Social Participation and Digital Health Literacy Among Older Adults in the Community: The Mediating Roles of Self-Efficacy and Technophobia.

BackgroundExperts agree that the promotion of (digital) health literacy should be an integral part of the school curriculum. However, promoting (digital) health literacy within the German school system is difficult because (digital) health education is not a mandatory school subject in all the German states. Therefore, experts suggest that (digital) health literacy could be addressed as part of the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).ObjectiveThe goal of this study was to evaluate a newly developed e-learning course that was designed to improve (digital) health literacy in school-age children and concurrently to teach skills specified in the mandatory framework for digital education and digital literacy in schools. It was hypothesized that participants’ health literacy and digital health literacy levels would be higher after completing the e-learning course than they were before doing the course. Furthermore, it was hypothesized that after completing the e-learning course, participants’ subjective and objective knowledge in the domain of (digital) health literacy would be higher than it was before doing the course.MethodsThe pre-post measurement study was conducted online. After participants (N=323) gave their informed consent to participate in the study, they provided demographic information and answered all measures (premeasurement). Following this, participants had 7 days to complete the e-learning course. After finishing the e-learning course, participants answered all the measures again (postmeasurement).ResultsTo test the hypotheses, Bayesian paired samples t tests (1-sided) were conducted. After completing the e-learning course, participants showed higher health literacy levels. Specifically, they showed higher competency levels in the domains of theoretical knowledge (Bayes factor [BF]–0=676,000; δ=–0.316), practical knowledge (BF–0=92,300; δ=–0.294), critical thinking (BF–0=7.42e+13; δ=–0.482), self-awareness (BF–0=11,500,000; δ=–0.345), and citizenship (BF–0=266,000; δ=–0.306). Furthermore, participants achieved higher digital health literacy levels. Specifically, they achieved higher competency levels in the domains of information searching (BF–0=2.339; δ=–0.135), evaluating reliability (BF–0=2.03e+11; δ=–0.434), and determining relevance (BF–0=316,000; δ=–0.308). Moreover, participants demonstrated higher subjective (BF–0=3.58e+82; δ=–1.515) and objective knowledge (BF–0=3.82e+97; δ=–1.758) in the domain of (digital) health literacy.ConclusionsThe newly designed e-learning course provides an easy way for schools and teachers from all German states to integrate (digital) health literacy education into their school curriculums and lessons. The evaluated course is especially attractive because it was designed to improve (digital) health literacy and at the same time to teach skills specified in the mandatory framework for digital education and digital literacy in schools developed by the German Conference on Education Ministries and Cultural Affairs (Kultusministerkonferenz).

HighlightsWhat are the main findings?Among 94 surgical inpatients, 25–27% showed inadequate digital or navigational health literacy.Digital health literacy declined significantly across age groups (p = 0.038), while navigational literacy varied widely without age-related differences (p = 0.239).Emergency surgery was independently associated with lower navigational literacy (β = −31.07; p = 0.018).Digital and navigational literacy were strongly correlated (ρ = 0.86), indicating overlapping competencies.What are the implications of the main findings?As healthcare increasingly shifts toward digital models, deficits in digital and navigational literacy may exacerbate inequities and hinder safe post-discharge transitions.Developing age-adapted and context-sensitive strategies—particularly for patients undergoing emergency surgery—is essential to promote equity and prevent digital exclusion.Background/Objectives: The digitalization of healthcare in general, and particularly of surgical care, increasingly requires patients to navigate online information and digital follow-up systems. Limited digital or navigational health literacy may hinder safe recovery and exacerbate health inequities. This study aimed to assess levels of digital and navigational health literacy and their associations in a sample of surgical patients. Methods: A cross-sectional study was conducted with ninety-four adults undergoing elective or emergency surgery, using the validated HLS19-DIGI (digital health literacy) and HLS19-NAV (navigational health literacy) instruments. Data collection took place between March 2025, and 28 August 2025, at a hospital in the Lisbon district. Descriptive analyses, bivariate analysis, and multiple regression were used to identify sociodemographic and clinical predictors. Results: Digital literacy varied significantly across age groups (p = 0.038), with median scores declining from 87.5 (31–45 years) to 31.2 (>65 years). Navigational literacy was lower in emergency versus elective surgery patients (41.7 vs. 83.3; p = 0.036). In adjusted models, self-employment predicted lower digital literacy (β = −36.06, p = 0.009), while emergency surgery remained the only predictor of navigational literacy (β = −31.07, p = 0.018). Digital and navigational literacy were strongly correlated (ρ = 0.859). Conclusions: The surgical patients in this study demonstrated marked literacy deficits, particularly older adults and those undergoing emergency procedures. Digital and navigational literacy appear to reflect overlapping competencies. As healthcare shifts toward digital models, it is essential to develop age-adapted strategies to promote equity and prevent exclusion.

