JMIR Publications

ABSTRACT

Background:

Digital health interventions continue to evolve and have the potential to improve health care delivery. However, they are not accessible to everyone and may pose risks due to health misinformation. To overcome these hurdles, individuals need a sufficient level of electronic health literacy (eHL), and healthcare providers need to be able to assess the eHL of individuals to provide targeted solutions. For around two decades, researchers have been operationalizing eHL considering technological innovations.

Objective:

The main objective of this paper is to provide an up-to-date overview of how eHL has been assessed in the European Economic Area, Switzerland, and the United Kingdom in recent years and which methodological limitations need to be considered.

Methods:

A rapid review was conducted. Records were searched via CINAHL, PubMed, and Google Scholar on January 31, 2025, and systematically selected. Peer-reviewed empirical papers published in German or English since 2020 that assessed eHL in the European Economic Area, Switzerland, or the United Kingdom were included in the final analysis. The synthesis focused on the publication trend, validation objectives, target groups, sample sizes, data collection countries and languages, eHL measurement instruments, data collection methods and modes, and eHL assessment-related limitations reported in the included papers.

Results:

In total, 101 papers were included in the final analysis. The number of publications per year shows an overall upward trend (2020: 11/101, 11%; 2024: 28/101, 28%). Of the included papers, 20 (20/101, 20%) aimed to validate at least one eHL measurement instrument. Individuals without a specific health-related perspective were the most common target group (52/101, 51%), and the inclusion of broad adult age ranges was often reported (81/101, 80%). Sample sizes ranged from ≤50 (4/101, 4%) to >2,000 participants (7/101, 7%). Nineteen data collection countries and languages were identified. Versions of 9 self-report eHL measurement instruments were used, most frequently the eHealth Literacy Scale (eHEALS) (74/101, 73%). All included papers reported the use of surveys to collect data. In terms of data collection modes, most of the included papers were assigned to the online or electronic cluster (57/101, 56%). Reported limitations were self-report biases (28/101, 28%), selection biases due to the data collection modes (21/101, 21%), and specific limitations regarding 5 of the identified eHL measurement instruments (11/101, 11%).

Conclusions:

This paper contributes to a research field that is attracting growing research interest. Specifically, it provides an overview of current eHL assessment approaches and associated limitations. Thus, it supports researchers and healthcare providers to evaluate existing and develop new eHL assessments as a basis for providing targeted solutions, and policy makers to set standards for digital interventions or educational programs. Clinical Trial: PROSPERO Registration: CRD42025642890