Digital health literacy interventions for older adults: A systematic review and meta-analysis of effects and...

Although digital health literacy interventions for older adults have increased, it remains unclear which components are commonly used, and which may be linked to greater improvement. We conducted systematic review and meta-analysis and used the user- and task-oriented domains of the Transactional Model of eHealth Literacy to develop a theory-informed framework for mapping intervention targets and delivery features. English-language intervention studies published over the past two decades were identified through scientific databases. Twenty-three studies involving 3702 older adults were included, including seven randomized controlled trials (RCTs). Component mapping showed that most interventions targeted knowledge and technological skills, whereas task-oriented features varied in delivery channel, content or resource source, and instructional modality. Five RCTs contributed to the primary comparative meta-analysis, which showed a moderate improvement in digital health literacy favoring intervention groups over control conditions (SMD = 0.47, 95% CI: 0.08-0.86). A supplementary synthesis of uncontrolled within-group pre-post changes also indicated improvement, but these findings were exploratory. Exploratory subgroup analyses suggested larger observed improvements in interventions integrating digital and health-related knowledge and skills than in those focusing on digital competencies alone. No clear subgroup differences were found by delivery channel, content or resource source, instructional modality, or relational support. Comparative evidence suggests that these interventions can improve older adults' digital health literacy, although the limited number of RCTs and substantial heterogeneity warrant caution. The component-level findings are exploratory and require confirmation in comparative studies. Interventions combining health-related knowledge with practical digital skills appear promising and warrant further evaluation in RCTs.