JMIR Publications

ABSTRACT

Background:

Digital health literacy (DHL), the ability to seek, understand, and apply digital health information, has become increasingly important in the United Kingdom (UK), with a focus on digital transformation within the health service. While digital tools offer the potential to improve access and equity, they may also exacerbate existing health inequities if segments of the population are unable to engage with them effectively. Understanding the determinants of DHL is essential to designing inclusive digital health services.

Objective:

To measure DHL among adults in the UK and identify its sociodemographic, economic, and social determinants.

Methods:

A cross-sectional online survey was disseminated to a nationally representative sample of UK adult Internet users, November to December 2024. DHL was self-reported using the validated eHealth Literacy Scale (eHEALS), which ranges from eight to 40. eHEALS score was dichotomized into high and low DHL based on a cut-off of 26. A multivariable logistic regression model was built to identify sociodemographic and economic determinants of DHL.

Results:

The median eHEALS score was 31; 21% of participants had a low level of DHL, while 79% had a high level of DHL. Those aged 45–64 and 65 years and older, compared to the 18–45 age group, had 1.61 and 1.98 times the odds of low DHL, respectively (45–64 years odds ratio [OR]: 1.61, 95% confidence interval [CI]: 1.13 to 2.31, P=.01; 65 years and older OR: 1.98, 95% CI: 1.36 to 2.91, P<.001). Females had 0.55 times the odds of low DHL (OR: 0.55, 95% CI: 0.42 to 0.74, P<.001), and those with an undergraduate or postgraduate degree or higher had lower odds of low DHL, compared to those educated to below degree level (undergraduate degree OR: 0.49, 95% CI: 0.33 to 0.71, P<.001; postgraduate degree or higher: OR: 0.48, 95% CI: 0.32 to 0.71, P<.001). In subgroup analysis among participants with chronic health conditions, age was no longer a significant predictor of DHL.

Conclusions:

Among UK Internet users, male sex, lower educational attainment, and older age were statistically significant sociodemographic associates of low DHL, though the model’s modest explanatory power suggests that additional factors beyond those examined play an important role. As findings are based on Internet users, the prevalence of low DHL in the general population is likely higher than reported. This study provides a partial basis for identifying population groups who may benefit from additional support, but intervention design should not rely solely on the sociodemographic factors identified here. Inclusive educational interventions and digital health solutions that account for a broader range of determinants are needed to ensure that digital transformation in healthcare helps to narrow health inequities. Clinical Trial: Not applicable.