Effectiveness of eHealth literacy interventions: a systematic review and meta-analysis of experimental studies

Abstract

Background: eHealth Literacy (eHL) is a set of competencies and skills encompassing the knowledge, comfort and perceived ability to identify, evaluate and apply electronic health information to health problems. Given its role in the appropriate use of health technologies, ensuring equitable access to health information and improving patient outcomes, this study aims to systematically retrieve, qualitatively and quantitative pool and critically appraise available experimental evidence on the effectiveness of eHL interventions across different population groups.

Methods: Following the PRISMA guidelines, we conducted a systematic review in PubMed/Medline, Scopus, Web of Science, Embase, Cochrane Library and ClinicalTrials.gov, including original experimental studies quantifying the effectiveness of interventions aimed at increasing eHL, as assessed by the eHealth Literacy Scale (eHEALS) or other validated scales. We performed a random-effects model meta-analysis comparing changes in eHL levels before and after the interventions, and between the intervention and control groups. Heterogeneity was assessed using I² statistics.

Results: Out of the 504 studies retrieved, 15 studies conducted between 2011 and 2023 met the inclusion criteria. Target populations of eHL interventions included adults in 7 studies, older people in 5 and young people in 4. The meta-analysis included 10 studies that used the eHEALS. Participants showed a mean increase in eHEALS scores of 5.81 points (95% CI = 3.36-8.26, N = 1025) following the eHL interventions compared to the pre-intervention period. In the analysis between the intervention and control groups, we found a statistically significant difference in eHL improvement in favour of the intervention group, with mean eHEALS scores 3.62 points (95% CI = 1.63-5.60, N = 1258) higher in the intervention group than in the control groups. Subgroup analyses by intervention type, stratified by Collaborative Learning (CL) or Individualistic Learning (IL) showed significant increases in eHealth Literacy in the pre-post intervention analysis (CL: UMD = 5.19, CI = 0.01-10.38, N = 402; IL: UMD = 6.05; CI = 3.14-8.97, N = 623) and in the intervention vs. control analysis in the IL group (DMD = 4.98; CI = 1.77-8.12, N = 540).

Conclusions: Our findings support the effectiveness of tailored interventions in significantly enhancing eHL, providing key insights for evidence-based intervention design targeted to different population groups.

Keywords: Digital health; Digital health literacy; eHealth literacy; eHealth literacy interventions.

Fig. 1

Flow diagram of the studies selection process. From: Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71)

Fig. 2

Forest plot (A) and funnel plot (B), after trim and fill method, of the meta-analysis assessing the pooled difference in eHEALS scores in the pre- vs. post- intervention datasets

Fig. 3

Forest plot (A) and funnel plot (B), after trim and fill method, of the meta-analysis assessing the pooled difference in eHEALS scores in the intervention group vs. control group datasets

Fig. 4

Forest plot and funnel plot after trim and fill method, of the meta-analysis assessing the pooled difference in eHEALS scores in the pre- vs. post- intervention datasets, stratifying by intervention type: Collaborative Learning (A, B), Individualistic Learning (C, D)

Fig. 5

Meta-regression analysis to assess the association between pre- and post-intervention outcomes and baseline eHealth Literacy (Overall, A; Collaborative Learning, B; Individualistic Learning, C)

Fig. 6

Meta-regression analysis to assess the association between pre- and post-intervention outcomes and age (Overall, A; Individualistic Learning, B)