Objective  To investigate current situation and influencing factors of e-health literacy among middle-aged and elderly community residents in various regions of Tai′an municipality, Shandong province for providing evidences to the improvement of e-health literacy in the population.

  Methods  Using multistage random cluster sampling, we conducted a face-to-face questionnaire survey among 6 652 urban and rural residents aged ≥ 45 years and above in 6 prefectures/counties/districts of Tai′an municipality during August 2020. The E-Health Literacy Scale (e-HEALS) – Chinese Version and a self-designed general questionnaire were adopted in the study.

  Results  For all the participants, the overall score of e-HEALS was 13.19 ± 9.71 and the overall score of the urban participants was significantly higher than that of the rural participants (15.44 ± 11.15 vs. 12.44 ± 9.06, t = 9.937; P < 0.001). The proportion of the all participants assessed with qualified e-health literacy (overall score of e-HEALS ≥ 32) was only 11.80% and the proportion was significantly higher in the urban participants than that in the rural participants (17.80% vs. 9.80%, χ² = 77.65; P < 0.001). The results of multivariate unconditional logistic regression analysis revealed that for both urban and rural participants, those with the education of junior high school and above, with household income of 30 000 RMB yuan and more in 2019, and having a self-rated good health are more likely to have a qualified e-health literacy, while those aged 60 years and above and suffering from chronic disease are more likely to have an unqualified e-health literacy; the urban participants being married currently are more likely to have a qualified e-health literacy; the rural female participants are more likely to have an unqualified e-health literacy.

  Conclusion  Among middle-aged and elderly community residents in Tai′an city, the e-health literacy of the urban dwellers is higher than that of rural dwellers and age, education, household income in 2019, self-rated health, and whether suffering from chronic disease are main influencing factors of e-health literacy for both urban and rural dwellers.