The continuous proliferation and extensive use of social media have deeply revolutionized the dissemination of information, transformed the health care industry, and advanced the progress of eHealth. Social media platforms refer to online platforms that enable individuals to engage in interactions and present themselves selectively, either in real time or with a delay, to both wide and specific audiences [1], which have had robust expansion in recent years. Presently, the global monthly active users of the 2 prominent social media platforms, Facebook and Twitter, have attained sums of 3.06 billion and 2.5 million accordingly [2]. Especially during the COVID-19 pandemic, the adoption of social media in health areas was maximized. In the presence of lockdown and social distancing measures, social media emerged as the most effective platform for individuals to obtain health-related information [3,4]. The introduction of social media signaled a fundamental change in the field of eHealth communication. Its widespread use and robustness have established social media as a potential platform for the public to obtain health information [5,6], improve their health behaviors [7], promote social support [8-10], manage diseases, and choose health care institutions [11].

For older adults, who are often marginalized in digital innovation, social media offers a potential solution to bridge the health communication gap and promote active aging. According to the Pew Internet report [12] released in 2021, older adults are among the fastest-growing groups using social media. Moreover, social media use among older adults has grown further with the outbreak of the COVID-19 pandemic [13]. With the increasing use of social media among older adults, their opportunities to engage in eHealth are also expanding. Unlike younger individuals, who prefer a variety of software options, older adults tend to favor a single platform [14]. Therefore, compared to other specialized digital health platforms, social media serves as a more familiar and user-friendly integrated platform for health information, social support, and health care services for older adults. This effectively lowers the barriers for older adults to adopt eHealth technologies. Recently, some research has indicated that social media can effectively enable older individuals to access health information and knowledge, thereby improving their health management [15,16]. Moreover, the experience of social media has been found to be associated with older adults’ willingness to adopt telemedicine [17].

However, it does not mean that there is no threshold for older adults to truly benefit from eHealth technology via social media. eHealth literacy, which is a crucial determinant of an individual’s use of health technology [18], is an essential competency that older adults need to possess to successfully integrate into the eHealth trend. The notion of eHealth literacy, initially introduced by Norman and Skinner [19], refers to the “ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” However, the definition was presented in the context of Web 1.0, ignoring the internet-based nature of technology in Web 2.0. The definition has subsequently been updated by several scholars [20-26]. The interactivity of eHealth systems is an important element that most scholars focus on in the new definition. In particular, Paige et al [26] developed the concept and content of eHealth literacy based on the transactional model of communication, further emphasizing the interactivity factor. They define eHealth literacy as “...the ability to locate, understand, exchange, and evaluate health information from online environments in the presence of dynamic contextual factors and to apply the knowledge gained across ecological levels for the purposes of maintaining or improving health” [26]. Their conceptualization not only preserves the fundamental elements of conventional eHealth literacy but also underscores that communication refers to the capacity to establish connections and identities with other internet users by exchanging health-related information, which sheds light on our understanding of eHealth literacy based on the setting of Web 2.0.

eHealth literacy profoundly influences the effectiveness of an individual’s use of social media to engage in eHealth. Because the credibility of information on social media is lower than that of professional websites, eHealth literacy, particularly critical health literacy, is essential to help evaluate the reliability of the information [27,28]. In addition, high eHealth literacy enables individuals to be better informed and equipped to access, share, and discuss health-related information and issues [29] and gain better satisfaction with the health information [30]. Therefore, eHealth literacy is a crucial skill that older adults must possess to successfully integrate into the eHealth trend through social media.

However, a harsh reality is that eHealth literacy among older people is generally found to be low compared to the younger generation [31-33]. Research has found that lower eHealth literacy makes it challenging for older adults to participate in eHealth, widening the digital divide in eHealth [34-36]. Older adults are perceived to be targets of misinformation and fraud on social media platforms and are more vulnerable to online scams [37]. They are very concerned about their privacy and security when sharing information on social media, and they consider this conduct to be highly risky [37,38]. Moreover, older adults tend to lack the perceived usefulness and ease of use of new technologies, making them slower to adopt these technologies compared to younger individuals [39], and thus they are more likely to encounter technical difficulties. These challenges not only prevent older people from truly benefiting from eHealth but may also lead to a digital divide in eHealth.

