐2.13), less evaluation (AOR 1.05, 95% CI 0.61‐1.79), and less decision ability (AOR 1.10, 95% CI 0.64‐1.90). Among frail participants, less eHealth literacy (AOR 0.85, 95% CI 0.48‐1.51), along with its dimensions, including less application (AOR 0.85, 95% CI 0.47‐1.54), evaluation (AOR 0.89, 95% CI 0.50‐1.57), and decision ability (AOR 0.99, 95% CI 0.55‐1.76), were associated with medication adherence in urban areas; less eHealth literacy (AOR 0.89, 95% CI 0.48‐1.65), along with its dimensions, including less application (AOR 1.23, 95% CI 0.62‐2.44), evaluation (AOR 0.98, 95% CI 0.53‐1.82), and decision ability (AOR 0.90, 95% CI 0.49‐1.67), were associated with medication adherence in rural areas. Conclusions: The results of this study suggest that there is an association between eHealth literacy and medication adherence among older people with frailty and prefrailty. To promote medication adherence, eHealth literacy can be helpful in tailoring interventions.

The health of older people, especially functional ability, has become a hot topic for scholars in various countries. There is insufficient research on the urban-rural disparity in the functional ability of older people. This study aimed to explore the urban-rural gap in the functional ability of older people and the related influencing factors. The data analyzed in this study were collected through a cross-sectional survey conducted in China. Furthermore, binary logistic regression was utilized to assess the relationship between functional ability and the independent variables, and Oaxaca-blinder decomposition was used to explore urban-rural differences in functional ability among older people. The percentage of urban older people who were functionally robust was 65.9%, which was significantly higher than the rural 40.4%, and the difference was found to be statistically significant (χ² = 274.93, p < .001). Furthermore, our study identified factors affecting the functional ability of older people in urban areas, including age, BMI, education, social participation, and trust. In contrast, for older people in rural areas, in addition to these factors, gender, drinking, and social connection were also found to be factors affecting their functional ability. Moreover, the results of the Oaxaca-Blinder decomposition showed that the most critical factor influencing the urban-rural differences in functional ability among older people was social participation (26.5%). Besides, education (14.4%), living status (-10.8%), age (7.3%), and trust (-6.9%) likewise influence the urban-rural disparity. A higher proportion of older people in rural areas have limited functional ability than in urban areas. Moreover, the disparity in social participation levels significantly contributed to the differences in functional ability observed between older adults in urban and rural settings. This study underscores the significance of enhancing the social engagement of older adults, particularly those living in rural communities.