Background

As more people search for health information online, it is critical that they can obtain accurate health information and access healthcare services. Digital health literacy, sometimes referred to as eHealth literacy, is defined by the World Health Organization as the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem. Examples of digital health literacy include being able to find and evaluate health information online, access telehealth services, and communicate with healthcare providers electronically. The dramatic rise of online health information¹ and use of telehealth services² requires a population with the skills to evaluate information, avoid misinformation,³ and access services. 

Digital health literacy requires personal health literacy skills. Personal health literacy is the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others. Digital literacy⁴ is the ability to use information and communication technologies to find, evaluate, create, and communicate information, requiring both cognitive and technical skills.

Digital health literacy is positively associated with health literacy and access to technology.⁵

Higher levels of digital health literacy correlate to more knowledge⁶ of health conditions, and greater self-efficacy in managing chronic health conditions. Higher levels of digital health literacy are also associated with accessing personal health records.⁷

Components of Digital Health Literacy

The Transactional Model of eHealth Literacy⁸ outlines four components of digital health literacy:

1. Functional: Sufficient basic skills in reading and writing to be able to function effectively in everyday situations.
2. Communicative: The ability to collaborate, adapt, and control communication about health with users on social online environments and multimedia.  
3. Critical: The ability to evaluate the credibility, relevance, and risks of sharing and receiving health information on the internet.
4. Transactional: The ability to apply health knowledge gained from the internet across diverse ecological contexts. Transactional literacy is the highest cognitive level of eHealth literacy, meaning it is informed and built upon from all lower-level eHealth literacy dimensions (i.e., critical, communicative, and functional).

Digital Health Literacy and Patient Safety

The impact of digital health literacy on patient outcomes is still an emerging field of research.^9,10 The ability to engage with digital resources is becoming increasingly necessary to find information, communicate with providers, manage appointments, access health records, and participate in health prevention and management interventions. There are many overlaps in the risk factors for low personal and digital health literacy, including age, race/ethnicity, socio-economic status, and educational status, which may lead to widening gaps in health equity.^11,12 As more research is being conducted on the relationship between digital health literacy and outcomes, patients should be screened for digital health literacy with a questionnaire such as the eHealth Literacy Scale (eHEALS) and provided interventions to increase their ability to participate in the health care system and manage their health.¹³

Strategies to Improve Digital Health Literacy

Organizations can foster digital health literacy by applying health literacy best practices to their health promotion materials and telehealth services. The Office of Disease Prevention and Health Promotion recommends writing actionable content, displaying content clearly on the page, organizing content and simplifying navigation, engaging users, and testing your site with individuals with low health literacy. Organizations can also foster digital health literacy by developing materials and training that help patients learn how to find and evaluate health information by identifying reliable sources.

Health systems can promote digital health literacy by learning more about their patients’ access to technology, offering information in different media forms, such as audio for individuals with limited literacy, and providing technical assistance on accessing patient portals and telehealth services.  

Current Context

Digital health literacy is an emerging field. The World Health Organization has developed a Global Strategy on Digital Health that identifies digital health literacy as a “digital determinant of health” and seeks to advance digital health literacy at a population level by identifying core competencies and developing training. The Federal Communications Commission is currently working to support access to digital health through increasing broadband in rural areas. There are a number of educational materials targeted to assist organizations in creating health websites and tools for patients and improving the digital health of patients by educating them on locating and evaluating health information online.

Elizabeth Seidel, MSW
Program Manager
Hartford Institute for Geriatric Nursing
NYU Rory Meyers College of Nursing

Tara Cortes, PhD, RN, FAAN
Professor of Geriatric Nursing
NYU Rory Meyers College of Nursing

Cynthia Chong, MPA
Project Coordinator
Hartford Institute for Geriatric Nursing
NYU Rory Meyers College of Nursing

References

1. Fox S, Duggan M. Health Online 2023: One in three American adults have gone online to figure out a medical condition. Pew Research Center. January 15, 2013. Accessed August 11, 2023. [Available at]
2. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022;49(4):517-530. [Free full text]
3. Swire-Thompson B, Lazer D. Public health and online misinformation: challenges and recommendations. Annu Rev Public Health. 2020;41:433-451. [Free full text]
4. Digital Literacy. ALA Literacy Clearinghouse. Accessed August 11, 2023. [Available at]
5. Lee HY, Jin SW, Henning-Smith C, et al. Role of health literacy in health-related information-seeking behavior online: cross-sectional study. J Med Internet Res. 2021;23(1):e14088. [Free full text]
6. Stellefson ML, Shuster JJ, Chaney BH, et al. Web-based health information seeking and eHealth literacy among patients living with chronic obstructive pulmonary disease (COPD). Health Commun. 2018;33(12):1410-1424. [Free full text]
7. Cheng C, Gearon E, Hawkins M, et al. Digital health literacy as a predictor of awareness, engagement, and use of a national web-based personal health record: population-based survey study. J Med Internet Res. 2022;24(9):e35772. [Free full text]
8. Paige SR, Stellefson M, Krieger JL, et al. Proposing a transactional model of eHealth literacy: concept analysis. J Med Internet Res. 2018;20(10):e10175. [Free full text]
9. Bíró É, Vincze F, Nagy-Pénzes G, et al. Investigation of the relationship of general and digital health literacy with various health-related outcomes. Front Public Health. 2023;11:1229734. [Free full text]
10. Neter E, Brainin E. Association between health literacy, eHealth literacy, and health outcomes among patients with long-term conditions. European Psychologist. 2019; 24(1):68-81. [Available at]
11. Azzopardi-Muscat N, Sørensen K. Towards an equitable digital public health era: promoting equity through a health literacy perspective. Eur J Public Health. 2019;29(Supplement_3):13-17. [Free full text]
12. Jackson DN, Trivedi N, Baur C. Re-prioritizing digital health and health literacy in Healthy People 2030 to affect health equity. Health Commun. 2021;36(10):1155-1162. [Available at]
13. Faux-Nightingale A, Philp F, Chadwick D, et al. Available tools to evaluate digital health literacy and engagement with eHealth resources: a scoping review. Heliyon. 2022;8(8):e10380. [Free full text]