Another trend worth noting is the significant potential of social media itself to enhance eHealth literacy. Previous studies have found a positive correlation among individuals’ proficiency in using social media, their level of activity, and the number of social media platforms they use with their eHealth literacy [9,10]. In particular, the frequent use of social media to search for and engage with health information holds great potential for improving individual eHealth literacy [40]. Furthermore, the social support provided by social media can effectively enhance individuals’ understanding of health information and their ability to make informed health decisions, thereby improving eHealth literacy [9]. Social media is also an essential tool for eHealth literacy interventions. For example, Jiang [41] found that health interventions implemented through community-based, proactive health management apps on social media not only increased patients’ engagement in health management but also improved their eHealth literacy. Similar findings have been observed in studies involving older adults. Research indicates a significant association between older adults’ health-related behaviors on social media and their eHealth literacy levels [42]. A notable characteristic is the heightened use of social media and enhanced eHealth awareness among older individuals following the COVID-19 pandemic [13,43,44].

Therefore, within the context of Web 2.0, a highly promising approach to effectively integrating older adults into the eHealth landscape is to establish a virtuous cycle where their effective use of social media for health-related behaviors reinforces their eHealth literacy. On the one hand, older adults can use familiar social media platforms to access health information and engage in health management or health interventions, gradually enhancing their eHealth literacy through practice. On the other hand, as their eHealth literacy improves, their ability to effectively use social media for eHealth engagement and their satisfaction with these interactions will also increase, ultimately bridging the digital divide in the eHealth domain.

To achieve this goal, it becomes urgent to explore the relationship between social media and eHealth literacy among older adults. Understanding older adults’ social media use patterns—such as frequency of use and platform preferences—along with the impact of health information–seeking behaviors, health management, and health interventions conducted via social media on their eHealth literacy, is essential for identifying both the potential and barriers of social media in promoting health and enhancing eHealth literacy for this population. Simultaneously, examining the influence of eHealth literacy on older adults’ ability to effectively use social media for health-related engagement can help identify current gaps in their eHealth literacy and propose targeted interventions. By deeply grasping the relationship between social media and eHealth literacy, older adults can comprehensively and systematically build a social media–based eHealth integration platform that meets their level of eHealth literacy. Ultimately, a virtuous cycle of mutual promotion between social media and eHealth literacy of older individuals will be formed.

Existing systematic literature studies on eHealth literacy in older individuals have mostly concentrated on examining the determinants that impact eHealth literacy in this population [45] or the intervention [32,46]. Some studies on social media and older adults’ health primarily focus on the impact of social media on their mental health [47,48]. However, few studies systematically and comprehensively review the behaviors of older adults using social media for health purposes, nor do they summarize the correlations between these behaviors and health outcomes. In particular, research on behavioral patterns and preferences of older adults engaging with health-related content on social media; the role of platform design in promoting health literacy; how older adults’ eHealth literacy influences their health-related behaviors on social media; and how these behaviors, in turn, affect their eHealth literacy is limited. Without a clear understanding of these dynamics, the significance and potential of social media as a tool for enhancing older adults’ eHealth literacy and bridging the digital divide in eHealth remain insufficiently elucidated. This gap may ultimately turn social media from a promising tool for improving older adults’ health into a potential weapon that harms this vulnerable population. Furthermore, with the outbreak and end of the COVID-19 pandemic, the user landscape of social media and the developmental landscape of eHealth technology have both changed, necessitating a reassessment of social media use patterns and older individuals’ eHealth literacy.

This systematic literature review addressed these gaps by focusing on the correlation between older adults’ social media behavior, including general social media use behavior (eg, social media use patterns or habits) and social media health behaviors (eg, health information behaviors, self-management, or interventions), and their level of eHealth literacy. Specifically, this study aimed to answer the following research questions (RQs):

RQ1: What are the specific social media behaviors (including general use behavior and health behaviors) of older adults on social media?