Background With the development of digital devices in the health field, digital health literacy has become an important issue in promoting and protecting people’s health. Digital health literacy was measured in a representative sample of the French adult population in order to assess its level and to identify the socio-demographic characteristics of individuals with the lowest literacy levels. Comparisons with works carried out in other European countries as well as implications for the implementation of digital interventions will be discussed. Methods Digital health literacy was assed using the HLS19-DIGI-HI Instrument. This 8-item scale measuring the skills related to dealing with digital health information was introduced in the 2023 Health Barometer survey, conducted by the French national public health agency. The survey included French-speaking individuals living in France, aged 18-85, selected through randomly generated phone numbers. 3007 persons were interviewed using a computer assisted telephone interview. A continuous score and categories were calculated to determine the level of Digital Health Literacy. Their associations with sociodemographic characteristics were studied using univariate and multivariate analysis. Results 1902 persons declared they used internet to search information or advice on health on internet in the last 12 months and completed the Digital health literacy questionnaire. 61 % of these individuals have a low level of digital health literacy (29 % “inadequate” and 32% “problematic”). Multiple sociodemographic characteristics were associated with lower levels of literacy in univariate and multivariate analysis. Conclusions These results are useful to better understand and assess the digital health literacy of the population according to their socio-demographic characteristics. They will provide a knowledge base to implement web-based interventions for promoting targeted digital health interventions, according to targeted audiences. Key messages • This study in large random sample of the French population showed frequent difficulties to deal with online health information. • Multiple sociodemographic characteristics were associated with digital health literacy and can help to support implementation of targeted digital health interventions.

Purpose: This study aimed to examine the level of digital health literacy and identify factors associated with digital health literacy among older adults living alone in South Korea. Methods: A cross-sectional study was conducted on 140 older adults aged 65 and above who live alone. Descriptive statistics and non-parametric methods were used to explore the relationship between digital health literacy and independent variables. A generalized linear model was used to identify factors associated with digital health literacy. Results: Among 140 smartphone-owning older adults living alone, 52.1% were using the Internet via digital devices, and the participants’ average digital health literacy score was 6.64±7.46. Univariate analysis results showed significant differences in digital health literacy according to age, education level, and multimorbidity. The factors associated with digital health literacy were identified as gender (B=−0.36, p=.031), age (B=−0.06, p<.001), education level (B=0.12, p<.001), and sleep problems (B=−0.06, p=.006). Conclusion: Despite widespread Internet and smartphone use, older adults living alone with chronic diseases showed low levels of digital health literacy, which were significantly associated with gender, age, education level, and sleep problems. Enhancing digital health literacy among vulnerable populations is crucial for the effective implementation of digital health services. Collaborative efforts, including tailored digital health interventions to enhance the digital health literacy of vulnerable populations and supportive policies, are essential to bridge the digital divide and promote health equity.

