Digital Health Literacy, Telenursing Adoption, and Patient Engagement Among Patients with Hypertension in Urban Kano: A Path Analysis Study

Background: Digital health innovations including telenursing offer scalable solutions for hypertension management in Nigerian urban settings, yet digital health literacy barriers and adoption predictors have not been modelled through pathway analysis in Kano State. Aim: This study examined the pathways between digital health literacy, telenursing adoption, and patient engagement among hypertensive patients in urban Kano. Methods: A cross-sectional analytical study recruited 300 hypertensive outpatients at Aminu Kano Teaching Hospital through systematic sampling. Validated measures of digital health literacy, telenursing adoption readiness, and patient engagement were administered. Path analysis using AMOS modelled hypothesised relationships. Results: Digital health literacy significantly predicted telenursing adoption (beta = 0.47, p < 0.001) and directly predicted patient engagement (beta = 0.32, p < 0.01). Telenursing adoption partially mediated the literacy-engagement relationship. Age, educational level, and smartphone access moderated pathway strengths. Conclusion: Digital health literacy is the foundational determinant of telenursing uptake and patient engagement in this setting. Nurse-facilitated digital health literacy programmes and provision of affordable smartphone access are recommended as prerequisites for telenursing scale-up in Nigerian urban hypertension management. Keywords: digital health literacy, telenursing, hypertension, Kano, patient engagement.