Choosing the Best Digital Health Literacy Measure for Research: Mixed Methods Study

The global demographic shift towards longer life expectancy and complex health needs is increasing the number of people with chronic diseases, placing pressure on health and care systems. With the digitalization of healthcare, digital Health Literacy (dHL), or the use of digital skills in health, is gaining importance. It involves navigating digital health information, using digital tools effectively, and making informed health decisions. Measuring dHL can help identify gaps and develop strategies to improve dHL and health, ensuring citizens equal opportunity to participate in a digital healthcare system. The European project "The Improving Digital Empowerment for Active and Healthy Living (IDEAHL)" with the objective to empower European Union citizens to use digital instruments to take a more active role in managing their health and well-being creates the base for this overview.

This paper aims to conduct an overview of existing assessment tools for measuring dHL and recommend strategies for choosing relevant assessment tools.

This study was carried out as a mixed method study initiated by a scoping review (10 scientific databases, 14 databases with grey literature and 14 predefined reports) in addition to three papers published after finalisations the literature search in IDEAHL, followed by a qualitative workshop study and a final analysis combining results.

The literature search resulted in 33 papers on dHL instruments, that was analyzed together with three recently published reviews and findings from a workshop with 13 champions (understood as professionals with expertise in HL and dHL) from five countries (Spain, Denmark, Sweden, Australia, and Germany) representing the health sector or health literacy research. Future tools should adapt to the latest trends and technologies, considering attitudes towards digital health and trust in its services. They should identify beneficiaries of digital health services, measure the impact of dHL interventions, and objectively evaluate functional skills. These tools should be evidence-based, validate instruments, interpret dHL results, and capture diverse experiences to reveal health behaviour changes.

The eHealth Literacy Scale (eHEALS), despite being the most frequently utilized tool, has limitations in scope and adaptability. Future tools need to reflect digital trends, encompassing individual skills. However, it is important to note that the 'adequacy' of dHL is context-specific and relies on healthcare systems and the technology provided, particularly the user interface. The focus should be on health improvement, not just elevating dHL levels. A comprehensive approach to dHL assessments addressing diversity and relevance is crucial. Ethical considerations in dHL, including privacy and data security, are important due to potential feelings of shame among those with low literacy levels.