The mediating role of digital health literacy on the relationship of social isolation and digital technology anxiety among older cancer patients

Abstract

Background

Digital health technology has become increasingly important in cancer care and health management. However, older cancer patients may experience technology anxiety, which can reduce their willingness to use digital health services and limit access to technology-supported care.

Aim

This study aimed to examine the mediating role of digital health literacy in the relationship between social isolation and technology anxiety among older cancer patients.

Method

A cross-sectional survey was conducted among older cancer patients hospitalized at five tertiary hospitals in Guangdong Province, China. Using convenience sampling, a total of 319 valid questionnaires were collected. Data analysis was performed using SPSS 26.0 and AMOS 26.0, and structural equation modeling was used to test the hypotheses.

Results

The total scores of technology anxiety, social isolation, and digital health literacy of older cancer patients were 45.90 ± 9.21, 19.36 ± 5.46, and 44.19 ± 12.55, respectively, all at a moderately high level. Technology anxiety was negatively related to social connectedness (r=-0.268, p < 0.001) and digital health literacy (r=-0.292, p < 0.001). Digital health literacy mediated the relationship between social isolation and technology anxiety, where the mediated effect was − 0.096 (95% CI: -0.165-0.049).

Conclusion

Older cancer patients may experience considerable technology anxiety, particularly when they are socially isolated and have limited digital health literacy. Social isolation may be associated with higher technology anxiety partly through reduced digital health literacy. Healthcare professionals, especially nurses, should identify patients with limited social support and provide family-involved digital skills training and individualized guidance. Improving digital health literacy and reducing technology anxiety may promote older cancer patients’ use of telemedicine, patient portals, online appointment systems, and other digital health services, thereby supporting continuity of cancer care.

Introduction

The increasing prevalence of cancer among older populations has become a pressing public health concern. Older adults accounted for the majority of new cancer cases worldwide [1]. In China, data from 2022 estimated that approximately 2.79 million new cancer cases and 1.94 million cancer-related deaths occurred among older individuals, representing 55.8% of all cancer cases and 68.2% of all cancer deaths in the population [2].

In cancer care, Digital health technology (DHT) has been increasingly used to support symptom monitoring, treatment-related communication, follow-up care, health education, telemedicine, and access to professional consultation; however, its benefits for older patients largely depend on their ability and confidence in using these technologies [3–5]. However, the implementation of DHT in cancer care may also widen existing disparities among patients who are older, socioeconomically disadvantaged, or have limited digital skills [6]. Older patients frequently report technological anxiety, defined as apprehension or fear when using or anticipating the use of digital technology, which may reduce their willingness to use DHT and limit access to digital support resources [7, 8]. According to self-efficacy theory, confidence in one’s ability to use digital technology may reduce technology-related anxiety and increase willingness to engage with digital tools [9]. Social support theory further suggests that support from family members, peers, healthcare professionals, and communities may provide older cancer patients with practical assistance and emotional reassurance when using DHT [10]. For older cancer patients, support from family members, peers, healthcare professionals, and communities may be especially important, as these sources of support can provide practical assistance, emotional reassurance, and opportunities to develop confidence in using digital health tools.

While some studies have assessed the relationships between social isolation, digital health literacy and technology anxiety [7, 11], limited attention has been paid to the mediating role of digital health literacy in older cancer patients. Therefore, this study aimed to examine whether digital health literacy mediates the relationship between social isolation and digital technology anxiety in this population. Clarifying this pathway may inform interventions designed to improve digital health literacy, reduce technology-related anxiety, and promote access to digital health resources among older cancer patients.

Background

Research indicates that older adults are less likely to adopt new technologies [12, 13]. The reluctance to engage with digital tools can stem from a lack of confidence in their technological skills [8, 14]. Those with lower technological skills are more likely to experience anxiety when attempting to use technology, which can lead to increased feelings of isolation [15, 16]. For older cancer patients, this issue may be more pronounced because cancer diagnosis, treatment, rehabilitation, and follow-up often require repeated access to health information and continuous interaction with healthcare services [13]. The digital divide, reflected in unequal access to digital devices, Internet resources, and technology-related support, may restrict older cancer patients’ ability to obtain timely health information and participate in digital care, thereby increasing the risk of loneliness, anxiety, depression, and reduced engagement with health services [17–21]. Moreover, the digital divide can further complicate the situation, leaving vulnerable populations at a disadvantage, particularly when considering the role of social support [22, 23]. A study focusing on the use of information and communication technologies among older individuals revealed that frail seniors were less likely to engage with digital health resources compared to their non-frail counterparts [24].