Introduction Appropriate nutrition and healthy lifestyles are key elements in the prevention of non-communicable diseases and in promoting individual well-being. In this context, health and digital literacy are essential tools to foster people’s empowerment in managing their own health. Universities, as environments with a high concentration of young people and professionals, play a strategic role in health promotion. They have the opportunity to optimize the health literacy of their students and empower them to make informed decisions for themselves and their living environments [1]. Health Literacy, meaning the ability of individuals to meet the complex demands of health in a modern society, has been associated with better health decision-making and is considered a key social determinant of healthier behaviors. Moreover, in the field of nutrition, this competency affects food selection and preparation processes and, more broadly, eating habits, thus contributing to improved health and well-being of individuals [2]. For this reason, it is important to investigate Health Literacy as well as eHealth (defined as the use of information technologies in support of health and related fields) and Digital Health Literacy, all of which are increasingly important in Public Health. Objectives The ALFADIET study aims to analyze eating habits, adherence to the Mediterranean Diet, lifestyles, and levels of Health and Digital Health Literacy among students, faculty, and administrative staff of the University of Catania and the University of Palermo. Methods The population of the “ALFADIET” study will include students, from various degree programs and academic years, as well as teaching and non-teaching staff at the University of Catania and the University of Palermo. The study is based on an innovative real-time data collection methodology using the mobile Ecological Momentary Assessment (mEMA), aimed at capturing participants' daily behaviors. A web-based survey will be designed to collect basic demographic data and additional information. The study will use an updated, specially designed version of the HEALTHY-UNICT web app, customized and developed at the University of Catania [3]. This application will allow for the administration of validated questionnaires assessing dietary habits, behavioral factors, and health literacy. The information collected will include anthropometric variables, lifestyles (including smoking and physical activity), emotions, and demographic characteristics. The survey will be conducted on a representative sample of students, teaching and non-teaching staff, through the use of an innovative mEMA application, specially developed by an interdisciplinary team to meet the specific objectives of the study. Results The preliminary findings derive from a pilot study conducted on a small sample of 27 participants from the University of Catania, including students (74.1%), faculty members (18.5%), and administrative/technical staff (7.4%). The majority were female (81.5%), with a median age of 24 years. Among students, 70% were enrolled on schedule with their academic plan, and 50% lived away from their university location. A total of 92.6% of participants reported no significant medical conditions, and 88.9% did not report any food intolerances. Regarding lifestyle habits, 81.5% reported using multivitamin and multimineral supplements, 77.8% were non-smokers, and 88.9% preferred white meat (e.g., chicken, turkey, rabbit) over red meat. Most participants (63%) slept between 7 and 9 hours per night. Psychophysical issues impacting daily activities were reported as moderately difficult by 37% of respondents, very difficult by 14.8%, and extremely difficult by one participant, while 44.4% reported no difficulties. As for digital health literacy, 55.6% stated they were very capable of finding health-related information online, 51.9% felt very capable of knowing where to look for it, and 44.4% felt very capable of evaluating the quality of such information. Additionally, 48.1% reported being very capable of distinguishing between high- and low-quality health information. However, only 29.6% felt very confident using that information to make health-related decisions. Conclusions This pilot study provides an initial overview of dietary habits, lifestyle behaviors, and levels of health and digital health literacy among the university population, though based on a small sample. The data collected will help identify factors associated with greater adherence to the Mediterranean Diet and higher levels of health and digital health literacy, supporting the identification of target groups for future health promotion interventions. Moreover, the study serves to test the effectiveness of innovative digital tools for real-time behavioral data collection. The future evidence will serve as a foundation for developing personalized, sustainable, and replicable strategies aimed at improving health and fostering empowerment within the academic community.

Digital health literacy has emerged as a critical skill set to navigate the digital age. This review sought to broadly summarize the literature on associations between digital health literacy and (1) sociodemographic characteristics, (2) health resource use, and (3) health outcomes in the general population, patient groups, or parent or caregiver groups. A rapid review of literature published between January 2016 and May 2022 was conducted through a search of 4 web-based databases. Articles were included on the basis of the following keywords: "measured digital health literacy," "digital literacy," "ehealth literacy," "e-health literacy," "electronic health literacy," or "internet health literacy" in adult populations; participants were from countries where English was the primary language; studies had to be cross-sectional, longitudinal, prospective, or retrospective, and published in English. Thirty-six articles met the inclusion criteria. Evidence on the associations between digital health literacy and sociodemographic characteristics varied (27/36, 75% included studies), with higher education (16/21, 76.2% studies that examined the association) and younger age (12/21, 57.1% studies) tending to predict higher digital health literacy; however, other studies found no associations. No differences between genders were found across the majority of studies. Evidence across ethnic groups was too limited to draw conclusions; some studies showed that those from racial and ethnic minority groups had higher digital health literacy than White individuals, while other studies showed no associations. Higher digital health literacy was associated with digital health resource use in the majority of studies (20/36, 55.6%) that examined this relationship. In addition, higher digital health literacy was also associated with health outcomes across 3 areas (psychosocial outcomes; chronic disease and health management behaviors; and physical outcomes) across 17 included studies (17/36, 47.2%) that explored these relationships. However, not all studies on the relationship among digital health literacy and health resource use and health outcomes were in the expected direction. The review presents mixed results regarding the relationship between digital health literacy and sociodemographic characteristics, although studies broadly found that increased digital health literacy was positively associated with improved health outcomes and behaviors. Further investigations of digital health literacy on chronic disease outcomes are needed, particularly across diverse groups. Empowering individuals with the skills to critically access and appraise reliable health information on digital platforms and devices is critical, given emerging evidence that suggests that those with low digital health literacy seek health information from unreliable sources. Identifying cost-effective strategies to rapidly assess and enhance digital health literacy capacities across community settings thus warrants continued investigation.

