JMIR Publications

ABSTRACT

Background:

Black and Hispanic adults in the U.S. face a disproportionately higher burden of cardiovascular disease (CVD) than non-Hispanic White adults. Digital health literacy (DHL) plays a key role in CVD prevention and management; however, research exploring DHL in this context is limited.

Objective:

Guided by the Health Belief Model and Social Cognitive Theory, this study examined associations between DHL and cardiovascular-related lifestyle behaviors, CVD, and CVD risk factors among Black and Hispanic adults.

Methods:

We conducted a secondary analysis of survey data from a cross-sectional study on health status, access, information use, and social determinants among Maryland, Virginia, and Washington, D.C. residents (March–June 2024). Participants were recruited via convenience sampling. DHL was measured using selected items from the Digital Health Literacy Inventory. Outcomes included self-reported CVD or risk factor diagnoses and lifestyle behaviors (fruit, vegetable, and sugar-sweetened beverage [SSB] intake, and physical activity). Multivariable linear and logistic regression models were used to assess associations, adjusting for age, sex at birth, race, ethnicity, education, employment, household income, and health literacy.

Results:

Among 1,221 participants, the mean (SD) age was 44 (16) years; most were female (64%), insured (87%), non-Hispanic (69%), and identified as Black/African American/African (64%). DHL was significantly associated with patterns of eating vegetables (β = 0.073, p = 0.014) and SSB consumption (β = 0.121, p = 0.008). DHL showed a significant non-linear association with fruit intake (EDF = 2.636, F = 3.987, p = 0.006), with a ~1.43-fold change in expected fruit intake from lowest to highest DHL scores. The relationship was negative between DHL scores of 1–1.8, non-significant between 1.89–3.71, and positive between 3.72–4. DHL was not significantly associated with self-reported CVD or its risk factors.

Conclusions:

Greater DHL was linked to healthier dietary behaviors, including increased vegetable and fruit intake. However, the unexpected association between higher DHL and greater SSB consumption highlights the complexity of health behavior and the importance of further exploration. DHL-focused interventions may improve cardiovascular health but should be carefully designed to avoid unintended consequences. Future experimental and longitudinal studies are needed to clarify causal pathways linking DHL with health behaviors and CVD outcomes, as well as to assess the quality and content of online health information accessed by individuals. Clinical Trial: NA