JMIR Publications

ABSTRACT

Background:

The Digital Health Literacy Instrument (DHLI) was developed in 2017 to measure individuals’ ability to access, understand, evaluate, and apply online health information. As the digital world and digital health technologies have evolved rapidly, with the widespread use of mobile devices, apps, and enhanced data security requirements, the original DHLI required updating.

Objective:

This study aimed to revise and validate an updated version of the DHLI (DHLI 2.0) that reflects current digital health practices and to examine the psychometric properties of a short-form version to facilitate broader use in research and practice.

Methods:

The DHLI 2.0 comprises 24 items across eight skill domains, including a newly added subscale on data security. Items were updated to incorporate the use of mobile devices (e.g., smartphones, tablets) and to reflect current online behaviors. Data were collected in June 2024 through an online survey among members of a representative citizen panel in Friesland, the Netherlands (n=2728). Socio-demographics, internet and health-related internet use, general health literacy (measured with the Single Item Literacy Screener), self-reported health, and healthcare use were assessed. Internal consistency was evaluated using Cronbach’s alpha, and construct validity was assessed via Spearman’s rho correlations with related constructs.

Results:

Internal consistency was high for both the full (α=.94) and short-form (α=.90) scales. Most subscales showed satisfactory to excellent reliability (α=.71–.93), while “Securing privacy” and “Using security measures” demonstrated moderate reliability (α=.65–.66). The DHLI 2.0 total scores were approximately normally distributed (skewness –0.5; kurtosis 0.4). As expected, digital health literacy was negatively correlated with age (ρ=-.39, P<.001) and positively correlated with education (ρ=.22, P<.001), income (ρ=.27, P<.001), time spent online (ρ=.32, P<.001), and general health literacy (ρ=-.42, P<.001).

Conclusions:

The DHLI 2.0 provides an updated, reliable, and valid measure of digital health literacy covering eight key domains, including data security. The 16-item short form offers a concise alternative suitable for research and possibly practical applications in health and eHealth contexts.