Digital health literacy, also known as eHealth literacy, refers to the ability to search for, access, understand, evaluate, and apply health information from electronic sources [25]. Older adults often have lower digital health literacy, which may limit their use of online health resources and their ability to manage health conditions [26–28]. For older cancer patients, this limitation may affect their understanding of treatment information, adverse effects, appointment arrangements, and follow-up instructions [27]. However, older adults with low health literacy are less likely to use the Internet for health-related purposes, which can exacerbate health disparities and limit their engagement with necessary health services [25, 29]. Lower levels of digital health literacy usually coexist with higher technology anxiety, and the interaction between these factors may exacerbate the reluctance to digital use among older adults [7]. Greater engagement in community and cultural activities has been associated with higher digital health literacy and better psychological well-being among older adults [11, 30]. Conversely, social isolation may reduce opportunities for older cancer patients to receive assistance from family members, peers, or healthcare professionals when using patient portals, telemedicine platforms, or online health information.

Tailored interventions are needed to address social isolation and limited digital health literacy in order to reduce technology anxiety and promote DHT use among older adults with cancer. Social Support Theory suggests that encouragement and assistance from others may strengthen confidence and capability, whereas Self-Efficacy Theory emphasizes that greater confidence in performing specific tasks may reduce anxiety during technology use [31, 32].

Based on existing theories and current research, we hypothesize that older cancer patients with higher levels of social isolation are more likely to report greater digital technology anxiety. Specifically, higher social isolation may be associated with lower digital health literacy, which in turn may be linked to higher digital technology anxiety.

Method

Setting and sample

The cross-sectional survey was conducted among older cancer patients hospitalized at five tertiary hospitals in Guangdong Province from July to September 2023. These hospitals are well-renowned institutions in South China, with significant influence both regionally and nationally. Patients admitted to these hospitals come from various areas within Guangdong Province as well as different regions across the country, reflecting a diverse range of socio-economic backgrounds. A convenience sampling method was employed. The inclusion criteria were as follows: age ≥ 60 years; a confirmed tumor diagnosis through imaging and pathological examination; ability to understand the meaning of each questionnaire item; voluntary participation; and completion of informed consent. Patients with severe physical illnesses that hindered their cooperation in the investigation, as well as those with a history of mental illness, were excluded. Additionally, participants who dropped out during the survey were also excluded.

According to the N: q rule, the rational ratio of the sample size (N: q) should be between 10 and 20 [33]. This study included 18 independent variables (related to sociodemographic information, the Technophobia Scale, Digital Health Literacy Assessment Scale, and Lubben Social Network Scale); therefore, the appropriate sample size was between 180 and 360. A total of 350 questionnaires were distributed, of which 328 were collected, resulting in a recovery rate of 93.7%. After screening out incomplete questionnaires and those with contradictory answers, the total number of valid questionnaires was 319, which constitutes an appropriate sample size.

Data collection

After obtaining consent from the Ethics Committee and the nursing department of the hospital, we engaged with and received support from the head nurse in each department. A paper questionnaire was developed, consisting of general information (10 items), the Technophobia Scale (3 dimensions, 13 items), the Digital Health Literacy Assessment Scale (3 dimensions, 15 items), and the Lubben Social Network Scale (2 dimensions, 6 items). These scales have been widely used in previous studies, and this research did not involve the development of new scales. Detailed descriptions of these scales are provided in the following section. Clear instructions were given, emphasizing that the survey was intended solely for academic research and that responses would be anonymous and treated with strict confidentiality. A trained investigator distributed the questionnaires during patients’ free time, using standardized instructions to explain the study’s purpose and the importance of their participation. The completed questionnaires were collected on-site and verified for completeness.

Measurement tools

Demographic characteristics

Participants’ demographic characteristics were collected using a questionnaire designed by the researcher. This questionnaire included 10 items: gender, age, education level, living style, residence, marital status, per capita monthly household income, self-assessed health status, degree of health concern, and willingness to participate in studies. Detailed information and the distribution of these variables are presented in Table 1.

Table 1.