BackgroundWearable technologies have the potential to support health promotion and disease prevention. However, it remains unclear how the role of social determinants of health (SDoH) and digital determinants of health (DDoH) plays in this context.ObjectiveThis study investigates differences in sociodemographic factors and digital health literacy between wearable users and non-users, whether the association with wearable use varies across age groups and its potential mediator.MethodsA cross-sectional nationwide telephone survey was conducted in November 2022 in a panel of adult internet users in Germany. Assessments included self-reported wearable use, sociodemographic factors (sex, age, education, household size and income, and residence region), and digital health literacy (measured with the eHealth Literacy Scale, eHEALS). Associations between wearable use, sociodemographic factors and digital health literacy were analyzed using binomial logistic regression models in the total sample and with age group stratification, with a supplementary mediation analysis examining digital health literacy as a mediator in the relationship between age and wearable use.ResultsOverall, 24% (223/932) of participants (52% male, mean age 55.6 years) reported using wearables for health. Wearable use was lower among participants aged 65 and above, with lower educational attainment, living in 1–2 person households, with below-average household income, and residing in smaller cities or former East Germany. Wearable use prevalence is substantially lower in older age groups (18–40: 36%; 41–64: 26%; 65+:14%). Wearable users reported higher levels of digital health literacy (mean: 30.7, SD = 5) than non-users (mean: 28.3, SD = 6). Stratified analyses indicate that the association between digital health literacy and wearable use varies by age group, with significant positive association observed in older age groups (OR = 1.00, 95% CI: 0.94 to 1.07 in age group 18–40; OR = 1.07, 95% CI: 1.03 to 1.12 in age group 41–64; OR = 1.11, 95% CI: 1.04 to 1.19 in age group 65+). Mediation analysis indicated that digital health literacy partially mediates the relationship between age and wearable use (indirect effect: coefficient = -0.0156, 95% CI: -0.0244 to -0.00791, p <.001).ConclusionsThis study indicates sociodemographic disparities in wearable use among the German population and differences in digital health literacy between wearable users and non-users. A generational divide in wearable use was identified, with older adults being less likely to embrace this technology. This was especially true for older adults with lower digital health literacy. Future public health initiatives employing health technologies should take SDoH and DDoH into consideration to ensure effective and equitable impacts.

In the context of aging and digitalization, the development and application of digital health can help meet the growing health needs of older adults. Improving digital health literacy of older adults may be an effective way to alleviate the shortage of public health resources and improve their health-related quality of life (HRQoL). However, the impact of digital health literacy on HRQoL in older adults and the underlying mechanism remain unclear. This study intends to explore whether digital health literacy has an effect on HRQoL in community-dwelling older adults, and whether health-promoting lifestyle plays a mediating role between digital health literacy and HRQoL, while providing a theoretical basis for the scientific construction of HRQoL intervention programs for older adults. The cross-sectional study was conducted in Chongqing, China from September 2020 to April 2021. 572 community-dwelling older adults were surveyed by stratified sampling. Data on sociodemographic characteristics, digital health literacy, health-promoting lifestyle and HRQoL were collected. Univariate analysis was used to compare the differences in HRQoL among community-dwelling older adults with different sociodemographic characteristics. Pearson correlation analysis was used to explore the correlation between digital health literacy, health-promoting lifestyle and HRQoL. SPSS PROCESS macro was used to examine the mediating effect of health-promoting lifestyle between digital health literacy and HRQoL. The mean score of HRQoL was 97.97 (SD 11.45). Univariate analysis showed that there were statistically significant differences in HRQoL among community-dwelling older adults with different gender, age, educational level, marital status, and monthly household income per capita (p < 0.05). There were positive correlations between digital health literacy, health-promoting lifestyle and HRQoL, with correlation coefficients ranging from 0.416 to 0.706 (p < 0.001). Digital health literacy was positively associated with HRQoL (β = 0.210, p < 0.001), and health-promoting lifestyle mediated the relationship between digital health literacy and HRQoL, with an indirect effect of 0.175 (95% Bootstrap CI 0.135-0.214). Digital health literacy can affect HRQoL through the mediating effect of health-promoting lifestyle. It is suggested that relevant management institutions, communities and families should strengthen the cultivation of the digital health literacy of older adults, promote their development of health-promoting lifestyle, and ultimately improve HRQoL.