RQ2: How do these behaviors impact their eHealth literacy?

RQ3: How does eHealth literacy influence older adult’s social media behaviors?

RQ4: What factors influence older adults’ use of social media for health-related purposes?

Through a comprehensive literature review following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria [49], this review investigated the relationship between social media and older individuals’ eHealth literacy and associated characteristics. PRISMA checklist is provided in Multimedia Appendix 1. We did not register the procedure for this review to a systematic review database.

Scopus, Web of Science, and PubMed were selected as databases for this review. The online database search was conducted on May 17, 2024. Although the notion of eHealth literacy was initially presented in 2006 [19], there is some previous literature that may use other vocabularies, such as computer health literacy and internet health literacy, to refer to eHealth literacy. To ensure the thoroughness of the assessment, the literature search was conducted within the period framework of 2000 to 2024. Search terms were generated around the following research themes: “social media,” “eHealth literacy,” and “older people.” Because eHealth literacy is a broad concept, this study not only covers the synonyms of eHealth literacy but also expands on the definition provided by Norman [19] and Paige [26] by adding related content about what eHealth literacy encompasses, such as health literacy, digital literacy, information literacy, and media literacy. Furthermore, the objective of this study was to investigate the correlation between social media and the eHealth literacy of older adults, as well as associated elements. Consequently, the primary focus was given to social networking platforms that facilitate communication and interaction with the public regarding health matters, health information, and health management. Therefore, the definition provided by Carr and Hayes [1] was adopted, and the latest global user activity rankings were used to filter the top-ranked social media as search extensions [2]. All keywords were searched in the database in combination with Boolean logic. A comprehensive list of search queries is presented in Textbox 1. A separate search string for each database is provided in Multimedia Appendix 2.

The selected papers for review had to adhere to the pre-established inclusion criteria. First, the included papers should have been primary research articles written in English and published between January 2000 and May 2024. Other document types, such as reviews, editorials, conference papers, letters, notes, commentaries, book chapters, books, or study protocols, were excluded from the considered literature. Second, the participants under study must have been older individuals. Given the absence of a universally defined age for older individuals, the United Nations generally designates individuals aged ≥60 years as older individuals [50]. However, some articles use national retirement ages as criteria for the research population [42] or define older people as those aged ≥50 years from the perspective of cognitive aging [51]. Considering the diversity in defining older people and the current minimum retirement age of 50 worldwide [52], this review included participants aged ≥50 years to ensure a broader spectrum of articles. Furthermore, it is anticipated that the papers will pertain to eHealth literacy among older persons who are active on social media and investigate the elements that impact their use of social media to enhance their eHealth literacy. Considering this criterion, the following articles were omitted: (1) discussions concerning phone calls, SMS text messages, email, web portals, and telemedicine or mobile health (mHealth) without social media engagement; (2) articles that were not based on health contexts, such as internet literacy, media literacy, digital literacy, and information literacy, for older adults; and (3) articles that were based on internet or social media behaviors of older adults unrelated to eHealth literacy. Furthermore, this paper identified a correlation between eHealth literacy and the social media activities of older people. Details on the particular inclusion and exclusion criteria can be found in Textbox 2.

There were 3 steps in literature screening. The first step was removing duplicates. Articles identified in the database were filtered into Microsoft Excel and duplicates were removed. Following this was the process of screening the title and abstract. A preliminary screening was conducted by 2 reviewers (CZ and AW) who independently identified important themes in the title and abstract. The age range of the study population was first identified, and studies where the population was not aged ≥50 years were excluded. If the age range could not be identified from the title and abstract, the article was reviewed for relevance to the topic, and theme-related studies were included for full-text review; otherwise, they were excluded. For example, the study by Willis [53] was included for full-text review because the abstract mentioned interviews with online health community members without specifying their ages. However, the full-text review revealed that participants were aged 37 to 85 years, resulting in this study’s exclusion.

The last step was full-text screening. Following the initial screening, the selected articles were reviewed in full text. During this process, 2 independent researchers carefully and comprehensively reviewed the full texts of the selected studies. This stage prioritized the exclusion of literature that did not fit the language, type of article, and age of the study population. Among them, the study conducted by Aung et al [54] was omitted from consideration because it was only a research plan.

