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Digital Health Literacy

Original Editor - Angeliki Chorti Top Contributors - Angeliki Chorti, Kim Jackson, Rujuta Naik and Alexandra Stead

Introduction

Digital Health Literacy (DHL) or e-Health Literacy generally refers to the degree to which individuals have the ability to find, understand and use information and services from electronic sources in order to make health decisions and take appropriate actions.[1] In other words, DHL may combine functional, communicative and critical thinking skills of health literacy (the ability to make health-informed decisions) and digital literacy (the ability to effectively and safely use digital technologies).

In their conceptual model for DHL, Norman and Skinner[1] were the first to propose six domains of skills and abilities to effectively deal with health-related information from electronic sources:

  • Traditional literacy: basic functional literacy skills, e.g. the ability to read and understand text, language skills
  • Information literacy: ability to know how knowledge is structured and used so that it informs other people
  • Scientific literacy: ability to place health-related findings in the right context
  • Media literacy: ability to appraise media information and place it in different contexts
  • Computer literacy: ability to use digital technologies and access electronic health information
  • Health literacy: ability to deal with information in a manner that promotes health decisions

Note: Some authors tend to relate DHL to Health Literacy (HL). Del Giudice et al.[2] suggest that studying or working in the health field leads to a higher functional HL level and this correlates to a greater DHL score. However, some evidence has indicated that DHL and HL should not be used interchangeably.[3] One possible reason for this may be the fact that what is required for these two constructs is different and unique.[3]

Why is DHL important?

Digital health technologies are becoming more common due to their potential to improve healthcare delivery and outcomes. Clinicians and patients are required to have e-Health skills and competencies so that they can take advantage of what digital technologies can offer, and be able to increase the control they can have on their own health by gaining better health-related understanding and management [4]

For patients, this type of informed and active participation is the foundation of the International Classification of Functioning, Disability and Health (ICF) model, and the shift to Person-Centred Care (PCC), concepts that extend beyond a narrow perspective of the patient by considering the whole life of the person.[5][6] Despite this, it must be noted that DHL may not necessarily secure better health outcomes.[7]

For clinicians, lack of digital skills in combination with compromised user friendliness of technology may increase their workload and related distress, result in workflow and documentation problems and lead to significant safety risks. [8][9][10][11]

DHL in the Health Professions

[12]

Despite the suggested importance of Digital Health, the use of digital solutions by health professionals and students is not yet fully satisfactory.[13] [14] Physiotherapists are cautious about implementing digital change. Among the reasons for the low level of adoption of e-Health tools are a lack of familiarity with implemented tools and inadequate training and support. [15] [16] The lack of adequate training in e-Health in physical therapy education is often attributed to negative attitudes towards e-Health which are often driven by a related lack of quality and evidence of an ill-defined concept with unclear ways to use it.[17] Some efforts to create competency frameworks for allied health professions (AHP) have already been addressed (e.g. Digital Health Capability Framework for Allied Health Professionals of the Department of Health, Victoria or AHP Digital Competency Framework in the UK). Many clinicians lack knowledge about the existing framework and report the need for areas for further improvement.[18] It is proposed that attributes required to be taught in a digital health course should see digital health through data, technology multidisciplinary science, application and disciplinary lens.[19]

DHL in Patient Groups

DHL is an important determinant of digital health equity,[20] and trust in digital health information.[21] The eHealth Action Plan 2012-2020 identified the lack of awareness of digital opportunities as one of the barriers to accomplishing health equity and proposed activities to increase citizens' digital health literacy.[22] To date, equal access to healthcare cannot be accomplished and one factor contributing to this is that the overall digital health literacy of populations most in need of accessible healthcare is relatively low.[23][24] However, digital literacy issues due to lack of access and the ability to use digital technology are not the only challenges when dealing with patients and vulnerable groups. Obstacles to gaining benefits from digital services are also connected to the following issues:

  • Security compromise arising from confidentiality problems and lack of trust when using digital platforms
  • Practical issues due to space, acoustic and language barriers
  • Lack of human connection and misunderstandings in situations where face-to-face interactions and non-verbal communication cannot be replaced
  • Lack of awareness of what is available and of value

[20][25]

Validated Assessment Tools

There are numerous validated tools for assessing DHL. Some of them, based on reports from published literature,[7] [26] [27] [28] [29] [30] [31] are listed below. Choosing the most appropriate tool may rely on various factors that dictate the most relevant context. Acceptability, relevance, up-to-date and ethical assessment of DHL for clinical use may also be linked to the involved healthcare and social systems, perceptions about digital technology, scientific advancements and technology specifics. [7]