Digital health literacy describes an individual's ability to use digital information and tools to improve their own health. Understanding how digital health literacy varies across populations could help improve health equity. However, the determinants of digital health literacy have been scarcely evaluated. This study aims to assess the levels of digital health literacy in 4 countries (United Kingdom, Sweden, Italy, and Germany) and explore potential associations between digital health literacy and demographic characteristics and self-perceived health status. A cross-sectional online survey was disseminated to participants from the United Kingdom, Italy, Germany, and Sweden in December 2020. Digital health literacy was self-reported using the validated eHealth Literacy Scale (eHEALS; range: 0-40); low digital health literacy has been previously defined as an eHEALS score<26. Participant characteristics collected were sex, age group, ethnicity, country, and perceived overall health status. A multivariable linear regression analysis was performed to explore associations between these variables and digital health literacy. A total of 6331 participants were included (51.7% female, n=3272). The mean eHEALS score was 29.2 (SD 6.8). Participant age, sex, health status, and country of residence were included in the final multivariable model. Compared to the 45- to 54-year age group, the 55 years and older age group had lower digital health literacy (β=-1.0; 95% CI -1.4 to -0.5; P<.001), while digital health literacy was higher in those aged 25-34 years (β=0.9; 95% CI 0.3-1.5; P=.002) and 35-44 years (β=0.6; 95% CI 0.1-1.2; P=.03). Better health status was associated with greater digital health literacy (β=0.3; 95% CI 0.2-0.4; P<.001). Compared to participants from Germany, those from the United Kingdom (β=2.1; 95% CI 1.7-2.5; P<.001) and Sweden (β=2.9; 95% CI 2.4-3.4; P<.001) had higher digital health literacy scores, while there was no difference with Italian participants (P=.399). Sex and ethnicity did not have any significant effect on digital health literacy. This study found significant variations in digital health literacy by age, health status, and country of residence. Targeted educational programs for vulnerable groups, particularly those of older age and poorer health status, are essential. Policies fostering accessible digital health solutions and mitigating health technology-related uncertainties for these populations are crucial for achieving optimal health outcomes.

Background: Health literacy is increasingly recognized as an essential determinant of health, readiness, and safety in the military, especially as health systems become more digitalized. However, evidence on general and digital health literacy in the armed forces remains limited. This study examined levels of general health literacy and digital health literacy among Lithuanian soldiers and explored their associations with sociodemographic, service-related, and health characteristics. Methods: A cross-sectional survey was conducted among 603 military personnel serving in the national armed forces. General and digital health literacy were measured with HLS19-Q12 and HLS19-DIGI. Data on sociodemographic and military characteristics, self-rated health, and self-reported long-term illnesses were collected. Descriptive statistics, correlation analyses, and multivariable regression models were used to analyze the data. Results: The sample was predominantly male (81.9%) with a mean age of 39.08 years (SD = 8.89). The mean general health literacy score was 80.1 (SD = 19.17), whereas the mean digital health literacy score was 67.81 (SD = 30.05). Overall, 45.0% of soldiers had excellent general health literacy, and 12.0% had inadequate general health literacy; 42.1% had excellent digital health literacy, and 35% had inadequate digital health literacy. Higher levels of health literacy were positively associated with better self-rated health and social status. No statistically significant associations were found between health literacy and gender, age, education, length of service, type of military service, and self-reported long-term health complaints. Conclusions: Military personnel in this study displayed relatively high general health literacy, yet digital health literacy was lower and more unevenly distributed, indicating a potential vulnerability for health outcomes as access to information, communication, and care increasingly relies on digital platforms. Given the cross-sectional design, causal inferences cannot be drawn. Military health services may build on existing health literacy strengths while considering strategies to address digital health literacy gaps (e.g., targeted training, tailored support, and user-friendly digital solutions, including service design), acknowledging that feasibility and implementation depend on organizational context and resources.

