Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Feb 28, 2020
Date Accepted: Jun 3, 2020
Warning: This is an author submission that is not peer-reviewed or edited.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.
Applying the eHealth literacy lens: A systematic review of eHealth interventions targeted at socially disadvantaged groups
ABSTRACT
Background:
eHealth holds the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users in order to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalised, leading to potential widening of health disparities.
Objective:
This systematic review aimed to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups.
Methods:
A systematic search was conducted across ten databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine eHealth literacy components of reviewed interventions. Results were analysed using narrative synthesis.
Results:
Fifty-one studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities with only two studies focused on low-literacy groups. eHealth literacy was not considered in the development of any of the studies and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited and eHealth intervention developmental frameworks were rarely used. Strategies to assist users to engage with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions.
Conclusions:
The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups while evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realisation of recent technological advancements and, importantly, improve health equity. Clinical Trial: N/A
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