Digital Health Literacy in Elective Open-Heart Surgery Patients: Cross-Sectional Study

Digital health solutions play a key role in health care, but their safe and effective use depends on patients' digital health literacy. While digital health solutions are beneficial for patients with cardiac disease, disparities in digital health literacy may limit access, particularly for patients undergoing cardiac surgery with complex care and psychological challenges. Unaddressed, these disparities could exacerbate inequalities in accessing beneficial digital services. Denmark's advanced digital health care system provides a unique context to evaluate digital health literacy.

This study aimed to assess digital health literacy levels in patients scheduled for elective open-heart surgery and examine associations with sociodemographic factors and concurrent health issues.

We conducted a cross-sectional survey of consecutive patients scheduled for elective open-heart surgery at 3 university hospitals covering approximately two-thirds of Denmark's population. Patients with cognitive impairment or language barriers preventing completion of the questionnaire were excluded. The questionnaire was administered in paper form by medical staff during preoperative consultations. Digital health literacy was assessed using the validated 8-item eHealth Literacy Scale (eHEALS; range 8-40), along with 2 additional questions from the validated Danish version assessing the perceived importance and usefulness of online health information. Sociodemographic data collected included age, gender, cohabitation status, social support for technology use, educational level, and number of concurrent health issues. Descriptive and comparative analyses examined associations between eHEALS scores and sociodemographic variables and health issues. Exploratory subscale analyses evaluated the 3 eHEALS domains-awareness, skills, and ability to evaluate online health information-to identify areas in which patients may require additional support.

Of 576 eligible patients, 313 (54.3%) completed the survey between February 2024 and July 2024. Response rates varied across sites: 71.1% (133/187), 58.5% (134/229), and 28.8% (46/160) in sites 1, 2, and 3, respectively. Nonresponse was primarily due to logistical challenges during preoperative consultations, with only a few patients excluded because of cognitive impairment, language barriers, or refusal. The median eHEALS score was 30 (IQR 27-32), indicating generally high digital health literacy scores (cutoff score ≥26). Scores were negatively correlated with age (Spearman ρ=-0.18; P=.002) and positively associated with educational level (Kruskal-Wallis test: χ22=17.0; P<.001). No substantial associations were observed for gender, cohabitation status, social support for technology use, or number of concurrent health issues. Exploratory subscale analyses suggested that patients felt least confident in evaluating the quality and relevance of online information, highlighting a potential focus for tailored support.

Patients scheduled for elective open-heart surgery generally reported high digital health literacy levels, but challenges remain in critically appraising digital health information. Younger age and higher educational levels were associated with higher self-reported digital health literacy, but the association was modest. This underscores the need for individual assessment to identify patients who may benefit from tailored support.