Demographic characteristics of the older cancer patients (n = 319)

Characteristics	n	%
Gender
Male	141	44.2
Female	178	55.8
Age (years)
60–65	154	48.3
66–70	105	32.9
71–75	48	15
≥ 76	12	3.8
Education level
Primary school	86	27
Junior middle school	107	33.5
Senior high school	103	32.3
College/Undergraduate or above	23	7.2
Living arrangement
Living with spouse	127	39.8
Living with children	32	10
Living with spouse and children	121	37.9
Living with family other than children	3	0.9
Admission to a nursing home	10	3.1
Other types	26	8.2
Residence
Rural	173	54.2
Urban	146	45.8
Marital status
Unmarried	13	4.1
Married	278	87.1
Divorcee	2	0.6
Widowhood	26	8.2
Per capita monthly income(CNY)
<1000	52	16.3
1000–2999	128	40.1
3000–4999	81	25.4
≥ 5000	58	18.2
Self-assessed health status
Excellent	14	4.4
Well	70	21.9
Average	186	58.3
Poor	49	15.4
Degree of health concern
Extreme concern	60	18.8
Greater concern	140	43.9
General concerns	102	32
No concern	17	5.3
Willingness to study
Very willingness	28	8.8
General willingness	127	39.8
Not very willing	120	37.6
Unwilling	44	13.8

Technological anxiety

The Technophobia Scale was developed by Khasawneh to evaluate individuals’ attitudes toward new technologies [34].The Chinese version of the scale was revised by Sun et al. [35]. It consists of three dimensions: technology tension, technology fear, and privacy and security concerns, with a total of 13 items. Each item is rated on a 5-point Likert scale ranging from 1 to 5, indicating a range from “completely non-compliant” to “compliant.” The total score of this scale ranges from 13 to 65, with higher scores reflecting greater anxiety about digital health technology. The reliability of the Chinese version is satisfactory, with Cronbach’s alpha coefficients ranging from 0.759 to 0.911 for the overall scale and each dimension, as well as content validity indices exceeding 0.800. In this study, the scale’s Cronbach’s alpha coefficient was 0.887.

Digital health literacy

The Digital Health Literacy Assessment Scale (DHLAS) was developed by Liu et al. [36] to evaluate the level of digital health literacy among older adults in the community. This scale encompasses three dimensions: the ability to acquire and assess digital health information, the ability to interact with digital health information, and the ability to apply digital health information, comprising a total of 15 items. A 5-point Likert scale was employed, with scores ranging from 1 (“very non-compliant”) to 5 (“very compliant”). The total score of this scale ranges from 15 to 75; a higher score reflects a greater level of digital health literacy. The scale demonstrates excellent reliability, with a Cronbach’s alpha coefficient of 0.959. In this study, the scale’s Cronbach’s alpha coefficient was 0.927.

Social isolation

The Lubben Social Network Scale developed by Lubben et al. [37], was designed to assess the level of social isolation of older adults mainly by quantifying their interactions with family and friends, reflecting the closeness of their social ties. The scale includes two dimensions, family network and friend network, with a total of 6 items; it adopts a 6-point Likert scale with a total score of 0–30, with higher scores indicating that older adults have closer social ties and lower levels of social isolation. A score of less than 6 on each dimension indicates the presence of family isolation or friend isolation, and a total score of less than 12 on the scale indicates the presence of social isolation. The Chinese version was revised by Chang et al. [38], and the Cronbach’s α coefficients of the total scale and the dimensions were between 0.830 and 0.950. In this study, the scale’s Cronbach’s alpha coefficient was 0.846.

Statistical analysis

Data analysis was conducted using SPSS 26.0 and AMOS 26.0, with a two-sided p < 0.05 indicating statistical significance. The analysis proceeded in the following steps [39]: (a) Descriptive Statistics and Correlation Analysis: We began with descriptive statistics to describe the patient’s demographic characteristics in the present study, including factors such as age, gender, education level, and socioeconomic status. Correlation analyse were conducted to assess relationships among the variables. (b) Mediation Model Development: A mediation model was constructed using structural equation modeling (SEM) with maximum likelihood estimation. In this model, digital health literacy was examined as the mediator between social isolation and technological anxiety. (c) Criteria for Model Acceptability: The model’s fit was evaluated based on the following criteria: RMSEA < 0.08, CFI ≥ 0.90, TLI > 0.90, and SRMR < 0.05. (d) Testing Direct and Indirect Effects: The significance of both direct and indirect relationships was examined using bootstrapping analysis, which involved 2000 bootstrap samples and a 95% confidence interval (CI). The mediation effect was considered significant if the 95% CI for the indirect effect did not include zero.

