Technology acceptance, eHealth literacy, and health-related quality of life among community-dwelling older adults in urban and rural Xi’an, China: a moderated mediation study of smart eldercare technology

Population ageing has made smart eldercare technology a central instrument of healthy ageing policy in China, yet accepting a device does not by itself guarantee health benefits for older adults. This study examined whether eHealth literacy statistically mediates the association between technology acceptance and health-related quality of life (HRQoL) among community-dwelling older adults, and whether the strength of this pathway differs between urban and rural residents. A cross-sectional survey was administered between June and September 2025 in Xi’an, China, using stratified sampling across urban districts and rural counties; 612 older adults aged 60 and above were approached and 552 valid questionnaires were retained (304 urban, 248 rural; valid response rate 90.2%). Acceptance of smart eldercare technology was measured with a 16-item instrument based on the unified theory of acceptance and use of technology, eHealth literacy with the 8-item eHEALS, and HRQoL with the EQ-5D-5L descriptive system and the EQ visual analogue scale (EQ-VAS); depressive symptoms were assessed with the 15-item Geriatric Depression Scale. Measurement models fitted the data well ( χ 2 (242) = 267.92, CFI = 0.996, RMSEA = 0.014, SRMR = 0.024) and all scales showed satisfactory reliability ( α = 0.786 to 0.934). Conditional process analysis showed that acceptance predicted eHealth literacy ( b = 0.358, p < 0.001), that acceptance interacted with residence ( b = 0.194, p = 0.009), and that eHealth literacy predicted EQ-VAS scores after adjustment ( b = 3.520, p < 0.001). The indirect effect of acceptance on EQ-VAS through eHealth literacy was significant in both groups but larger among urban [1.942, 95% CI (1.184, 2.764)] than rural residents [1.259, 95% CI (0.729, 1.858)], and the index of moderated mediation was significant [0.683, 95% CI (0.185, 1.283)]. Parallel analyses with depressive symptoms as the outcome confirmed the pattern; after excluding never-users of smart devices the first-stage interaction was attenuated ( p = 0.059), while eHealth literacy continued to predict EQ-VAS. The findings position eHealth literacy as a plausible pathway linking technology acceptance to quality of life and indicate that urban environments amplify this association, supporting digitally inclusive smart eldercare deployment for rural older adults.