Navigating the digital and intergenerational contexts: A scoping review of health information avoidance behavior in Middle-aged and older adults

With the acceleration of the global population aging process, extending healthy lifespan has become a core issue in public health. Meanwhile, the rapid development of digital technologies is profoundly affecting people's daily lives, changing the ways in which personal health information is acquired, communicated, and serviced. The diversification of information acquisition channels has made information access and communication more convenient. By searching for health knowledge on the Internet, the elderly's ability to understand and manage their health can be improved, and healthy lifestyles can be promoted. However, the popularization of information and communication technologies has also brought new problems. Exposure to social media and various information sources has led to information overload, which in turn induces information anxiety and a tendency to avoid health information. The latest research shows that nearly one-third of individuals tend to avoid medical information, and this proportion even reaches as high as 41% when it comes to incurable diseases such as Alzheimer's disease. Another survey also found that nearly a quarter of American elderly people aged 65 and above have healthcare avoidance behaviors . The utilization rate of relevant health services among the elderly is not ideal, and the avoidance of health information hinders the realization of healthy aging. Based on the life course perspective, this study includes the middle-aged group in the investigation. Middle age is the intersection of growth and decline paths, during which physical and cognitive functions begin to gradually decline. Some scholars have pointed out that a better health status in middle age is the cornerstone of health in old age, and the health behavior patterns formed during this stage will have an impact on diseases and health in later life. In view of the physical and mental vulnerability associated with aging and differences in health literacy, middle-aged and elderly people are more likely to be high-risk groups for health information avoidance behaviors. Therefore, helping middle-aged and elderly people reduce their avoidance of health information and promoting better health management is crucial for improving their health levels. In recent years, health information avoidance behavior has gradually attracted attention in the fields of health communication, public health, and nursing. Although existing studies have explored this behavior from related factors such as information overload, risk perception, and emotional reactions, there are still the following shortcomings: First, existing studies focus on different disease types, health information, or communication platforms, and the factors presented are relatively fragmented, lacking a systematic framework to explain the process from environmental stimuli to behavioral responses, which limits the overall understanding of health information avoidance behavior among middle-aged and elderly people. Second, in the context of the rapid development of the digital health information environment, the mechanism of health information avoidance among middle-aged and elderly people may be more complex, requiring comprehensive research on the specific impact of information overload and technical barriers on the elderly's information avoidance behavior. Third, the middle-aged and elderly groups are deeply embedded in family structures. Existing studies mostly focus on the information environment and individual cognition, and pay less attention to the unique impact of intergenerational interaction within the family on avoidance behavior, which is crucial in a collectivist culture and an aging society. Finally, most existing studies take the general adult population as the research object, and the systematic attention to the middle-aged and elderly groups is still relatively insufficient. Due to their unique physiological, psychological, social, and environmental backgrounds, middle-aged and elderly people during the digital transformation period show unique vulnerabilities in the manifestation and formation process of their health information avoidance behavior. Therefore, it is necessary to regard middle-aged and elderly people as an interconnected overall group and conduct a comprehensive examination from the perspective of the life course. This scoping review adopts the SOR framework to depict the complex picture of health information avoidance among middle-aged and elderly people, integrates global evidence, and pays special attention to the background of digital health information and family background.