Subsequent full-text reviews primarily excluded literature that did not address social media or was not explicitly about social media, as well as literature from nonhealth contexts. For example, some (39/153, 25.5%) articles, such as Mao et al [55] and Evans et al [56] discussed the association between telemedicine or mHealth and eHealth literacy in older adults, but these technologies did not involve social media platforms and were, therefore, excluded. Moreover, a few (4/153, 2.6%) articles discussed internet behaviors and eHealth literacy among older individuals, but it was unclear whether internet behavior related to social media was excluded [57-60]. In addition, some (3/153, 2%) articles, while exploring important components of eHealth literacy in older adults, such as digital literacy, information literacy, or media literacy, were not based on a health context and were, therefore, excluded [61-63]. Notably, several (3/153, 2%) papers examined the influence of social media on alleviating loneliness among older individuals, which did not address eHealth literacy and were excluded [64-66]. Finally, some (3/153, 2%) articles, while dealing with social media and eHealth literacy, did not allow the interaction between the 2 to be judged and were, therefore, excluded [67-69].

For articles that met the inclusion criteria in the full-text review, we annotated the study population, the research methodology, and the relevant factors in preparation for subsequent data extraction. To ensure the reliability of the study, a cross-review was conducted, and YM was introduced to resolve any discrepancies.

This review used the quality assessment (QA) tool developed by Sirriyeh et al [69] to evaluate the quality of the included studies. The QA tool establishes 6 QAs and assigns scores on a 3-point scale from 0 to 1 (0=no, 0.5=partly, and 1=yes). Studies with an overall score of >3 points are recognized as being of sufficient quality. Two researchers (CZ and AW) independently scored the included studies, and the sum of the scores obtained was used to assess the study quality. Inconsistent results were resolved by third-party (YM) intervention.

To capture the basic information and trends of the studies included, we developed a standardized table summarizing the fundamental characteristics of the research. This table extracted details, such as the authors, publication year, country, participants’ age, and research methods, from the included literature. Furthermore, to clarify the roles played by different types of social media, we extracted and categorized the social media platforms mentioned in the articles. In addition, as no restrictions were imposed on the research methods of the included studies, which covered qualitative, quantitative, and mixed methods approaches, thematic analysis [70] was used to describe and analyze the literature. According to Braun and Clarke [70], thematic analysis is a flexible research tool with a high degree of theoretical freedom, making it applicable within various theoretical frameworks and capable of providing rich and detailed data descriptions.

We conducted a manual, qualitative content analysis guided by the RQs, integrating classifications of social media health behaviors, definitions of eHealth literacy [26], and the social-ecological model (SEM) [71] to inform the coding and thematic analysis. At the same time, we paid attention to identifying new behaviors or phenomena not initially anticipated and incorporated them into the analytical framework. The qualitative thematic analysis framework is illustrated in Figure 1.

Specifically, guided by RQ1, in addition to focusing on older adults’ general social media behaviors (including use habits, such as frequency of use and platform preferences), we reviewed the literature on the application of social media in the health domain. This allowed us to extract consumer-related behavioral manifestations resulting from the use of social media in health contexts. As both health consumers and professionals can act as providers or recipients of support during interactions on health platforms [72], we examined health behaviors not only from the perspective of consumers or patients but also from the perspectives of health care professionals or other organizations interacting with consumers or patients. Our analysis identified key consumer-related applications of social media in health, including health information (searching, sharing, and evaluating); telemedicine; health management; health education; health promotion; and health intervention [73-76]. These applications served as the foundation for our coding and thematic extraction. To ensure rigor, we used the “conceptual matrix” proposed by Webster and Watson [77] (Multimedia Appendix 3 [13,14,42,44,51,69,78-88]) to examine themes and systematically record emerging themes during the analysis process.

