JMIR Publications

ABSTRACT

Background:

With the ongoing digitalization of healthcare, digital health literacy (DHL) is becoming increasingly important. Appropriate measurement instruments are needed to assess DHL accurately. The wide range of Digital Health Measurement Instruments (DHLMIs) available makes selection difficult and raises questions about the suitability and comparability of the instruments.

Objective:

The aim of this review was to provide an overview of available measurement instruments for assessing DHL and to compare their dimensions. Thereby, overlaps and differences between the instruments were to be identified in order to determine which (key) dimensions are most commonly studied and thus define DHL.

Methods:

A narrative overview of reviews was conducted. The database search was conducted in November 2024 in MEDLINE and Google Scholar using specific search terms and predefined inclusion and exclusion criteria and all initial records were screened in a multi-stage process. At the review level, systematic and scoping reviews published since January 1, 2020 were included that analyzed DHLMIs. At the primary study level, studies were included in which DHLMIs were used for self-assessment, performance-based evaluation, or a combination of both. Data extraction was carried out by one reviewer and verified for accuracy and completeness by a second. Data on underlying theories, methods of data collection (performance-based or self-reported) and target groups were extracted. The DHL dimensions measured, their definitions, and the associated items were systematically categorized by two researchers using qualitative content analysis according to Kuckartz.

Results:

Nine reviews were included. Of the 126 measurement instruments examined in these reviews, 29 were selected for detailed analysis after applying the inclusion and exclusion criteria. The majority of the measurement instruments (n = 18; 62.1%) were not based on a theory, 16 (55.2%) measured DHL exclusively via self-report, and 18 (62.1%) addressed specific target groups. The measurement instruments encompassed a total of 193 original dimensions of digital health literacy. The number of dimensions measured per instrument varied between two and 22. The qualitative content analysis identified a total of 30 assigned dimensions. Key dimensions captured in almost all the instruments, although under different names, include evaluating health information, using health information, researching health information, and the ability to use technology.

Conclusions:

The large number of measurement instruments and original dimensions makes it difficult to select suitable instruments for measuring DHL, and to compare and synthesize study results. Nevertheless, we were able to identify key dimensions as relevant regardless of target groups and types of digital applications. Our findings offer a foundation for refining existing instruments and developing new ones. They provide practical guidance for researchers and healthcare professionals in selecting suitable DHLMI. Additionally, our review underlines the importance of theory to ensure content validity and comparability of DHLMIs.