Ethical considerations

The present study was approved by the Ethics Committee of Sun Yat-sen University Cancer Center [IRB No: B2023-210]. All participants were informed about the detailed information regarding the study. The completion of the survey implied consent. Participants could decide whether or not to participate and could withdraw at any time without consequences.

Results

Demographic characteristics

Table 1 presents the demographic characteristics of older cancer patients. Of all the participants, 55.8% were female, with 48.3% aged between 60 and 65 years. A significant portion of the respondents had completed only junior middle school (33.5%) and were living with their spouse (39.8%). Additionally, 54.2% of participants resided in rural areas, and 87.1% were married. Regarding monthly income, 40.1% reported a per capita income ranging from 1000 to 2999 yuan. In terms of self-perceived health, 58.3% considered their health to be average, while 43.9% expressed higher concerns about their health; notably, 39.8% showed a greater willingness to learn.

The total scores for technological anxiety, social isolation, and digital health literacy were 45.90 ± 9.21, 19.36 ± 5.46, and 44.19 ± 12.55, respectively. The average scores for technological anxiety, social isolation, and digital health literacy were 3.53 ± 0.71, 3.23 ± 0.91, and 2.95 ± 0.84, respectively, as shown in Table 2.

Table 2.

The scores of TS, DHLAS, and LSNS among the older cancer patients [n = 319, M ± SD]

Dimensions	Number of items	Dimensional score	Average score of items	Ranking
TS	13	45.90 ± 9.21	3.53 ± 0.71	-
Technological tension	5	17.74 ± 4.17	3.55 ± 0.83	2
Technological fear	5	17.33 ± 4.28	3.47 ± 0.86	3
Privacy and Security Concerns	3	10.82 ± 2.53	3.61 ± 0.84	1
DHLAS	15	44.19 ± 12.55	2.95 ± 0.84	-
Acquisition and assessment of capacity	9	26.60 ± 8.35	2.96 ± 0.93	1
Interactive capacity	3	8.73 ± 3.10	2.91 ± 1.03	3
Application capability	3	8.86 ± 3.16	2.95 ± 1.05	2
LSNS	6	19.36 ± 5.46	3.23 ± 0.91	-
Family level	3	9.77 ± 3.13	3.26 ± 1.04	1
Friendship level	3	9.59 ± 3.14	3.19 ± 1.05	2

TS Technophobia Scale, DHLAS Digital Health Literacy Assessment Scale, LSNS Lubben Social Network Scale

Correlation analysis

Pearson’s correlation analysis demonstrated a negative correlation between technological anxiety and both social isolation (r = -0.268, p < 0.001) and digital health literacy (r = -0.292, p < 0.001), as detailed in Table 3.

Table 3.

The correlations among technological anxiety, social isolation, and digital health literacy of the older cancer patients(n = 319)

Item	TS total score	DHLAS total score	LSNS total score
TS total score-	1.0
DHLAS total score	− 0.292**	1.0
LSNS total score	− 0.268**	0.226**	1.0

TS Technophobia Scale, DHLAS Digital Health Literacy Assessment Scale, LSNS Lubben Social Network Scale

^**p<0.01

Mediating effect of digital health literacy between technological anxiety and social isolation

Structural equation modeling was employed to test the hypotheses of this study, which yielding good model fit indices: χ²/df = 1.018, RMSEA = 0.007, CFI = 1.000, TLI = 0.999, GFI = 0.986, AGFI = 0.971. The analysis revealed that social isolation significantly negatively affected technological anxiety (β=-0.269, P < 0.05), while digital health literacy also had a significant negative impact on technological anxiety (β=-0.296, P < 0.05). Furthermore, social isolation positively influenced digital health literacy (β = 0.323, P < 0.05) (Fig. 1).

Fig. 1.