RQ2 and RQ3 explored the correlation between older adults’ health behaviors on social media and their eHealth literacy. We adopted the definition of eHealth literacy provided by Paige et al [26] as the guiding framework for thematic analysis. Paige et al [26] delineated eHealth literacy into four dimensions:

We extracted descriptions from the literature relevant to these 4 dimensions and performed theoretical mapping to determine the eHealth literacy dimensions they pertained to. For studies that only referred to eHealth literacy as a general concept, we assumed that they encompassed all 4 dimensions.

Finally, we conducted a cross-analysis between older adults’ social media use behaviors—including general and health-related behaviors (as identified in the themes extracted based on RQ1)—and the 4 dimensions of eHealth literacy. This analysis aimed to uncover the relationships between the 2, focusing on whether older adults’ social media use behaviors enhance or hinder their eHealth literacy and whether their eHealth literacy strengthens or diminishes their health-related behaviors on social media. Given the diversity of research methods in the included studies, our qualitative content analysis not only focused on explicit conclusions from studies that directly examined these relationships but also considered implicit or related findings within the research.

Guided by RQ4, we examined the factors influencing older adults’ use of social media to access health information or health services in each article. Because these factors included not only barriers and facilitators but also neutral factors, we adopted the SEM to enable a more comprehensive extraction and integration of these influencing factors. SEM, developed by Bronfenbrenner [71], provides a systematic framework for understanding the impact of various environmental elements on individual behavior and development. According to SEM, the influencing factors are categorized into 4 dimensions: individual, interpersonal, institutional or organizational, and social levels.

CZ and AW analyzed all the articles and extracted the relevant themes. AAA and YQ reviewed the full text of the articles to validate the extracted themes. All conflicts were resolved by EM. Finally, multiple meetings were held to discuss the results of the thematic analysis and reach a consensus.

Search results and data collection process are shown in the PRISMA flow diagram in Figure 2. Initially, 1591 articles were identified (Scopus, 840/1591, 52.79%; Web of Science, 501/1591, 31.49%; and PubMed, 250/1591, 15.71%). A total of 48.21% (767/1591) of articles were screened by excluding certain articles based on the exclusion criteria, such as article type, language, and date, and after duplicates were removed. Subsequently, 38.6% (614/1591) of articles were eliminated following the screening of the title and abstract, while 8.6% (137/1591) of articles were eliminated after the assessment of the entire text. Publications were eliminated throughout the full-text screening process for the following reasons: (1) non-English (3/153, 2%), (2) note (1/153, 0.6%), (3) commentary (1/153, 0.7%), (4) study protocol (1/153, 0.7%), (5) younger population (65/153, 42.5%), (6) non–social media (39/153, 25.5%), (7) outside health context (24/153, 15.7%), and (8) not related to the correlation between eHealth literacy and older population (3/153, 2%). Although a considerable amount of research was identified at the outset, many articles used social media only as a tool for the recruitment of research participants or for distributing questionnaires, without discussing social media, and were, therefore, excluded.

Comprehensive information regarding the included research is provided in Table 1.

Generally, most (15/16, 94%) articles were published between 2020 and 2024, namely, after the COVID-19 pandemic. Only 1 (6%) study was conducted in 2015 [78]. Nearly two-thirds (11/16, 69%) of the studies were from Asian countries, including China (6/16, 38%) [14,42,44,79-81], Korea (2/16, 13%) [82,83], Thailand (2/16, 13%) [13,84], Singapore (1/16, 6%) [59]. In total, 13% (2/16) of studies were from the United States [85,86], and 1 (6%) study was from Italy [87]. Concerning the age definition of older individuals, except for 2 (13%) papers that did not provide a specific age criterion [87,88], the age definition ranges of the studies mainly used ≥50 years (5/16, 31%) [14,79,80,84,86] or ≥60 years (5/16, 31%) [13,44,80,83,84], and a few studies used ≥65 years (2/16, 13%) [82,85] or ≥55 years (1/16, 6%) [81]. Moreover, 1 (6%) Chinese study used the retirement age as the range of the study population, that is, ≥55 years for women and ≥60 years for men, respectively [42]. Most (12/16, 75%) studies were quantitative (Textbox 2), including surveys (10/16, 62%) [13,42,78-80,82,84,86-88] and experiments (2/16, 13%) [51,83], while 2 (13%) studies used mixed methods [44,85]. Only 2 (13%) studies were qualitative, using interviews [14,81].

