Gender Differences in the Digital Divide, Digital Back-Feeding, and Health-Related Quality of Life Among Rural Older Adults: Cross-Sectional Study (Preprint)

<sec> <title>BACKGROUND</title> The digital divide has loomed as a global public issue in recent years. However, evidence is limited regarding whether the digital divide is associated with health-related quality of life (HRQOL) and whether digital back-feeding would buffer this association. </sec> <sec> <title>OBJECTIVE</title> This study aims to explore the role of digital back-feeding in the relationship between the digital divide and HRQOL among older men and women living in rural China. </sec> <sec> <title>METHODS</title> We used data from wave 3 of the Shandong Rural Elderly Health Cohort, conducted in 2022. A total of 3242 (n=1946, 60.02% women) rural older adults were included in the analysis. Moderating effect analysis was performed using Tobit regression models and margins plots. </sec> <sec> <title>RESULTS</title> A total of 71.01% (2302/3242) of the participants reported experiencing digital divide. Participants experiencing digital divide were significantly associated with lower HRQOL as measured by EQ-5D-5L scores (β=–0.020; &lt;i&gt;P&lt;/i&gt;&amp;lt;.001). We found that digital back-feeding buffered the relationship between digital divide and HRQOL (β=0.024; &lt;i&gt;P&lt;/i&gt;=.02). Furthermore, gender-stratified analyses revealed divergent moderation patterns; a significant buffering role was observed in women (β=0.031; &lt;i&gt;P&lt;/i&gt;=.02), whereas no substantially significant moderating role emerged in men. </sec> <sec> <title>CONCLUSIONS</title> Our study established a significant inverse association between the digital divide and HRQOL among rural adults. Digital back-feeding emerged as a measurable protective buffer mitigating this adverse relationship. Furthermore, this buffering effect was only observed among older women. Policy implications underscore the necessity of gender-tailored digital inclusion strategies, particularly advocating for technology-proficient adult offsprings to prioritize digital engagement with their mothers in digitally marginalized rural communities. </sec>