Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: Aug 13, 2025
Date Accepted: Mar 9, 2026
Development of a Digital Health Literacy Assessment Framework for Older Adults: A Delphi-Based Study
ABSTRACT
Background:
Digital health literacy (DHL) plays a critical role in improving health outcomes. As a digitally marginalized group, older adults face significant barriers in utilizing digital technologies for health information access and e-health services, hindering their ability to benefit from digital dividends. Accurate assessment of DHL is a prerequisite for developing targeted interventions.
Objective:
To develop and validate a comprehensive evaluation index system for DHL among older adults, providing a systematic and reliable tool for assessing DHL.
Methods:
A combination of a literature review, focus group discussions, and the Delphi method was employed to construct a comprehensive evaluation index system. A cross-sectional survey was conducted to validate the reliability and validity of the scale.
Results:
Two rounds of expert consultation were conducted with 15 experts, and 135 older participants were included in the survey. The expert authority coefficients (Cr) were 0.748 and 0.768, respectively, and Kendall’s harmony coefficient was statistically significant. The “Individual Competency-Environmental Support” dual-pathway evaluation index system comprises six primary indicators, thirteen secondary indicators, and twenty-seven third-level indicators. The system demonstrated high reliability and strong criterion validity.
Conclusions:
The comprehensive evaluation index system for DHL among older adults demonstrates scientific rigor and structural validity, which emphasize the importance of both individual-level intrinsic factors and external environmental factors in shaping DHL among older adults. Future empirical validation should be extended to older populations across diverse regions. Clinical Trial: None
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