Regarding features related to social media, most (11/16, 69%) articles discussed a wide range of social media platforms [13,44,78-82,84,86-88], and a few (5/16, 31%) articles explored the role of individual social media only [14,42,51,83,85], covering WeChat (2/16, 13%) [83], Facebook (1/16, 6%) [51], The BAND app (NAVER Corp) (1/16, 6%) [83], and Virtual Online Communities for Aging-Life Experiences (1/16, 6%) [85]. Moreover, social media was mostly (11/16, 69%) regarded as both a medium for health information and health-related relationships [13,42,44,51,78,79,81,82,84,86,88]. Furthermore, 1 (6%) study examined the dual role of social media as a medium for health-related interactions and information [80]. Social media was discussed as a health intervention or health education tool (2/16, 13%) [83,85], and a health management and communication tool (1/16, 6%) [14]. Only 1 (6%) article did not discuss the role of social media [87].

To further capture the characteristics of older adults in using social media platforms, this review extracted and categorized the social media platforms mentioned in the studies included (Table 2). Kordzadeh [72] categorized social media platforms applied in health care into 2 types: online social networks and virtual health communities (VHCs). The former includes large-scale, general-purpose internet platforms, such as Facebook, Twitter, Instagram, and YouTube, which are designed for broad collaboration among internet users. In contrast, the latter consists of social media sites specifically designed for individuals to discuss health-related topics.

On the basis of the included studies, most (11/16, 69%) explored the role of general social media in the health of older adults without specifying the particular platforms. Among the studies that addressed online social network platforms, the most commonly mentioned were WeChat and Facebook. These platforms are widely popular among older adults in their respective regions and are frequently used for accessing and sharing health-related information. Conversely, VHC platforms exhibited a more distinct health-focused orientation. Only 2 (13%) studies in the included literature specifically examined VHC platforms, namely BAND and Virtual Online Communities for Aging-Life Experiences, highlighting their value as tools for online support groups and health interventions [83,85].

According to the results of the quality appraisal (Multimedia Appendix 4 [13,14,42,44,51,69,78-88]), the scores of the included studies ranged from 3.5 to 5.5, with all of them exceeding 3, which is considered to be of sufficient quality. Moreover, none of the studies obtained a score of 0 on the individual evaluation items. This suggests that the included studies effectively elucidated the purpose, interest, utility, methodological process, approach concept, comparison and measurement with other similar studies, and limitations of the study on a high level of clarity.

As this study focused on the relationship between social media and eHealth literacy among older adults, an analysis of their social media use behaviors was conducted. This thematic analysis included both the general use behaviors of older adults and their health-related behaviors stemming from social media use. Table 3 presents the results of the thematic analysis, identifying 2 themes related to general social media use behaviors and 5 themes associated with health-related behaviors.

The general social media use behaviors of older adults describe their use patterns, including frequency of use, platform preferences, and other related habits. Among the included studies, 19% (3/16) [78,84,87] investigated the time spent or frequency of social media use by older adults. Wu and Yu [14] explored platform preferences among older adults, noting their inclination toward instant text messaging features on social media. Unlike younger users, older adults tended to prefer platforms with limited features and familiar interfaces, rather than overly complex or feature-rich social media platforms.

For the thematic analysis of older adults’ health behaviors on social media, we adopted a combined approach of using predefined themes and identifying emergent themes. Drawing from previous research on the application of social media in health communication, certain themes were established in advance. These themes were further refined and expanded during the full-text review stage. Ultimately, 5 primary themes emerged: health information, health interventions, health decision-making, self-management, and telemedicine—all of which aligned with our predefined themes.

However, in the extraction of subthemes, we uncovered more nuanced information. For instance, while the predefined theme of health information behavior initially encompassed information-seeking, sharing, and evaluation behaviors, the coding process revealed additional discussions by researchers on older adults’ learning of health knowledge, trust in health information sources, and frequency of health information use. For example, the study by Tan et al [88] examined how trust in different information sources influenced older adults’ decisions regarding COVID-19 vaccination [88].