The final standardized model. Lubben Social Network Scale is a 6-point Likert scale with a total score of 0–30, with higher scores indicating that older adults have closer social ties and lower levels of social isolation

The mediating effect test indicated that the total effect of social isolation on technological anxiety was − 0.364 (p < 0.001), with a 95% confidence interval (CI) of [-0.501, -0.205]. The direct effect of social isolation on technological anxiety was − 0.269 [-0.414, -0.093]. Notably, digital health literacy mediated the relationship between social isolation and technological anxiety, with a mediating effect of -0.096 [-0.165, -0.049]. The 95% CIs for the direct, indirect, and total effects did not include 0 (Table 4). Thus, digital health literacy among older cancer patients served as a partial mediator between social isolation and technological anxiety, accounting for 26% of the total effect.

Table 4.

The mediating effect of digital health literacy between technological anxiety and social isolation among the older cancer patients(n = 319)

Model pathways	Product of coefficients		Bootstrapping 95% CI
	Point estimate	Boot SE	Lower	Upper	P
Indirect effect
Social isolation→Digital health literacy→Technological anxiety	-0.096	0.028	-0.165	-0.049	<0.001
Direct effect
Social isolation→Technological anxiety	-0.269	0.078	-0.414	-0.093	<0.001
Total effect
Social isolation→Technological anxiety	-0.365	0.073	-0.501	-0.205	<0.001

Discussion

Status quo of technological anxiety, social isolation, and digital health literacy

In this study, the total score of technological anxiety was at a moderately high level, which was consistent with the results of Wu et al. [40] and higher than that of Yang et al. [41]. The results suggested that technological anxiety in older cancer patients need to be further reduced. The possible reasons could be: (1) In this study, 60.5% of participants are in primary and junior middle school. The lower level of education affects an individual’s ability to understand and use digital technology, they may experience anxiety when confronted with technological challenges [40]. (2) Over half of the participants did not have a strong willingness to learn new things, which may lead to a lack of knowledge regarding digital health technology and further exacerbate technological anxiety [42]. (3) The rapid development of smart medicine makes digital technology unavoidable when older patients seek medical treatment, patients are at a loss but unable to do anything, and their negative emotions such as tension, fear, and fear increase [42]. (4) Older patients’ own ability is usually not enough to face the impact of digital technology, it is difficult to distinguish the authenticity and correctness of network information, and various negative emotions continue to breed [43]. Therefore, health professionals can provide some digital health technology training or provide one-on-one help to solve common technological doubts and organize activities to encourage older cancer patients to learn digital technology and establish confidence in use [5, 38]. Additionally, in the future, digital health management equipment should fully consider the use habits and characteristics of the elderly people, and develop some models such as “elderly mode” and “care mode” to promote better integration into digital life [18].

The study also found that the total score of social isolation presented a moderately high level, similar to the result of Gu et al. [44], but significantly higher than the score reported by Wang et al. [45]. This may be caused by the different research subjects, compared with older patients with chronic, the older cancer patients are passively socially isolated due to their physical decline or dysfunction, they are inability to socialize in the same way as before. Also, with body image disorders or hypoimmunity, they choose to withdraw and distance themselves from others to avoid misunderstanding, discrimination and some unfavorable health condition [46]. Moreover, older cancer patients might not want their children or friends to worry about their condition and negative emotions associated with the disease, and then initiatively perform social isolation [47]. In addition, most of the participants’ economic conditions were poor, which isn’t conducive to the establishment of diverse social relations and widespread social activities, and increases the risk of social isolation [48]. Friends and relatives should early identify patients’ state of social isolation, afford more communication and care to patients, their support can help patients alleviate physical and mental stress, and maintain normal social activities [19, 21, 42]. Healthcare workers could strengthen professional guidance to improve patient confidence, according to the problems encountered in the social participation and different needs to help them develop social support network such as close connections with other patients or some support groups, so that patients can get emotional support to avoid social isolation [24, 43].

Additionally, the total score of digital health literacy of older cancer patients indicated a moderate level, which was comparable to the findings of Liu et al. [49] for community older people. First, education level has been evidenced to be an important positive factor affecting digital health literacy, which promotes digital health knowledge use more often and effectively [47], and only 7.2% of patients’ education level were college/undergraduate or above in this study. Second, with the imbalanced distribution of digital technology resources, older cancer patients especially live in rural areas may lack access to updated information and knowledge, therefore leading to a relatively lower digital health literacy [50]. Third, age has a significant correlation with digital health literacy, older people usually have poor digital learning and technical acceptance capabilities, and with physical function decreases due to cancer, the frequency of network usage and daily network use time is decline [8, 10]. Therefore, the digital health literacy of older cancer patients needs to be improved. Healthcare professionals should help older cancer patients strengthen their willingness to learn about digital health technology and conduct targeted training on the use and access to digital health information [49, 50]. Families and patients should be encouraged to give positive feedback by sharing experience and exchanging ideas, so as to enhance the confidence and skills to obtain medical and health knowledge online, and help better cope with the challenges of the digital age [7, 8].

