JMIR Publications

ABSTRACT

Background:

Digital health literacy is a key factor in enabling users to navigate in an increasing digitalized healthcare system. Low levels of digital health literacy are associated with higher age, low education and income as well as low functional health literacy. Around 6.2 million adults living in Germany have low reading and writing skills. Due to their low literacy, this group is often excluded from research studies and therefore little is known about their digital health literacy and use of digital health tools.

Objective:

The objectives of this study were to assess digital health literacy of adults with low reading and writing skills and to explore which digital health tools they used in everyday life.

Methods:

A cross-sectional survey and focus groups were conducted with adults aged 18-64 years with low reading and writing skills living in Bremen, Germany. In addition, a stakeholder workshop was held to derive recommendations on how digital health literacy can be improved. The survey questionnaire comprised 21 items addressing use of digital health technologies and digital health literacy (eHealth literacy scale, eHEALS). Focus group participants completed several tasks on online health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and logistic regression. Qualitative content analysis was applied to analyze the focus group data and the written documentation of the stakeholder workshop.

Results:

Survey participants (n=96) were on average 43 years old (SD=10.7), 72% were female and 92% were not born in Germany. Participants reported to mainly use information-related digital health technologies such as health apps (42%), health websites (31%), or activity trackers (28%). Mean digital health literacy score was 22 (SD=8.0) points with 35% of participants reporting a low digital health literacy (score between 8-19/40 points). Digital health technology use was associated with higher digital health literacy. In the focus groups (five focus groups, n=39, mean age 43 years (SD=12.6), 87% female), limited technical skills and language problems were identified as the most important challenges for participants. Moreover, focus group participants reported that they favour videos when searching for health information online and prefer to seek support from family members or local organizations for health issues. Stakeholders (n=15) recommended that health websites should be available in multiple languages, contain simple and easy-to-read language, and use images, symbols, and videos.

Conclusions:

Adults with low reading and writing skills use digital health technologies, but reported a low digital health literacy, and find it challenging to search for health information on the internet due to lacking technical skills and language problems. To ensure that adults with low reading and writing skills are not further left behind future research should focus on developing tailored interventions to promote digital health literacy.