Social media use and mental health among older adults with multimorbidity: the role of self-care efficacy.

OBJECTIVES: To describe the prevalence and trends in the use of social media over time and explore whether social media use is related to better self-care efficacy and thus related to better mental health among United States older adults with multimorbidity. MATERIALS AND METHODS: Respondents aged 65 years+ and having 2 or more chronic conditions from the 2017-2020 Health Information National Trends Survey were analyzed (N = 3341) using weighted descriptive and logistic regression analyses. RESULTS: Overall, 48% (n = 1674) of older adults with multimorbidity used social media and there was a linear trend in use over time, increasing from 41.1% in 2017 to 46.5% in 2018, and then further up to 51.7% in 2019, and 54.0% in 2020. Users were often younger, married/partnered, and non-Hispanic White with high education and income. Social media use was associated with better self-care efficacy that was further related to better mental health, indicating a significant mediation effect of self-care efficacy in the relationship between social media use and mental health. DISCUSSION: Although older adults with multimorbidity are a fast-growing population using social media for health, significant demographic disparities exist. While social media use is promising in improving self-care efficacy and thus mental health, relying on social media for the management of multimorbidity might be potentially harmful to those who are not only affected by multimorbidity but also socially disadvantaged (eg, non-White with lower education). CONCLUSION: Great effort is needed to address the demographic disparity and ensure health equity when using social media for patient care.

Low adoption of mobility device in later life: Insights from the lens of intersectionality.

OBJECTIVES: To investigate the utilization of mobility device, whether age and gender-related use disparities exist, and whether falls can further explain use disparities over time among Chinese older adults in need of devices. METHODS: Community-dwelling older adults who needed mobility devices and completed four waves of the China Health and Retirement Survey 2011-2018 were included (N = 1,302). A categorical variable was created to represent respondents' intersectionality of age (50-64, 65-74, and ≥75 years) and gender (men vs. women). RESULTS: The baseline prevalence of device use was 18.2 % (n = 237). Overall, the device use increased over time. Intersectionality-wise, oldest-old women were 1.53 times more likely than youngest-old men to use devices over time. Respondents with falls were more likely to use devices over time. CONCLUSIONS: Older adults with mobility impairment, especially the oldest-old women and those with falls, lag in mobility devices utilization, suggesting future tailored interventions to support these populations.

Screening of liothyronine network pharmacology role in the treatment of ischemic stroke and molecular mechanism.

OBJECTIVE: The present study aimed to elucidate mechanisms of liothyronine on the treatment of ischemic stroke (IS). METHODS: Differential analysis based on R limma package was used to identify differentially expressed genes, which were then mapped into the connectivity map database for identification of liothyronine associated with IS. Tumor necrosis factor (TNF) signaling pathway was verified through pathway enrichment analysis via Enrichr online. Ischemia stroke mouse model was built up for further analysis. Infarct area and regional cerebral blood flow (rCBF) were measured by 2, 3, 5-triphenyltetrazolium chloride and laser Doppler flowmetry, respectively. Light microscope was used for the evaluation of body weight and dark neurons. Serum TXB2 , 6-Keto-PGF1a , TNF-α, and interleukin-6 (IL-6) levels in mice were measured using enzyme-linked immuno sorbent assay. In addition, relative protein expression levels of brain-derived neurotrophic factor, nestin, and Sox2 were detected by Western blot analysis. RESULTS: Liothyronine with a negative connectivity was identified as one promising treatment for IS through TNF signaling pathway. The experimental results showed that liothyronine treatment significantly meliorated infarct area and the number of dark neurons in IS mice. Liothyronine greatly ameliorated the expression levels of TXB2 and 6-Keto-PGF1a . Besides, rCBF and body weight change of IS mice were increased gradually with increase of drug concentration. Based on pathway enrichment analysis, anti-inflammatory response (TNF-α and IL-6) relevant to TNF signaling pathway was identified, which was further validated in vitro. Furthermore, proteins as neural stem cell markers made a difference with liothyronine treatment. CONCLUSION: Liothyronine may be a novel therapeutic component to exploit an effective medicine for the treatment of IS.

Longitudinal relationships between grip strength, subjective memory complaints and cognitive function among middle-aged and older adults in China.

