eHealth literacy, cyberchondria and perceived stress among older adults in primary care: a cross-sectional study

BACKGROUND: Digital health information use among older adults has increased rapidly; however, higher exposure to online health information may also contribute to anxiety-related behaviors such as cyberchondria. Evidence regarding the associations among eHealth literacy, cyberchondria, and perceived stress in older adults within primary care settings remains limited. This study aimed to examine the associations between eHealth literacy, cyberchondria, and perceived stress among older adults attending a primary healthcare center and to evaluate how these variables differ according to sociodemographic and health-related characteristics. METHODS: This descriptive cross-sectional study was conducted between March and December 2025 in a Family Health Center in Zonguldak, Türkiye. The sample consisted of 303 adults aged ≥ 65 years who actively used the internet for health information. Data were collected using a Sociodemographic Characteristics Form, the eHealth Literacy Scale (eHEALS), the Cyberchondria Severity Scale (CSS), and the Perceived Stress Scale (PSS-14). Since scale scores were not normally distributed, non-parametric tests (Mann-Whitney U and Kruskal-Wallis) were used. Three linear regression models (unadjusted and adjusted for age, gender, and education level) were constructed to examine the associations among eHealth literacy, cyberchondria, and perceived stress. RESULTS: Participants demonstrated moderate levels of eHealth literacy, cyberchondria, and perceived stress. eHealth literacy scores were significantly higher among women, younger-old adults, participants with higher education and income levels, and those with more frequent internet use (p < 0.05). Cyberchondria levels varied according to age, education, income, chronic disease status, and internet use patterns (p < 0.05). Perceived stress was mainly associated with health-related variables. Regression analyses revealed a significant positive association between eHealth literacy and cyberchondria (β = 0.399, p < 0.001). Although the overall regression model for perceived stress was not statistically significant (p = 0.109), cyberchondria showed a small but significant negative association with perceived stress (β = -0.132, p = 0.037). CONCLUSIONS: Higher eHealth literacy among older adults may coexist with increased cyberchondria rather than functioning solely as a protective factor. These findings suggest that digital health competence alone may not reduce anxiety associated with online health information seeking. Primary care interventions should therefore focus not only on improving access to digital health information but also on enhancing critical appraisal skills and supporting anxiety management strategies tailored to older adults.