Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries
IntroductionDigital 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.MethodsUsing a concept validation approach, the aim of the...
Saved in:
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-03-01
|
| Series: | Frontiers in Public Health |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1472706/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849394353026367488 |
|---|---|
| author | Diane Levin-Zamir Diane Levin-Zamir Stephan Van den Broucke Éva Bíró Henrik Bøggild Lucy Bruton Saskia Maria De Gani Saskia Maria De Gani Hanne Søberg Finbråten Sarah Gibney Robert Griebler Lennert Griese Øystein Guttersrud Øystein Guttersrud Zuzana Klocháňová Zdenek Kucera Christopher Le Christopher Le Thomas Link Julien Mancini Dominika Miksova Doris Schaeffer Carlota Ribeiro da Silva Kristine Sørensen Christa Straßmayr Miguel Telo de Arriaga Miguel Telo de Arriaga Mitja Vrdelja Jürgen Pelikan |
| author_facet | Diane Levin-Zamir Diane Levin-Zamir Stephan Van den Broucke Éva Bíró Henrik Bøggild Lucy Bruton Saskia Maria De Gani Saskia Maria De Gani Hanne Søberg Finbråten Sarah Gibney Robert Griebler Lennert Griese Øystein Guttersrud Øystein Guttersrud Zuzana Klocháňová Zdenek Kucera Christopher Le Christopher Le Thomas Link Julien Mancini Dominika Miksova Doris Schaeffer Carlota Ribeiro da Silva Kristine Sørensen Christa Straßmayr Miguel Telo de Arriaga Miguel Telo de Arriaga Mitja Vrdelja Jürgen Pelikan |
| author_sort | Diane Levin-Zamir |
| collection | DOAJ |
| description | IntroductionDigital 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.MethodsUsing 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).ResultsThe 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.DiscussionThe 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. |
| format | Article |
| id | doaj-art-aaacb702e0064b5b8b6d93d7491eab6a |
| institution | Kabale University |
| issn | 2296-2565 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj-art-aaacb702e0064b5b8b6d93d7491eab6a2025-08-20T03:40:00ZengFrontiers Media S.A.Frontiers in Public Health2296-25652025-03-011310.3389/fpubh.2025.14727061472706Measuring digital health literacy and its associations with determinants and health outcomes in 13 countriesDiane Levin-Zamir0Diane Levin-Zamir1Stephan Van den Broucke2Éva Bíró3Henrik Bøggild4Lucy Bruton5Saskia Maria De Gani6Saskia Maria De Gani7Hanne Søberg Finbråten8Sarah Gibney9Robert Griebler10Lennert Griese11Øystein Guttersrud12Øystein Guttersrud13Zuzana Klocháňová14Zdenek Kucera15Christopher Le16Christopher Le17Thomas Link18Julien Mancini19Dominika Miksova20Doris Schaeffer21Carlota Ribeiro da Silva22Kristine Sørensen23Christa Straßmayr24Miguel Telo de Arriaga25Miguel Telo de Arriaga26Mitja Vrdelja27Jürgen Pelikan28School of Public Health, University of Haifa, Haifa, IsraelDepartment of Health Education and Promotion, Clalit Health Services, Tel Aviv, IsraelPsychological Sciences Research Institute, Université Catholique de Louvain, Louvain-la-Neuve, BelgiumDepartment of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, HungaryPublic Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, DenmarkDepartment of Health, Dublin, IrelandCareum Foundation, Careum Center for Health Literacy, Zurich, SwitzerlandCareum School of Health, Kalaidos University of Applied Sciences, Zurich, SwitzerlandDepartment of Health and Nursing Sciences, Faculty of Social and Health Sciences, University of Inland Norway, Elverum, NorwayDepartment of Health, Dublin, Ireland0Competence Centre Health Promotion and Healthcare, Austrian National Public Health Institute, Vienna, Austria1School of Public Health, Bielefeld University, Bielefeld, Germany2Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, Oslo, Norway3The Norwegian Centre for Science Education Department, The Faculty of Mathematics and Natural Sciences, University of Oslo, Oslo, Norway4Department of Public Health, Faculty of Health Care and Social Work, Trnava University Trnava, Trnava, Czechia5Czech Health Literacy Institute, Prague, CzechiaDepartment of Health and Nursing Sciences, Faculty of Social and Health Sciences, University of Inland Norway, Elverum, Norway6Department of Community Health, The Norwegian Directorate of Health, Oslo, Norway7Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, Vienna, Austria8Aix Marseille University APHM INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, Marseille, France7Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, Vienna, Austria1School of Public Health, Bielefeld University, Bielefeld, Germany9Direção-Geral da Saúde, Lisbon, Portugal0Global Health Literacy Academy, Risskov, Denmark0Competence Centre Health Promotion and Healthcare, Austrian National Public Health Institute, Vienna, Austria9Direção-Geral da Saúde, Lisbon, Portugal1Católica Research Centre for Psychological, Family and Social Well-Being, Universidade Católica Portuguesa, Lisbon, Portugal2Communication Unit, National Institute of Public Health, Ljubljana, Slovenia0Competence Centre Health Promotion and Healthcare, Austrian National Public Health Institute, Vienna, AustriaIntroductionDigital 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.MethodsUsing 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).ResultsThe 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.DiscussionThe 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.https://www.frontiersin.org/articles/10.3389/fpubh.2025.1472706/fulldigital health literacyeHealth literacyHLS19digital health literacy measurementmeasurement scale validationhealth information technology literacy |
| spellingShingle | Diane Levin-Zamir Diane Levin-Zamir Stephan Van den Broucke Éva Bíró Henrik Bøggild Lucy Bruton Saskia Maria De Gani Saskia Maria De Gani Hanne Søberg Finbråten Sarah Gibney Robert Griebler Lennert Griese Øystein Guttersrud Øystein Guttersrud Zuzana Klocháňová Zdenek Kucera Christopher Le Christopher Le Thomas Link Julien Mancini Dominika Miksova Doris Schaeffer Carlota Ribeiro da Silva Kristine Sørensen Christa Straßmayr Miguel Telo de Arriaga Miguel Telo de Arriaga Mitja Vrdelja Jürgen Pelikan Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries Frontiers in Public Health digital health literacy eHealth literacy HLS19 digital health literacy measurement measurement scale validation health information technology literacy |
| title | Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries |
| title_full | Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries |
| title_fullStr | Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries |
| title_full_unstemmed | Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries |
| title_short | Measuring digital health literacy and its associations with determinants and health outcomes in 13 countries |
| title_sort | measuring digital health literacy and its associations with determinants and health outcomes in 13 countries |
| topic | digital health literacy eHealth literacy HLS19 digital health literacy measurement measurement scale validation health information technology literacy |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2025.1472706/full |
| work_keys_str_mv | AT dianelevinzamir measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT dianelevinzamir measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT stephanvandenbroucke measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT evabiro measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT henrikbøggild measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT lucybruton measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT saskiamariadegani measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT saskiamariadegani measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT hannesøbergfinbraten measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT sarahgibney measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT robertgriebler measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT lennertgriese measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT øysteinguttersrud measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT øysteinguttersrud measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT zuzanaklochanova measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT zdenekkucera measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT christopherle measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT christopherle measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT thomaslink measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT julienmancini measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT dominikamiksova measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT dorisschaeffer measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT carlotaribeirodasilva measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT kristinesørensen measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT christastraßmayr measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT migueltelodearriaga measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT migueltelodearriaga measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT mitjavrdelja measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries AT jurgenpelikan measuringdigitalhealthliteracyanditsassociationswithdeterminantsandhealthoutcomesin13countries |