Negative correlation between technological anxiety and social isolation

The results implied that the higher the social isolation, the worse the technological anxiety of older cancer patients, which is comparable to the study reported by Peng et al. [51]. The reason could be that social isolation causes older cancer patients to lack social support, so that fewer opportunities to contact and learn digital technology, thus anxiety will generate when using new technologies [52]. According to Self-Efficacy Theory and Social Support Theory, this lack of social interaction diminishes their perceived self-efficacy regarding technology use, further exacerbating their anxiety levels. Meanwhile, research shows that social isolation causes individuals to lack long-term social interaction and mental stimulation, which can accelerate cognitive decline, which in turn, they are less capable of understanding and using technological tools, when facing digital interfaces can be particularly anxiety [25, 49]. Moreover, social isolation leads to a lack of interest in pursuing novel things, and patients’ old habits or ways of thinking are solidified, making them face great challenges in accessing and using digital technology, presenting technological anxiety and exclusion [16, 17]. It is encouraging that patients’ children and friends provide abundant emotional support to alleviate the social isolation of patients, which aligns with Social Support Theory. This support enhances patients’ self-efficacy in using digital technology, as they receive assistance with applications like WeChat, Weibo, TikTok, and other internet apps, as well as through video conferencing and telephone calls, helping them better integrate into the social environment and the digital age [48]. Furthermore, nursing staff should pay more for communication with patients, provide personalized nursing according to different patients’ characteristics and needs, also give support and necessary help to use digital health services [44, 53].

Negative correlation between technological anxiety and digital health literacy

The study found that the higher the digital health literacy, the lower the technical anxiety of older cancer patients, which is consistent with Kim et al. [7]. Patients with a high level of digital health literacy can better adapt to hospital digital construction, proficient in various hospital procedures and smart devices in a short period, and reduce the level of technological anxiety [21, 38]. Moreover, those patients are more confident in obtaining and recognizing the effectiveness of online health resources and knowledge, which will reduce the concern for privacy security and personal information leakage and their tension, fear, and anxiety about using technology will lower [18]. Furthermore, a high level of digital health literacy encourages patients to practice network health knowledge acquisition and take the initiative to seek help through the internet once they encounter technical difficulties, thus technical barriers are better broken and the less technological anxiety they experience [17, 40, 49]. It is recommended that hospital administrators should strengthen digital health publicity and push, actively introduce digital health-related acquisition methods and operational processes, and provide digital technology education and training activities to improve the digital health literacy of older cancer patients, in turn, reducing their technological anxiety [18, 25]. Besides, family members should provide appropriate intelligent products and patiently assist patients in cultivating a digital mindset, help them master online consultation, registration, and other digital health skills, eliminate their panic about digital technology [3, 18, 19]and enjoy the well-being brought by digital health. Clinically, technological anxiety may reduce older cancer patients’ willingness to use telemedicine, patient portals, online appointment systems, and digital symptom-reporting tools. This avoidance may delay communication with healthcare professionals, reduce access to treatment-related information, and interfere with adherence to treatment and follow-up plans. Therefore, reducing technological anxiety should be considered an important component of nursing support and continuity of cancer care.

A mediating role of digital health literacy between social isolation and technological anxiety

The study demonstrated that digital health literacy mediated the association between social isolation and technological anxiety. Specifically, older cancer patients with higher levels of social isolation may have fewer opportunities to receive interpersonal support, informal guidance, and practical assistance in using digital health tools, which may contribute to lower digital health literacy. In turn, insufficient digital health literacy may make it more difficult for patients to search for, understand, evaluate, and apply online health information, thereby increasing uncertainty and anxiety when they are required to use digital technologies in cancer care. Social support theory posits that individuals can offer both emotional and instrumental support by cultivating close relationships and establishing social support networks with specific relational resources [16]. For older cancer patients, a higher level of family care and a closer network of friends significantly reduce the risk of social isolation [54]. Notably, information support is the most prevalent form of assistance provided by family members when addressing health challenges [55]. Thus, family members, friends, and other supporters may help older cancer patients interpret online health information, operate patient portals or telemedicine platforms, and solve common problems encountered during digital health service use. Such support may improve digital health literacy and subsequently reduce technological anxiety [20]. Furthermore, self-efficacy theory indicates that belief in one’s ability to perform actions necessary to achieve specific goals is a prerequisite for behavioral change. From this perspective, digital health literacy may function as a key mechanism through which social isolation affects technological anxiety: limited social support may reduce patients’ opportunities to acquire digital skills and confidence, whereas improved digital health literacy may strengthen perceived self-efficacy and reduce anxiety during technology use [56].