  • eHealth Literacy Scale (eHEALS): [32][33] [34] [35][36] [37][37] the most commonly used self-reported tool, with various versions [38][39][40] [41]and the first published structured self-report scale, great for a quick look at someone's confidence in digital skills, but with limitations in scope and adaptability
  • eHealth Literacy Questionnaire (eHLQ): [42][43][44] this tool, based on a well-defined a priori eHealth Literacy Framework, is useful for understanding and assessing people's interaction with digital health services.
  • Digital Health Literacy Instrument (DHLI): [45] [46][47] [48]a more comprehensive instrument adding 6 distinct skills i.e. navigational skills, quality of information search, reliability assessment, relevance determination, self-generated content and privacy protection
  • HLS19-DIGI:[49] [50] [51][52] [53] this extended version of the Digital Health Literacy Instrument (DHLI) was originally validated in the massive European Health Literacy Survey (2019-2021) of 28,057 participants from 13 countries as part of the WHO M-POHL network. It has also been translated, modified and validated to suit the needs of the Greek population.[54]
  • eHealth Literacy Assessment (eHLA):[55] [44][56] [57] more comprehensive and adaptable to current trends, assesses context-specific and evolving skills required for DHL, beyond mere technology access

Clinical Bottom Line

Digital technologies are becoming more common. Making the most of what digital technologies can offer requires that clinicians and patients have related competencies. Digital Health Literacy (DHL) or e-Health Literacy generally refers to the degree to which individuals have the ability to find, understand and use information and services from electronic sources in order to make health decisions and take appropriate actions. DHL is related, but not the same as Health Literacy; it requires a different set of skills and poses unique challenges that need to be addressed in order to ensure that patients and health professionals benefit from digital services. Choosing a DHL tool to suit individual needs may not solely rely on factors of scientific robustness; relevant context is essential too to get the most of it.

Resources

European citizens' digital health literacy report

Digital health literacy in general populations - an international comparison

A Comprehensive Analysis of E-Health Literacy Research Focuses and Trends

HELPE. Health Literacy and Digital Health Literacy: concepts and recent advances

IDEAHL: Improving Digital Empowerment for Active Healthy Living. The IDEAHL Consortium. 2023.