BACKGROUND: Subjective memory complaints are considered an early sign of cognitive decline. Recent evidence shows that grip strength is an important predictor of cognitive function. However, few studies have compared whether one condition is uniquely associated with cognitive function when another condition is controlled for. AIMS: To explore the longitudinal associations of cognitive function with subjective memory complaints and grip strength in middle-aged and older adults, with a particular focus on whether one condition is uniquely associated with cognitive function when another condition is considered. METHODS: A total of 3,877 middle-aged and older adults (aged 45-92 years) from the China Health and Retirement Longitudinal Study reported on their demographic and health status and completed measures of grip strength and subjective memory complaints, as well as a series of cognitive tests, every two years between 2011 and 2015. Generalized estimating equation models were used to assess the relationships between grip strength, subjective memory complaints, and cognitive function. RESULTS: Grip strength was longitudinally associated with cognitive function (ß = 0.021, 95% confidence interval [CI]: 0.011, 0.030, P < 0.001) independent of subjective memory complaints. In contrast, changes in the subjective memory complaints were not related to cognitive function over time (ß = 0.107, 95% CI: - 0.025, 0.238, P = 0.112). Only at baseline subjective memory complaints were associated with poorer cognitive function (ß = - 1.142, 95% CI: - 1.309, - 0.975, P < 0.001). CONCLUSIONS: Grip strength might be a more important clinical correlate of cognitive function decline over time than subjective memory complaints. DISCUSSION: Regular assessment and close monitoring of grip strength might help identify individuals who might be at high risk for cognitive impairment.

Comorbid pain and falls among Chinese older adults: the association, healthcare utilization and the role of subjective and objective physical functioning.

BACKGROUND: Pain and falls are significant disabling health conditions which cause substantial economic burdens on older adults and their families. Physical functioning (both subjective and objective) might play a significant role in older adults' pain and falls. In this study we aimed to examine: (1) the relationship between pain and falls among Chinese older adults; (2) pain-fall status (i.e., comorbid pain-fall, pain-only, fall-only, and neither-pain-nor-fall) in relation to healthcare utilization; and (3) whether physical functioning measured either subjectively or objectively would contribute differently to the pain intensity and to the occurrence of falls. METHODS: We used a nationally-representative sample of older adults from the 2011-2012 baseline survey of the China Health and Retirement Longitudinal Study (N = 4,461, aged 60-95 years). Logistic, linear, and negative binomial models adjusted for demographic variables were used in the analysis. RESULTS: Overall, 36% of older adults reported pain, 20% had fall occurrences, and 11% had comorbid pain and falls. Pain intensity was significantly associated with falls. Individuals in groups of pain-only, fall-only, and comorbid pain-fall reported significantly higher healthcare utilization, that is, more frequent inpatient care and doctor visits than those in the neither-pain-nor-fall group. Subjective, not objective, physical functioning was associated with pain and falls. CONCLUSION: Pain and falls are significantly associated with each other, and both can lead to increased healthcare utilization. Compared to objective physical functioning, subjective physical functioning is more likely to correlate with pain and falls, suggesting that self-reported physical status should be considered when designing pain-fall preventive strategies.

"Being careful": How much caution is enough? The relational context of fear of older adult falling in older adult-family caregiver dyads.

Family caregivers play an important role in coping with older adult falls; however, their perspectives on fear of older adult falling are lacking from the falls prevention literature. A mixed-method design (N=25 dyads) with interview and survey data examined linguistic characteristics and coping strategies used by older adult and family caregiver dyads to manage fear of older adult falling. Fear of older adult falling consisted of both affective (e.g., worry) and cognitive (e.g., cautious) properties. Family caregivers more frequently used affective words and first-person plural pronouns ("we" language) when talking about fear of older adult falling, while older adults more frequently used cognitive and first-and-second person singular pronouns ("I", "you"). The concept of "being careful" was shared within dyads. However, dyad partners differed in their perspectives of what constituted "being careful" and the possibilities of future falling. Findings suggest that the need for family-centered interventions to prevent falls are needed.

Wearable device use in older adults associated with physical activity guideline recommendations: Empirical research quantitative.