Notably, health information behavior was the most frequently discussed theme, appearing in 75% (12/16) of the studies. Within this category, particular emphasis was placed on information-seeking (9/16, 56%), sharing (5/16, 31%), and evaluation behaviors (5/16, 31%). Furthermore, social media information also impacted older adults’ health decision-making. These decisions were not only limited to medical choices, such as vaccination [13,88], but also extended to addressing daily health-related challenges [80,85].

Self-management emerged as the second most frequently discussed theme (8/16, 50%), referring to older adults’ health management behaviors related to their diseases and lifestyles through social media. Among the aspects of self-management, health prevention was the most extensively explored subtheme (5/16, 31%), primarily due to the prevalence of the COVID-19 pandemic as the context in many studies. In addition to health prevention, older adults use social media for managing their lifestyles [81,85] and medical needs [14,86].

Finally, social media also serves as an important platform for older adults to engage in telemedicine and for implementing health interventions targeted at this population. Health interventions refer to planned efforts to modify older adults’ health behaviors via social media to improve their health outcomes. For instance, Lee and Ryu [83] and Chen et al [85] conducted online group health interventions for older adults using VHC platforms, demonstrating the potential of such platforms in facilitating health-related behavioral changes.

This study is the initial systematic literature review that investigates the correlation between social media use behaviors and eHealth literacy in the older adult population. The increasing global aging population, the proliferation of digital technologies, and the COVID-19 pandemic have significantly immersed older adults in the social media and eHealth phenomenon. This situation offers them both prospects and obstacles to fully benefit from digital health technologies. On the one hand, the advantages of social media have expanded the channels for older adults to engage in eHealth and, on the other hand, older adults’ eHealth literacy greatly influences their willingness to adopt social media, as well as their performance of health behaviors based on social media platforms.

To further integrate older adults into the eHealth trend and achieve active aging, it is essential to establish a positive feedback loop between social media behaviors and eHealth literacy. This involves enabling older adults to gradually enhance their eHealth literacy through health-related practices on social media, which, in turn, improves their social media health behaviors and experiences, ultimately bridging the digital divide. Therefore, this study aimed to synthesize and analyze recent research on this relationship, uncovering patterns and influencing factors to identify both the potential and barriers of using social media to enhance eHealth literacy among older adults. The findings are expected to inform targeted eHealth literacy interventions for this population, fostering a sustainable cycle of mutual reinforcement between health practices and health skills.

We extracted themes related to older adults’ social media behaviors and the dimensions of their eHealth literacy for cross-analysis. The findings reveal that older adults’ social media behaviors and eHealth literacy are mutually influential and interactive. Specifically, this review provides comprehensive answers to the RQs.

Regarding the first RQ, we identified that older adults’ social media behaviors encompass general use behaviors and health-related behaviors. General use behaviors include habits such as use frequency and platform preferences, while health-related behaviors involve a range of activities aimed at health purposes, such as health information behaviors, health decision-making, self-management, participation in health interventions, and engagement in telemedicine. Among these, health information behaviors are the most common and widely discussed health activities.

For the second RQ, most (14/16, 88%) of the reviewed studies confirmed the positive impact of older adults’ social media behaviors on enhancing their eHealth literacy. First, regarding general use behaviors, the frequency of social media use significantly improves older adults’ eHealth literacy, aligning with previous research that observed a positive correlation between the frequency of internet technology use and eHealth literacy [93,94]. In addition, familiar social media platforms enhance older adults’ perceived ease of use of digital technologies, thereby increasing their willingness to engage in health-related activities on social media [14].

Second, health-related behaviors on social media are the most effective and direct practices for improving older adults’ eHealth literacy. These practices include health information behaviors, health management, health interventions, telemedicine, and health decision-making, with health information behaviors being the most frequently (7/16, 44%) discussed. Older adults’ self-management and health decision-making activities are often built upon their understanding and application of health information obtained via social media. Furthermore, social media serves as a highly effective platform for group-based, online health interventions, where its interactive features enhance older adults’ participation in interventions and their willingness to adopt digital technologies [83,85]. The platform’s potential as a telemedicine tool, especially during the COVID-19 pandemic, has been highlighted as older adults began using social media for telemedicine and, through these practices, improved their eHealth literacy.

