JMIR Publications

ABSTRACT

Background:

Digital health literacy describes an individual’s ability to use digital information and tools to improve their own health. Understanding of how digital health literacy varies across populations could help improve health equity. However, the determinants of digital health literacy have been scarcely evaluated.

Objective:

This study aims to assess the levels of digital health literacy across four countries (UK, Sweden, Italy and Germany); and explore potential associations between digital health literacy and demographic characteristics and self-perceived health status.

Methods:

A cross-sectional online survey was disseminated to participants from the UK, Italy, Germany, and Sweden, in December 2020. Digital health literacy was self-reported using the validated eHealth Literacy Scale (eHEALS) (Range: 0-40); low literacy has been previously defined as an eHEALS score <26. Participant characteristics collected were gender, age group, ethnicity, country, and perceived overall health status. A multivariable linear regression analysis was performed to explore associations between these variables and digital health literacy.

Results:

6,331 participants were included (51.7% female). The mean eHEALS score was 29.2 (± 6.8). Participant age, gender, health status, and country of residence were included in the final multivariable model. Compared to the 45-54 age group, the ≥55 age group had lower digital health literacy (β=-1.0; 95% CI: -1.4 to -0.5, p<.001), while digital literacy was higher in those aged 25-34 (β=0.9; 95% CI: 0.3 to 1.5, p=.002) and 35-44 (β=0.6; 95% CI: 0.1 to 1.2, p=.031). Better health status was associated with greater digital health literacy (β=0.3; 95% CI: 0.2 to 0.4, p<.001). Compared to participants from Germany, those from the UK (β=2.1; 95% CI: 1.7 to 2.5, p<.001) and Sweden (β=2.9; 95% CI: 2.4 to 3.4, p<.001) had higher digital health literacy scores, while there was no difference with Italian participants (p=0.399). Gender and ethnicity did not have any significant effect on digital health literacy.

Conclusions:

This study found significant variations in digital health literacy by age, health status, and country of residence. Targeted educational programmes for vulnerable groups, particularly those of older age and poorer health status, is essential. Policies fostering accessible digital health solutions and mitigating health technology-related uncertainties for these populations are crucial for achieving optimal health outcomes. Clinical Trial: Not applicable.