AIMS AND OBJECTIVES: To (1) describe the socio-demographic and behavioural characteristics of older adults who use wearable devices for physical activity monitoring and (2) explore whether wearable device use increases the possibilities of meeting physical activity guideline recommendations among older adults and older adults with known cardiovascular disease or risk. BACKGROUND: Finding ways to increase physical activity and reduce cardiovascular disease risk among older adults is a public health priority. Wearable technology has great potential for promoting physical activity among older adults. DESIGN: A secondary analysis of the national data. METHODS: A nationally representative sample of older adults aged 65 years and older (mean age = 73.79 years, N = 1484) and a subsample of older adults with known cardiovascular disease or cardiovascular disease risk (mean = 74.32 years, N = 1098) was used in the analysis. All analyses were weighted to account for the complex survey design. This study was reported according to the STROBE checklist. RESULTS: The overall prevalence of wearable device use among older adults and older adults with cardiovascular disease risk was 16% and 14%, respectively. Older adults with higher household incomes, better self-rated health, and greater exercise enjoyment were more likely to use wearable devices. Compared with non-users, older adult users were more likely to meet the recommended levels of moderate (55% vs. 31%) and strengthening activity guidelines (46% vs. 25%), but not of the sedentary behaviour guideline (69% vs. 62%). Similar findings were also seen in older adults with known cardiovascular disease or risk. CONCLUSION: The uptake of wearable devices in older adults, particularly those with known cardiovascular disease or risk is still low. The use of wearable devices is an important facilitator of physical activity. It is critical to provide individualised support for their engagement. RELEVANCE TO CLINICAL PRACTICE: Age-friendly design and individualised support are recommended to increase older adults' adoption of wearable devices to improve their physical health. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution was involved in this study since we used publicly available data.

Depressive symptoms and falls among Chinese older adults: A bidirectional relationship.

BACKGROUND: Falls and depressive symptoms are prevalent and costly. Although they are frequently interrelated, the nature of interrelationships between them was not well understood. Therefore, using longitudinal data, we aimed to explore whether there is a longitudinal bidirectional relationship between falls and depressive symptoms among older Chinese and whether this is different for men and women. METHODS: Older adults aged 60 years+ who completed all 2011, 2013, 2015 waves of data from the China Health and Retirement Longitudinal Study on falls and depressive symptoms were included (N=2,203). Random intercept multilevel models were used to analyze data. RESULTS: Significant bidirectional associations at between-person (b=0.09, SE=0.01, p<0.001) and within-person levels (b=0.05, SE=0.02, p=0.005) were observed between depressive symptoms and falls. When participants reported falls, they reported higher levels of depressive symptoms. However, no gender differs in these relationships. CONCLUSIONS: Regardless of gender, there are significant bidirectional associations between falls and depressive symptoms.

What is the relationship between falls, functional limitations, and depressive symptoms among Chinese older adults? The role of living alone.

OBJECTIVES: Although the association between falls and depressive symptoms is well documented, the mechanisms underlying this association remain largely unexplored. We investigated the mediation role of functional limitations in the association between falls and depressive symptoms among Chinese older adults and determined whether the living arrangement (living alone or not) is a significant moderator of the above-mentioned mediation pathway. STUDY DESIGN: Cross-sectional study. MAIN OUTCOME MEASURES: Depressive symptoms were measured using the 10-item Center for Epidemiologic Studies Depression Scale short form (CESD-10), on which higher scores indicate higher levels of depressive symptoms. RESULTS: We used the harmonized China Health and Retirement Longitudinal Study national baseline data (2011-2012 year) involving 7410 participants aged 60 years and over. After adjusting for covariates (e.g., age and sex), the effects of falls on depressive symptoms were seen to be mediated by functional limitations among Chinese older adults (ß = 0.82, p < .001). The moderated mediation analysis, which assesses whether an indirect effect is conditional on values of a moderating variable, found that the mediation effect was contingent upon the living arrangement (ß = -0.60, p = .029). Specifically, the levels of functional limitations and depressive symptoms were higher for people with falls who were living with others relative to those living alone. CONCLUSIONS: These results suggest that functional limitations are an important intervening variable that links falls to depressive symptoms among Chinese older adults. Interventions to promote older adults' physical function and prevent falls are recommended to decrease the risk of depressive symptoms. These interventions can particularly benefit those who live with others.

The Development and Psychometric Evaluation of the Perceived Physical Literacy for Chinese Elderly Questionnaire.

