Abstract: [Purpose/Significance] Health is the foundation of survival, and the health of all people is the foundation of a country. However, the aging situation in China's rural areas is serious, and the health information literacy (HIL) of the middle-aged and elderly population is low. Improving the HIL of middle-aged and elderly people in rural areas is of great significance to personal health and the "Healthy China" strategy. In terms of research perspective and content, previous studies either used quantitative methods to measure the health level of rural middle-aged and elderly people, or used qualitative methods to analyze a certain aspect of HIL, but the reasons for the low level of HIL among rural elderly people are not explored from a qualitative perspective. Based on this, the author analyzes the reasons for the low level of HIL of the rural middle-aged and elderly from the perspective of qualitative research and proposes corresponding countermeasures. [Method/Process] Semi-structured interview method and ground theory were used to explore the reasons for low HIL among rural middle-aged and elderly people from five aspects: health information awareness, health information access, health information evaluation, health information utilization and health information service. A theoretical model of the causes of low HIL among rural middle-aged and elderly people was constructed. [Results/Conclusions] It is found that the reasons for the low HIL of the rural middle-aged and elderly people include personal cognitive limitations, objective condition limitations, and service delivery problems. Specifically, the reasons are rejection of digitalization, cognitive misunderstanding, physical condition limitation, digital equipment limitation, low quality of related services, and the lack of related services. Accordingly, from the level of personal cognition, it is proposed that multiple measures should be taken to promote health-related publicity and education to improve the awareness of HIL. For example, offline and online HIL education should be improved and the characteristics of rural social acquaintance should be used to improve publicity and HIL education. From the perspective of objective conditions, it is suggested that the material basis of life should be improved to raise the level of HIL. From the perspective of health information services, health care institutions, village committees, libraries and family members should be involved in the health information service system for the rural middle-aged and elderly people, and the quality of health information services should be improved. The interaction between the various causes can be further explored in the future.

Key words: health information literacy (HIL), the middle-aged and elderly, the rural, information behavior, healthy China