The impact of E-health literacy on patient loyalty in county-level public hospitals: the mediating role of value co-creation and the moderating role of perceived social support.

OBJECTIVES: This study explores the mechanisms by which E-health literacy among inpatients in county-level public hospitals influences patient loyalty. It further examines the mediating role of value co-creation and the moderating effect of perceived social support, seeking to provide empirical evidence for the digital transformation of county hospitals and patient relationship management. METHODS: A stratified random sampling method was employed to survey 784 inpatients in county-level public hospitals in Shandong Province. E-health literacy, value co-creation, perceived social support, and patient loyalty were assessed using a structured questionnaire. Correlation analysis, regression analysis, and moderated mediation models were applied to examine both the direct and indirect effects of E-health literacy on patient loyalty. RESULTS: E-health literacy was positively associated with patient loyalty, and value co-creation mediated this relationship. Furthermore, perceived social support was found to moderate the relationship between E-health literacy and patient loyalty, suggesting that elevated perceived social support weakened the positive association between E-health literacy and patient loyalty. CONCLUSION: E-health literacy appears to be an important factor associated with inpatient loyalty in county-level public hospitals. Value co-creation and perceived social support play important mediating and moderating roles, respectively, within this process. By enhancing patients' E-health literacy, promoting value co-creation behaviors, and leveraging social support resources, it is possible to foster sustained improvements in patient loyalty and advance the quality of smart healthcare services in county-level public hospitals.