BACKGROUND AND OBJECTIVES: Physical literacy refers to a holistic view of physical activity (PA), which proposes that a person needs to be motivationally, physically, strategically, mentally, socially, and knowledgeably prepared to be and stay physically active. It has been recently introduced in the field of older adults' PA. Our study sought to develop the Perceived Physical Literacy for Chinese Elderly Questionnaire (PPLCEQ) and evaluate its psychometric properties. RESEARCH DESIGN AND METHODS: We conducted qualitative interviews and literature reviews to develop the item pool. Expert panel review and cognitive interviewing were used to evaluate the questionnaire's content validity. A convenience sample of 388 Chinese older adults was recruited to assess the questionnaire's validity and reliability. RESULTS: The developed PPLCEQ includes 47 items. Consistent with the conceptual definition of physical literacy, exploratory factor analysis showed that the PPLCEQ is composed of 6 subscales. Participants' PPLCEQ scores were moderately correlated to their leisure-time PA (r = 0.38, p < .001), PA maintenance (r = 0.44, ps < .001), and perceived competence for exercising regularly scores (r = 0.58, p < .001). Moreover, the Cronbach's alpha and the test-retest reliability of the questionnaire were 0.88 and 0.70, respectively. DISCUSSION AND IMPLICATIONS: Psychometric assessment results suggest that the PPLCEQ is a reliable and valid tool that can be used in future studies investigating Chinese older adults' perceived physical literacy.

Transitional Care for Patients With Portal Hypertension: A Multicenter Study of Intervention for Post-TIPS Patients.

To explore the application effect of transitional nursing in patients with TIPS. A total of 368 patients were allocated to control group (conventional care) and intervention group (conventional care combined with transitional care). The Child-Pugh scores, blood ammonia levels, compliance behavior, medication compliance, and adverse event incidence rates were compared at 1, 3, 6, 9, and 12 months post-TIPS. There were significant differences in compliance behavior scores, Child-Pugh scores for group effects, time effects, and group × time interaction between the two groups at 1, 3, 6, 9, and 12 months post-TIPS, significant differences in blood ammonia levels at 9 months, and incidence of postoperative adverse events at 12 months after TIPS. Post-TIPS transitional care interventions increased patients' access to scientifically informed nursing, significantly improved patients' compliance behavior and health and decreased the incidence of postoperative adverse events.

Use of Electronic Communication with Clinicians Among Cancer Survivors: Health Information National Trend Survey in 2019 and 2020.

Purpose: To describe cancer survivors' use of electronic communication (e-communication) with clinicians and identify factors associated with their use, including the COVID-19 pandemic. Methods: Secondary analysis included cancer survivors (N = 1,482) from the combined Health Information National Trends Survey HINTS 5 Cycle 3 and Cycle 4. Survivors' use of e-communication was defined by at least one of four e-communication use behaviors in the past 12 months. Bivariate analysis and logistic regression were conducted to examine factors associated with e-communication use. All analyses considered the complex survey design using the jackknife replication method. Results: The prevalence of e-communication use was 64% among cancer survivors. The overall e-communication use slightly increased after the start of the COVID-19 pandemic (63% vs. 64%, p = 0.79). Older adults (≥65 years old) were less likely to use e-communication (odds ratio [OR] = 0.55; 95% confidence interval [CI], 0.36-0.86); survivors who were white (OR = 2.30; 95% CI, 1.36-3.86), living in a metro area (OR = 2.47; 95% CI, 1.44-4.27), diagnosed with breast cancer (OR = 2.03; 95% CI, 1.06-3.88), seeking cancer-related information previously (OR = 2.89; 95% CI, 1.83-4.58), or having a regular health care provider (OR = 2.07,; 95% CI, 1.10-3.88) were more likely to use e-communication. The start of the COVID-19 pandemic was marginally associated with the increased e-communication use (p = 0.053) when other variables were controlled. Conclusion: This nationally representative survey analysis has identified disparities in e-communication use among cancer survivors and revealed the potential increase in e-communication use under the impact of the COVID-19 pandemic. Additional support is clearly warranted for those older, nonwhite, living in rural areas, or without a regular provider, to promote their e-communication use for the delivery of optimal and high-quality cancer care.

Chinese expert consensus on the nursing management of the totally implantable venous access device.

The totally implantable venous access device (TIVAD) has been widely used in clinical nursing work in China. The use of TIVAD has significantly improved the safety of venous access and reduced the pain caused by a repeated puncture; however, it may also bring with it varying degrees of complications associated with the long-term insertion of TIVAD and the maintenance quality of the venous access. Standard maintenance of the venous access for TIVAD is very important for reducing complications and improving the efficacy and patient's quality of life. This consensus briefly describes the fundamental knowledge and operating procedures of TIVAD while focusing on the evaluation and management of perioperative nursing, the observation and treatment of complications, the operation methods, and precautions for maintenance of venous access, as well as health education. This agreement seeks to standardize the nursing care of TIVAD patients in China.

