Socio-Digital Characteristics of eHealth Literacy and Its Impact on Participatory Health and Digital Utilization Outcomes in Community-Dwelling Japanese Older Adults

eHealth literacy (eHL) is essential for navigating digital health services, particularly in super-aging Japan with accelerated digital transformation. The study investigated determinants of eHL and its impact on participatory health and digital utilization outcomes among older Japanese adults. In the community-based cross-sectional survey (N = 349), an eight-item five-point Likert scale measured eHL. Ordinal logistic regression investigated determinants of eHL and multivariate analysis of variance (MANOVA) for its impact on participatory outcomes. Mean age of participants was 76.95 (SD 6.56) years and 68.7% were female. Mean eHL was 18.02 (SD 8.66) and 28.37% had moderate to high eHL. eHL increased with higher education and increased Internet usage time. Social media users were 2.61 times more likely to have higher eHL than nonusers (aOR 2.61, 95% CI 1.39 to 4.98). Higher eHL enhanced self-perceived active aging and increased use of digital technology for nutrition and for accessing health and long-term care services. Socioeconomic and digital characteristics are key determinants of eHL in Japanese older adults, and competency in eHL linked to health-related digital technology use and perceived active aging. Investing in targeted digital inclusion with leveraging social media skills is a vital bridge ensuring active and healthy aging in Japan and comparable global settings.