Limitations

Our study has several limitations. First, although the sample size was moderate, the representativeness of the results was limited because the samples were drawn from only five tertiary hospitals in Guangdong province, However, it is important to note that these selected hospitals have significant regional influence and receive patients from various areas, encompassing diverse social-economic backgrounds. This geographical and socioeconomic diversity among patients can enhance the generalizability of the findings to a broader population within the province, yet it still presents limitations in fully capturing the experiences of older cancer patients in other regions of China. Therefore, further studies should draw samples from a wider group of older cancer patients (such as older cancer patients attending hospitals in other cities or at different levels). Second, all measurements were self-reported by participants, and self-report bias may exist. Finally, given the cross-sectional design of this study, we were unable to make inferences about causal effects. Future longitudinal studies are recommended to explore causal relationships between social isolation, digital health literacy, and technological anxiety.

Practical implications

Healthcare professionals and administrators should create a more supportive environment for older cancer patients, leading to improved health outcomes and a more positive experience with technology in healthcare. In nursing practice, reducing technological anxiety is clinically important because many aspects of cancer care now involve digital platforms, including telemedicine consultations, online registration, symptom monitoring, medication guidance, health education, and follow-up communication. Older cancer patients who feel anxious about using these tools may delay seeking help, miss digital health information, or avoid telemedicine services, which may negatively affect symptom management, treatment adherence, and continuity of care. Nurses can identify patients with high technological anxiety during admission, treatment, or follow-up, provide step-by-step instruction, involve family caregivers, and encourage repeated practice, thereby improving patient’ confidence, treatment engagement, and follow-up adherence. For example, hospitals could organize technology training workshops tailored to older cancer patients and engage family members in joint training sessions to enhance digital health literacy and confidence in using digital health services. Nurses could also provide individualized guidance for patients who have difficulty using digital platforms, such as demonstrating online appointment scheduling, telemedicine access, patient portal use, and electronic symptom reporting. Additionally, hospitals should regulate their digital health applications to better meet the needs of seniors, ensuring user-friendly interfaces that reduce technological anxiety and improve patient engagement.

Conclusion

This study found that older cancer patients experienced moderate to high levels of technological anxiety. Social isolation was positively associated with technological anxiety, and digital health literacy partially mediated this association. These results suggest that older cancer patients with limited social support may have fewer opportunities to acquire digital health knowledge and skills, which may increase their anxiety when using digital technologies. In nursing practice, technological anxiety should be recognized as a modifiable barrier to digital cancer care. Nurses can assess patients’ digital difficulties and social support needs during admission, treatment, and follow-up, provide step-by-step guidance, and encourage family caregivers to participate in digital skills training. Such strategies may improve digital health literacy, reduce technological anxiety, and promote the effective use of telemedicine, online registration, symptom reporting, and follow-up services among older cancer patients.

Authors’ contributions

JZ and XZ had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. JZ, XF, XZ, and WH contributed to the study concept, design, acquisition, analysis, or interpretation of data and study supervision: JZ and WH led the statistical analysis: JZ, YH, CZ, LZ, JD, XF and WH contributed to the administrative, technical, or material support: JZ, YH, CZ, LZ, JD, XF, WH, and ZX drafted the manuscript and all authors contributed to the final manuscript.

Funding

None.

Data availability

The original data can be obtained directly from the corresponding authors.

Declarations

Ethics approval and consent to participate

The present study was approved by the Ethics Committee of Sun Yat-sen University Cancer Center [IRB No: B2023-210]. All participants were informed about the detailed information regarding the study. The completion of the survey implied consent. Participants could decide whether or not to participate and could withdraw at any time without consequences.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.