Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jun 30:27:e66631.
doi: 10.2196/66631.

Determinants of Digital Health Literacy: International Cross-Sectional Study

Connor S Qiu #  1 , Tetiana Lunova #  2 , Geva Greenfield  1 , Gabriele Kerr  1 , Ömrüm Ergüven  1 , Thomas Beaney  1 , Benedict Hayhoe  1 , Erik Mayer  2   3   4 , Azeem Majeed  1 , Ana Luisa Neves  1   5
Affiliations

Determinants of Digital Health Literacy: International Cross-Sectional Study

Connor S Qiu et al. J Med Internet Res. .

Abstract

Background: Digital health literacy describes an individual's ability to use digital information and tools to improve their own health. Understanding how digital health literacy varies across populations could help improve health equity. However, the determinants of digital health literacy have been scarcely evaluated.

Objective: This study aims to assess the levels of digital health literacy in 4 countries (United Kingdom, Sweden, Italy, and Germany) and explore potential associations between digital health literacy and demographic characteristics and self-perceived health status.

Methods: A cross-sectional online survey was disseminated to participants from the United Kingdom, Italy, Germany, and Sweden in December 2020. Digital health literacy was self-reported using the validated eHealth Literacy Scale (eHEALS; range: 0-40); low digital health literacy has been previously defined as an eHEALS score<26. Participant characteristics collected were sex, age group, ethnicity, country, and perceived overall health status. A multivariable linear regression analysis was performed to explore associations between these variables and digital health literacy.

Results: A total of 6331 participants were included (51.7% female, n=3272). The mean eHEALS score was 29.2 (SD 6.8). Participant age, sex, health status, and country of residence were included in the final multivariable model. Compared to the 45- to 54-year age group, the 55 years and older age group had lower digital health literacy (β=-1.0; 95% CI -1.4 to -0.5; P<.001), while digital health literacy was higher in those aged 25-34 years (β=0.9; 95% CI 0.3-1.5; P=.002) and 35-44 years (β=0.6; 95% CI 0.1-1.2; P=.03). Better health status was associated with greater digital health literacy (β=0.3; 95% CI 0.2-0.4; P<.001). Compared to participants from Germany, those from the United Kingdom (β=2.1; 95% CI 1.7-2.5; P<.001) and Sweden (β=2.9; 95% CI 2.4-3.4; P<.001) had higher digital health literacy scores, while there was no difference with Italian participants (P=.399). Sex and ethnicity did not have any significant effect on digital health literacy.

Conclusions: This study found significant variations in digital health literacy by age, health status, and country of residence. Targeted educational programs for vulnerable groups, particularly those of older age and poorer health status, are essential. Policies fostering accessible digital health solutions and mitigating health technology-related uncertainties for these populations are crucial for achieving optimal health outcomes.

Keywords: cross-sectional; cross-sectional studies; determinants of digital health literacy; digital determinants of health; digital health; digital health literacy; digital literacy; eHealth; eHealth Literacy Scale; health equity; health literacy; linear regression analysis; multivariable linear regression analysis; online survey.

PubMed Disclaimer

Conflict of interest statement

Conflicts of Interest: BH also works for eConsult Health Ltd.

Figures

Figure 1
Figure 1
Mean eHealth Literacy Scale (eHEALS) score by age group.
Figure 2
Figure 2
Mean eHealth Literacy Scale (eHEALS) score by participant self-reported overall health status.
See this image and copyright information in PMC

References

    1. Flott K, Callahan R, Darzi A, Mayer E. A patient-centered framework for evaluating digital maturity of health services: a systematic review. J Med Internet Res. 2016;18(4):e75. doi: 10.2196/jmir.5047. https://www.jmir.org/2016/4/e75/ v18i4e75 - DOI - PMC - PubMed
    1. Kim J, Livingston MA, Jin B, Watts M, Hwang J. Fundamentals of digital health literacy: a scoping review of identifying core competencies to use in practice. Adult Learn. 2023;35(3):131–142. doi: 10.1177/10451595231178298. https://doi.org/10.1177/10451595231178298 - DOI - DOI
    1. van der Vaart R, Drossaert C. Development of the digital health literacy instrument: measuring a broad spectrum of health 1.0 and health 2.0 skills. J Med Internet Res. 2017;19(1):e27. doi: 10.2196/jmir.6709. https://www.jmir.org/2017/1/e27/ v19i1e27 - DOI - PMC - PubMed
    1. van Kessel R, Wong BLH, Clemens T, Brand H. Digital health literacy as a super determinant of health: more than simply the sum of its parts. Internet Interv. 2022;27:100500. doi: 10.1016/j.invent.2022.100500. https://linkinghub.elsevier.com/retrieve/pii/S2214-7829(22)00007-0 S2214-7829(22)00007-0 - DOI - PMC - PubMed
    1. Arias López MDP, Ong BA, Borrat Frigola X, Fernández AL, Hicklent RS, Obeles AJT, Rocimo AM, Celi LA. Digital literacy as a new determinant of health: a scoping review. PLOS Digit Health. 2023;2(10):e0000279. doi: 10.1371/journal.pdig.0000279. https://europepmc.org/abstract/MED/37824584 PDIG-D-22-00373 - DOI - PMC - PubMed

LinkOut - more resources