For the third RQ, the findings revealed that older adults’ eHealth literacy reciprocally influences their social media behaviors. This includes their willingness to adopt social media and other digital technologies [14,44,81], their ability to understand and evaluate health information on social media [44,51,88], their willingness to learn health knowledge through social media [79], and their proactivity in acquiring health information [42]. Among these, functional and critical eHealth literacy have the most significant impacts. A lack of functional eHealth literacy not only hinders older adults’ effective use of social media and other digital technologies but also reduces their willingness to adopt them. A deficiency in critical eHealth literacy affects their ability to understand and evaluate information, which further impacts their health decision-making and self-management behaviors.

By integrating the insights from RQs 2 and 3, we conclude that older adults’ eHealth literacy and their social media behaviors exhibit a reciprocal relationship, highlighting the need for interventions that leverage this dynamic to enhance both dimensions.

For the fourth RQ, older adults’ use of social media for health participation is influenced by individual, interpersonal, institutional or organizational, and social factors. At the individual level, inadequate digital skills [13,14,42,44,51,79,87] and age-related challenges [14,51,87] limit their ability to access and use social media effectively, contributing to the digital divide. Interpersonal factors, such as social support [14,78,80,81,83,85], enhanced health information acquisition or sharing and participation in health interventions, which are vital for improving eHealth literacy. Institutional barriers, including misinformation [13,42,44,51,78,82,88] and privacy concerns [14], further hinder their engagement, emphasizing the need for critical eHealth literacy. Moreover, the high penetration of social media, driven by technological advancements and the COVID-19 pandemic, has expanded access to health information and services, offering new opportunities to bridge these gaps [13,14,42,44,79,82,84,86]. Finally, promoting the use of eHealth technologies among older adults also requires consideration of cultural contextual factors at the societal level [14].

This review has several limitations. First, we only searched for keywords in the abstracts and titles, which, on the one hand, led to a large number of studies that used social media to recruit respondents unrelated to the topic appearing in the first search results. On the other hand, it could have resulted in the omission of articles in the primary content of the text dealing with the correlation between social media and eHealth literacy among older individuals. Second, the sample size for this review was relatively small due to the specificity of the research topic. Third, the thematic analysis conducted in this review was qualitative, and some (6/16, 38%) of the included studies did not directly examine the relationship between social media and eHealth literacy. Instead, they provided indirect evidence or theoretical suggestions that social media might enhance eHealth literacy in older adults. Therefore, the conclusions drawn in this review are primarily based on correlation rather than causation. Finally, the scarcity of existing research investigating this specific correlation highlights the need for more empirical studies that directly explore how social media impacts older adults’ eHealth literacy. Future research should address these gaps by using diverse methodologies and larger sample sizes to establish more comprehensive and definitive conclusions.

Given the significant potential of social media in enhancing eHealth literacy among older individuals and the need to improve eHealth literacy among this population, this review sought to investigate the correlation between the social media use habits of older adults and their eHealth literacy. The review analyzed studies conducted from January 2000 to May 2024. The results found that social media and older adults’ eHealth literacy influence and interact with each other. Older adults’ social media use behaviors, including social media use habits and health behaviors, have a significant impact on their eHealth literacy, suggesting that social media has significant potential to enhance eHealth literacy among older adults. In turn, older adults’ eHealth literacy affects their willingness to adopt digital technologies, such as social media, as well as their performance of social media behaviors for health purposes. Promoting a virtuous cycle of interaction between the 2 fosters active aging and helps establish a long-term mechanism to enhance eHealth literacy among older adults. Achieving this goal requires a comprehensive consideration of factors that influence older adults’ use of social media to improve eHealth literacy, including social media penetration, insufficient digital skills, misinformation on social media, age, privacy and safety, and cultural norms and values. On the basis of the results of the review, this study proposes several future considerations for improving eHealth literacy among older adults through social media.