JMIR Publications

ABSTRACT

Background:

Digital health interventions (DHIs) are increasingly adopted worldwide to address various public health issues. In 2006, Norman and Skinner introduced the “eHealth literacy model”, encompassing six domains of skills and abilities (basic, health, information, scientific, media, and computer) needed to effectively understand, process, and act on health-related information. Little is known about whether these domains are assessed or accounted for in DHIs.

Objective:

To explore how DHIs assess and evaluate the eHealth literacy model, and understand what health conditions are addressed and which technologies are employed.

Methods:

We conducted a scoping review of the literature on DHIs, based on RCT design, and reporting the assessment of any domain of the eHealth literacy model. We searched the Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Excerpta Medica dataBASE (EMBASE), and Cochrane Library. We performed a duplicate selection and data extraction process; we charted the results according to the country of origin, health condition, technology used, and eHealth literacy domain.

Results:

We identified 132 unique DHIs, conducted in 26 different countries between 2001 and 2020. Most DHIs were conducted in English-speaking countries (81/132, 61%), were delivered via web (69/132, 52%), and addressed noncommunicable diseases (57/132, 43%), or mental health issues (26/132, 20%). None of the interventions assessed all six domains of the eHealth literacy model. Most studies focused on the domain of health literacy (96/132, 73%), followed by digital (19/132, 14%), basic and media (4/132, 3%), information and scientific literacy (1/132, 1%). Seven studies covered both health and digital literacy (5%).

Conclusions:

While many selected DHIs assessed health or digital literacy, no studies comprehensively evaluated all domains of the eHealth literacy model; this evidence might overlook important factors that can mediate or moderate the effects of these interventions. Future DHIs should comprehensively assess the eHealth literacy model while developing or evaluated interventions, in order to understand how and why interventions can be effective.