References

  1. ↑ 1.0 1.1 Norman C., Skinner H. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res. 2006 Jun 16;8(2):e9. doi: 10.2196/jmir.8.2.e9.
  2. ↑ Del Giudice P., Bravo G., Poletto M., De Odorico A., Conte A., Brunelli L., Arnoldo L., Brusaferro S. Correlation Between eHealth Literacy and Health Literacy Using the eHealth Literacy Scale and Real-Life Experiences in the Health Sector as a Proxy Measure of Functional Health Literacy: Cross-Sectional Web-Based Survey. J Med Internet Res. 2018 Oct 31;20(10):e281.
  3. ↑ 3.0 3.1 Monkman H., Kushniruk A., Barnett J., Borycki E., Greiner L., Sheets D. Are Health Literacy and eHealth Literacy the Same or Different? Stud Health Technol Inform. 2017;245:178-182.
  4. ↑ Busse T. ,Nitsche J., Kernebeck S., Jux C., Weitz J., Ehlers J.,Bork U. Approaches to Improvement of Digital Health Literacy (eHL) in the Context of Person-Centered Care. Int J Environ Res Public Health. 2022 Jul; 19(14): 8309.
  5. ↑ Håkansson Eklund J., Holmström I., Kumlin T., Kaminsky E., Skoglund K., Höglander J., Sundler A., Condén E., Summer M. "Same same or different?" A review of reviews of person-centered and patient-centered care. Patient Educ Couns 2019 Jan;102(1):3-11.
  6. ↑ https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1472706/full
  7. ↑ 7.0 7.1 7.2 Thorup CB, Uitto M, Butler-Henderson K, Wamala-Andersson S, Hoffrén-Mikkola M, Schack Thoft D, Korsbakke Emtekær Hæsum L, Irrazabal G, Pruneda González L, Valkama K. Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study. J Med Internet Res. 2025 Apr 8;27:e59807.
  8. ↑ Wosny M, Strasser LM, Hastings J. Experience of Health Care Professionals Using Digital Tools in the Hospital: Qualitative Systematic Review. JMIR Hum Factors. 2023 Oct 17;10:e50357.
  9. ↑ Onyeabor US, Onwuasoigwe O, Okenwa WO, Schaaf T, Pinkwart N, Balzer F. Assessing the usability and performance of digital healthcare systems in Nigerian teaching hospitals: Challenges and future directions. Digit Health. 2025 May 21;11:20552076251341089.
  10. ↑ Olakotan O, Samuriwo R, Ismaila H, Atiku S. Usability Challenges in Electronic Health Records: Impact on Documentation Burden and Clinical Workflow: A Scoping Review. J Eval Clin Pract. 2025 Jun;31(4):e70189.
  11. ↑ Cahill M, Cleary BJ, Cullinan S. The influence of electronic health record design on usability and medication safety: systematic review. BMC Health Serv Res. 2025 Jan 6;25(1):31.
  12. ↑ Image by: <a href="https://www.freepik.com/free-vector/online-doctor-concept-illustration_7709378.htm#query=digital%20health&position=12&from_view=search&track=sph">Image by storyset</a> on Freepik [accessed 20-12-2022]
  13. ↑ Kuek A., Hakkennes S. Healthcare staff digital literacy levels and their attitudes towards information systems. Health Informatics Journal 2020; 26(1):592-612.
  14. ↑ Nationwide Assessment of Knowledge and Perception in Reinforcing Telemedicine in the Age of COVID-19 Among Medical Students From Pakistan. Front Public Health 2022; 10: 845415.
  15. ↑ Postolache G., Oliveira R., Postolache O. Contextual Design of ICT for Physiotherapy: Toward Knowledge and Innovation Ecosystem. EAI Endorsed Transactions on Creative Technologies;17(13):e3.
  16. ↑ Blumenthal J., Wilkinson A., Chignell M. Physiotherapists’ and physiotherapy students’ perspectives on the use of mobile or wearable technology in their practice. Physiotherapy Canada 2018; 70: 251–261.
  17. ↑ Wentink M., Siemonsma P., van Bodegom-vos L., de Kloet A., Verhoef J., Vlieland T., Meesters J. Teachers’ and students' perceptions on barriers and facilitators for eHealth education in the curriculum of functional exercise and physical therapy: a focus groups study. BMC Med Educ. 2019; 19:1–8.
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  19. ↑ Chevan J, Pak SS, Wilkinson SG, Toole E. Building a Foundation for Health Informatics Content in Physical Therapy Education Through Concept Analysis and Concept Mapping. Journal of Physical Therapy Education. 2023 Mar 1;37(1):24-30.
  20. ↑ 20.0 20.1 Kaihlanen A-M., Virtanen L., Buchert U., Safarov N., Valkonen P., Hietapakka L., Hörhammer I., Kujala S., Kouvonen A., Heponiemi T. Towards digital health equity - a qualitative study of the challenges experienced by vulnerable groups in using digital health services in the COVID-19 era. BMC Health Services Research 2022; 22:188.
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  22. ↑ European Commission. European Citizens' Digital Health Literacy Report. October 2014.
  23. ↑ Leader A., Capparella L., Waldman L., Cammy R., Petok A., Dean R., Shimada A., Yocavitch L., Rising C., Garber G., Worster B., Dicker A. Digital Literacy at an Urban Cancer Center: Implications for Technology Use and Vulnerable Patients. JCO Clin Cancer Inform 2021; 5:872-880.
  24. ↑ Liu S., Zhao H., Fu J., Kong D., Zhong Z., Hong Y.,Tan J., Luo Y. Current status and influencing factors of digital health literacy among community-dwelling older adults in Southwest China: a cross-sectional study. BMC Public Health 2022; 22:996.
  25. ↑ Almeida Fernades L. Digital Health Literacy: Paving the inclusivity road. Powerpoint presentation in Basics of Digital Health, Nov 2022.
  26. ↑ Lee J, Lee EH, Chae D. eHealth Literacy Instruments: Systematic Review of Measurement Properties. J Med Internet Res. 2021 Nov 15;23(11):e30644.
  27. ↑ Faux-Nightingale A, Philp F, Chadwick D, Singh B, Pandyan A. Available tools to evaluate digital health literacy and engagement with eHealth resources: A scoping review. Heliyon. 2022 Aug 23;8(8):e10380.
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  49. ↑ Pelikan JM, Link T, Straßmayr C, Waldherr K, Alfers T, Bøggild H, Griebler R, Lopatina M, Mikšová D, Nielsen MG, Peer S, Vrdelja M; HLS19 Consortium of the WHO Action Network M-POHL. Measuring Comprehensive, General Health Literacy in the General Adult Population: The Development and Validation of the HLS19-Q12 Instrument in Seventeen Countries. Int J Environ Res Public Health. 2022 Oct 29;19(21):14129.
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