Chinese Medical Students' Acceptance and Use of e-Health Services.

A web-based survey was conducted among 238 Chinse medical students to examine their acceptance and use of e-Health services. Chinese medical students are found to have limited experience and low satisfaction with current e-Health services, which indicates an urgent need to improve e-Health practice training based on a consumer-centered model of health care.

The mediation role of psychological capital between family relationship and antenatal depressive symptoms among women with advanced maternal age: a cross sectional study.

BACKGROUND: Due to changes in family policy in China, pregnancy at advanced age (30 years old or above) is prevalent. Advanced maternal age is known to be related to a variety of negative health outcomes, including antenatal depression. Family relationship quality might be an important factor for antenatal depressive symptoms among Chinese women with advanced maternal age. However, the underlying mechanisms in which family relationship quality can affect antenatal depressive symptoms among this population and how positive psychological capital (PsyCap) intervenes in this impact are not clear. OBJECTIVES: To describe the prevalence and demographic characteristics of antenatal depressive symptoms among Chinese pregnant women with advanced maternal age, and to explore the mediation effect of PsyCap in the associations between family relationship quality and antenatal depressive symptoms. METHODS: We conducted a cross-sectional survey at a tertiary hospital in China. A total of 192 women with maternal age of 30 years or older completed the questionnaires. Data on antenatal depressive symptoms, PsyCap, family relationship quality and demographic characteristics were collected. The multiple mediation models in SPSS's PROCESS macro were used to test whether PsyCap mediated the relationship between family relationship quality and antenatal depressive symptoms. RESULTS: Approximately 28.6% of participants had antenatal depressive symptoms and 6.8% reported poor family relationship quality. Participants with higher education (p = .02) and better family relationship quality (p = .00) were less likely to have antenatal depressive symptoms. PsyCap collectively (ß = 1.14, p < .05), or more specifically resilience (ß = 0.61, p < .05) significantly mediated the relationship between poor family relationship quality and antenatal depressive symptoms. DISCUSSION: The relationship between family relationship quality and antenatal depressive symptoms can be mediated by PsyCap collectively or via resilience specifically. It is important to screen antenatal depressive symptoms among pregnant women with advanced age, especially those who have poor family relationship quality. Counseling and psychotherapy initiatives for resilience-enhancing training for pregnant women at advanced age may provide a promising target to break the link between poor family relationship quality and antenatal depressive symptoms.

Functional limitations before and after cancer diagnosis and contributing factors: findings from the China health and retirement longitudinal study.

BACKGROUND: Although there is a general trend of functional decline with age, there lacks an understanding of how cancer diagnosis and other factors may contribute to this trend. This study aimed to examine functional limitation trajectories among adults with and without cancer, and before versus after the cancer diagnosis, and to explore potential contributing factors associated with functional trajectories among cancer survivors. METHODS: The sample were middle-aged and older Chinese adults who participated in all 3 waves of the China Health and Retirement Longitudinal Study (CHARLS, 2011-2015). Ordinary and multiphase growth curve analyses were conducted to examine (1) differences in functional trajectories between participants with (n = 139) and without cancer (n = 7,313), (2) pre-and post-cancer diagnosis changes in functional limitations among those who reported a cancer diagnosis over the 4-year timeframe, and (3) contributing factors associated with functional trajectories among cancer survivors, guided by the Disablement Process Models, including psychological (depressive symptoms), physical (pain and falls), cognitive (self-reported memory problems), and environmental (social contact and available support) factors. RESULTS: There was a trend of increased functional limitations among all participants over time (unstandardized ß = 0.17, p < .0001). However, participants with cancer did not differ from non-cancer participants in neither the level (unstandardized ß = 0.77, p = .08) nor the rate of functional decline (unstandardized ß = -0.43, p = .07). Functional limitation trajectories were different pre- versus post-cancer diagnosis, although not in expected directions (unstandardized ß = -0.48, p < .05). Cancer survivors with greater pain had higher levels of functional limitations which were sustained over time compared to those with less pain (unstandardized ß = 0.93, p < .001). CONCLUSIONS: The study confirmed that Chinese middle-aged and older adults had overall decreased functional decline over time. A novel finding that cancer survivors experienced less rapidly functional decline after the cancer diagnosis suggested that cancer diagnosis might serve as an inflection point at which early intervention is promising to slow the functional decline. In addition, findings that within-person contributing factors, such as pain, can be influential in functional limitation trajectories suggested that more attention is needed to pay to patients with cancer-pain. These findings demonstrated the heterogeneity of functional limitation trajectories and needs for person-centered interventions among Chinese cancer survivors.

