Currently submitted to: JMIR Preprints
Date Submitted: Aug 12, 2026
Open Peer Review Period: Aug 12, 2026 - Jul 28, 2027
(currently open for review)
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
TWO DECADES LATER: REDEFINING EHEALTH LITERACY FOR CURRENT AND FUTURE DIGITAL AGE: FINDINGS FROM AN INTERNATIONAL eDELPHI AND CONSENSUS STUDY
ABSTRACT
Background:
Digital health environments have rapidly evolved from static information sources into complex ecosystems involving social platforms, mobile applications, telehealth, electronic health records, and AI-enabled technologies. These changes have expanded the competencies required to engage with digital health information and highlighted limitations in existing conceptualisations of eHealth literacy.
Objective:
This study aimed to develop an updated, consensus-based definition of eHealth literacy that reflects current and emerging digital health environments.
Methods:
A multi-phase eDelphi process and consensus were conducted with an international panel of multidisciplinary experts and end-users. Participants completed iterative survey rounds to rate, prioritise, and provide feedback on proposed items until stability was achieved. Consensus was defined as ≥75% agreement. It was followed by consensus meetings to determine final items.
Results:
Twenty-eight multidisciplinary experts from ten countries participated across three eDelphi rounds. Subsequent consensus meetings resulted in the following final components across three domains: Knowledge; Skill; and Context, and six subdomains: Health Knowledge; Knowledge of Digital Ecosystem; Critical Thinking Skill; Technical Skill; Cognitive Skill; and Health Application Skill. These items informed an updated definition describing eHealth literacy as a multidimensional construct comprising interrelated domains of knowledge, skills, and contextual factors that enable individuals to engage with digital health tools, technologies, and AI-enabled services in ways that support informed judgement, communication, and health-related action
Conclusions:
This study provides the first expert consensus on a refined conceptualisation of eHealth literacy aligned with modern eHealth systems. It provides a foundation for future measurement development, intervention design, research, and policy.
Citation
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