Digital Health Literacy

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

Introduction[edit | edit source]

Digital Health Literacy (DHL) or e-Health Literacy 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 their conceptual model for DHL, Norman and Skinner [1] 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 research 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?[edit | edit source]

Digital health technologies are lately 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] This type of informed and active participation of patients is the foundation of the International Classification of Functioning, Disability and Health (ICF) model, and the shift to Person-Centered Care (PCC), concepts that extend beyond a narrow perspective of the patient by considering the whole life of the person.[5]

DHL in the health professions[edit | edit source]

Despite the suggested importance of Digital Health, the use of digital solutions by health professionals and students is not yet fully satisfactory. [7] [8] 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. [9] [10] 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. [11]There is a lack of competency framework for allied health professions to include in a curriculum and must be addressed. However, there are attributes required to be taught in a digital health course which sees digital health through data, technology multidisciplinary science, application and disciplinary lens. [12]

DHL in patient groups[edit | edit source]

DHL is an important determinant of digital health equity. [13] 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. [14] 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. [15][16] 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


Clinical bottom line[edit | edit source]

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 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.

Resources[edit | edit source]

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

References[edit | edit source]

  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. Image by: <a href="">Image by storyset</a> on Freepik [accessed 20-12-2022]
  7. Kuek A., Hakkennes S. Healthcare staff digital literacy levels and their attitudes towards information systems. Health Informatics Journal 2020; 26(1):592-612.
  8. 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.
  9. 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.
  10. 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.
  11. 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.
  12. 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.
  13. 13.0 13.1 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.
  14. European Commission. European Citizens' Digital Health Literacy Report. October 2014.
  15. 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.
  16. 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.
  17. Almeida Fernades L. Digital Health Literacy: Paving the inclusivity road. Powerpoint presentation in Basics of Digital Health, Nov 2022.