A cross-sectional examination of the relationship between nurses' experiences of skin lesions and anxiety and depression during the COVID-19 pandemic: Exploring the mediating role of fear and resilience.

AIM: To explore the mediating role of fear and resilience on the relationship between clinical nurses' reporting of skin lesions and their anxiety and depression during the coronavirus disease 2019 (COVID-19) pandemic. BACKGROUND: Prolonged personal protective equipment wearing may cause severe skin lesions among clinical nurses. The possible relationship between clinical nurses' reporting of skin lesions and their anxiety and depression remains unknown. Moreover, little is known about what factors could mediate such a relationship. METHODS: This is a cross-sectional online survey. CHERRIES was used to report results. RESULTS: Of 2014 participants, 94.8% (n = 1910) reported skin lesions. Skin lesions were positively related to anxiety (p < .001, ß = .228, SE = .099) and depression (p < .001, ß = .187, SE = .093). Fear activated while resilience buffered the relationship between clinical nurses' reporting of skin lesions and anxiety and between skin lesions and depression. CONCLUSION: Reduced fear and enhanced resilience level were related to decreased levels of anxiety and depression among clinical nurses. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers should evaluate the occurrence and severity of clinical nurses' skin lesions, arrange reasonable working duration to relieve skin lesions, provide appropriate psychological support to reduce clinical nurses' fear and implement various strategies to enhance their resilience, thereby decreasing their anxiety and depression. CLINICAL TRIAL REGISTRATION NUMBER: ChiCTR2000030290.

Prevalence, Factors, and Association of Electronic Communication Use With Patient-Perceived Quality of Care From the 2019 Health Information National Trends Survey 5-Cycle 3: Exploratory Study.

BACKGROUND: Electronic communication (e-communication), referring to communication through electronic platforms such as the web, patient portal, or mobile phone, has become increasingly important, as it extends traditional in-person communication with fewer limitations of timing and locations. However, little is known about the current status of patients' use of e-communication with clinicians and whether the use is related to the better patient-perceived quality of care at the population level. OBJECTIVE: The aim of this study was to explore the prevalence of and the factors associated with e-communication use and the association of e-communication use with patient-perceived quality of care by using the nationally representative sample of the 2019 Health Information National Trends Survey 5 (HINTS 5)-Cycle 3. METHODS: Data from 5438 adult responders (mean age 49.04 years, range 18-98 years) were included in this analysis. Multiple logistic and linear regressions were conducted to explore responders' personal characteristics related to their use of e-communication with clinicians in the past 12 months and how their use was related to perceived quality of care. Descriptive analyses for e-communication use according to age groups were also performed. All analyses considered the complex survey design using the jackknife replication method. RESULTS: The overall prevalence of e-communication use was 60.3%, with a significantly lower prevalence in older adults (16.6%) than that in <45-year-old adults (41%) and 45-65-year-old adults (42.4%). All percentages are weighted; therefore, absolute values are not shown. American adults who used e-communication were more likely to be high school graduates (odds ratio [OR] 1.95, 95% CI 1.14-3.34; P=.02), some college degree holders (OR 3.34, 95% CI 1.84-6.05; P<.001), and college graduates or more (OR 4.89, 95% CI 2.67-8.95; P<.001). Further, people who were females (OR 1.47, 95% CI 1.18-1.82; P=.001), with a household income ≥US $50,000 (OR 1.63, 95% CI 1.23-2.16; P=.001), with more comorbidities (OR 1.22, 95% CI 1.07-1.40; P=.004), or having a regular health care provider (OR 2.62, 95% CI 1.98-3.47; P<.001), were more likely to use e-communication. In contrast, those who resided in rural areas (OR 0.61, 95% CI 0.43-0.88; P=.009) were less likely to use e-communication. After controlling for the sociodemographics, the number of comorbidities, and relationship factors (ie, having a regular provider and trusting a doctor), e-communication use was found to be significantly associated with better perceived quality of care (ß=.12, 95% CI 0.02-0.22; P=.02). CONCLUSIONS: This study confirmed the positive association between e-communication use and patient-perceived quality of care and suggested that policy-level attention should be raised to engage the socially disadvantaged (ie, those with lower levels of education and income, without a regular health care provider, and living in rural areas) to maximize e-communication use and to support better patient-perceived quality of care among American adults.