JMIR Publications

ABSTRACT

Background:

Digital health technology (DHT) is increasingly vital for managing chronic diseases, as it enables patients to actively manage their health. Such tools have been shown to improve self-management and compliance with medical advice. Nonetheless, for DHT to be fully effective, patients with chronic conditions must be digitally literate. It is essential to assess a patient's digital health literacy (DHL) and understand what factors affect it to improve resource accessibility and usability.

Objective:

This study aims to assess digital health literacy (DHL) in patients with diabetes (DM), hypertension (HTN), and rheumatoid arthritis (RA) through a systematic review and meta-analysis using eHEALS. The focus is to determine average DHL scores, explore influencing demographic and socioeconomic factors, and gauge the effect of DHL on disease management. This work seeks to inform future DHL enhancement strategies for better chronic disease outcomes.

Methods:

This systematic review was conducted in accordance with PRISMA guidelines. We conducted a systematic literature review of seven databases (PubMed, SCOPUS, Embase, ERIC, CINAHL, Library Literature and Information Science Index, and Google Scholar) from their inception till the date the search was executed- August 14, 2022. An updated search was performed in June 2023 to ensure no recent studies had been published since the initial search. The study aimed to identify studies examining DHL using the eHEALS tool in adult people with three common chronic diseases that require self-management- diabetes mellitus, hypertension, and rheumatoid arthritis.

Results:

Eight studies involving 2527 subjects were included in this review. The overall pooled mean eHEALS score was 27.03 (95% CI: 25.08-28.98), indicating high overall DHL. Stratification by disease revealed higher DHL scores for DM (27.79) and HTN (28.48) but lower scores for RA (24.74). Quality assessment indicated a high standard of included studies. Factors influencing DHL included age, education, employment, and perception of the internet as a health resource. The limited number of studies in our study precluded meta-regression analysis.

Conclusions:

Digital health literacy (DHL) is essential for individuals with chronic conditions, empowering them to make well-informed decisions and effectively manage their health. However, due to a scarcity of studies, a comprehensive analysis of DHL determinants remains incomplete. While the internet offers a wealth of health information, unequal DHL and internet skills present barriers that must be overcome to achieve fair health outcomes. There's a clear imperative for more inclusive research to fully grasp the influence of DHL on health outcomes and to mitigate disparities, particularly in diverse populations. This will not only help in understanding DHL's role in diminishing disease rates and associated costs but also in ensuring that the benefits of digital health resources are equitably distributed. Clinical Trial: The study used a predefined protocol registered with prospero (CRD42023467462).