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. 2025 Mar 20:13:1472706.
doi: 10.3389/fpubh.2025.1472706. eCollection 2025.

Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries

Diane Levin-Zamir  1   2 , Stephan Van den Broucke  3 , Éva Bíró  4 , Henrik Bøggild  5 , Lucy Bruton  6 , Saskia Maria De Gani  7   8 , Hanne Søberg Finbråten  9 , Sarah Gibney  6 , Robert Griebler  10 , Lennert Griese  11 , Øystein Guttersrud  12   13 , Zuzana Klocháňová  14 , Zdenek Kucera  15 , Christopher Le  9   16 , Thomas Link  17 , Julien Mancini  18 , Dominika Miksova  17 , Doris Schaeffer  11 , Carlota Ribeiro da Silva  19 , Kristine Sørensen  20 , Christa Straßmayr  10 , Miguel Telo de Arriaga  19   21 , Mitja Vrdelja  22 , Jürgen Pelikan  10
Affiliations

Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries

Diane Levin-Zamir et al. Front Public Health. .

Erratum in

Abstract

Introduction: Digital health information sources are playing an increasingly prominent role in health promotion, public health and in healthcare systems. Consequently, digital health literacy skills are likewise becoming increasingly important.

Methods: Using a concept validation approach, the aim of the study was to validate the digital health literacy measure HLS19-DIGI, applied in the European Health Literacy Survey (2019-2021) of the WHO M-POHL network, analyzing data from 28,057 respondents from 13 countries. The instrument is a modified and extended version of the Digital Health Literacy Instrument (DHLI).

Results: The scale displayed high internal consistency. Confirmatory factor analysis (CFA) strengthened the hypothesized one-factor structure. In most countries, the data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). Pearson correlation with a measure of general health literacy showed sufficient discriminant validity, and a social gradient was found. Testing for predictive validity showed that the scale score predicts health-related outcomes.

Discussion: The study shows that considerable proportions of the general adult populations across countries in Europe have limited DHL skills. The level of DHL has direct potential consequences for some forms of health service utilization, in some countries. Implications of the study include recommendations for improving digital health literacy, promoting organizational health literacy and quality assurance for digital health information and resources.

Keywords: HLS19; M-POHL; digital health literacy; digital health literacy measurement; eHealth literacy; health information technology literacy; measurement scale validation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Percentage of respondents who responded "very difficult" or "difficult" to the items measuring the ability to access, understand, appraise and apply health information from digital sources (ranked by the overall percentage), for each country.
Figure 2
Figure 2
Average Percentage Response Patterns (APRP) for the item set measuring the ability to access, understand, appraise, and apply online health information, for each country (equally weighted).
Figure 3
Figure 3
Average Percentage Response Patterns (APRP) for item set measuring the ability to interact with digital health devices, for each country (equally weighted).
See this image and copyright information in PMC

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