BackgroundIncreasing reliance on digital health resources can create disparities among older patients. Understanding health-related, mobility, and socioeconomic factors associated with the use of eHealth technologies is important for addressing inequitable access to health care.ObjectiveWe sought to assess digital health literacy among patients aged ≥65 years and identify factors associated with their ability to access, understand, and use digital health resources.MethodsWe developed a survey instrument grounded in the Technology Acceptance Model and conducted a cross-sectional, mixed-mode survey of patients aged ≥65 years from an integrated, multispecialty medical center. Digital health literacy was measured using the eHeals health literacy scale, and responses were analyzed across self-rated health, self-reported mobility, and socioeconomic deprivation assessed with the Area Deprivation Index (ADI). Counts (n) and frequencies (%) are reported across response groups, and analyses for differences are performed using the χ2 test for independence or the Fisher exact test.ResultsAnalyses included 878 responses (response rate=878/2847; 30.8%). There was a significant difference in the distribution of race between responders and nonresponders (P<.001) but no significant differences were observed by age (P=.053) or gender (P=.73). Respondents with lower self-rated health had lower levels of digital health literacy; only 54.2% (n=13/25) participants with poor self-rated health were able to send a message to their doctor compared to 89.5% (n=68/77) of patients with excellent self-rated health. All comparisons across the digital health literacy domains revealed significant differences across self-rated health groups (P<.05). Respondents with mobility restrictions had lower levels of digital health literacy, including lower frequencies of reporting knowledge of what health resources are available on the internet (mobility restricted, n=92/182; 52.0% vs no mobility restriction, n=433/688; 64.7%), knowledge of how to find health resources on the internet (mobility restricted, n=120/182; 67.4% vs no mobility restriction, n=513/688; 76.8%), and ability to use a camera or video with a doctor easily (mobility restricted, n=58/182; 32.6% vs no mobility restriction, n=321/688; 48.0%). Older adults experiencing increased socioeconomic deprivation, as measured by the ADI, reported lower rates of digital health literacy across most categories, including knowledge of how to find health resources on the internet (high ADI, n=28/49; 59.6% vs low ADI, n=551/751; 75.5%) and the ability to send an electronic message to their doctor easily (high ADI, n=27/49; 57.4% vs low ADI, n=584/751; 80.2%).ConclusionsOur findings highlight the need for targeted interventions to improve engagement with eHealth among patients aged ≥65 years, who are impacted by poor health, limited mobility, and socioeconomic deprivation. Enhancing digital health literacy can help bridge the gap in access to digital health resources and improve overall health outcomes for this population.

Digital health technologies can potentially reduce health disparities in cancer care. However, the benefits of digital health technology depend partly on users' digital health literacy, that is, "capabilities and resources required for individuals to use and benefit from digital health resources," which combines health and digital literacy. We examined issues for digital health technology implementation in cancer care regarding digital health literacy, via stakeholder consultation. Consumers, health care professionals, researchers, developers, nongovernment and government/policy stakeholders (N=51) participated in focus groups/interviews discussing barriers, enablers, needs and opportunities for digital health implementation in cancer care. Researchers applied framework analysis to identify themes of digital health literacy in the context of disparity and inclusion. Limited digital and traditional health literacy were identified as barriers to digital technology engagement, with a range of difficulties identified for older, younger and socio-economically or geographically disadvantaged groups. Digital health technology was a potential enabler of health care access and literacy, affording opportunities to increase reach and engagement. Education combined with targeted design and implementation were identified means of addressing health and digital literacy to effectively implement digital health in cancer care. Implementing digital health in cancer care must address the variability of digital health literacy in recipients, including groups living with disadvantage and older and younger people, in order to be effective. SO WHAT?: If cancer outcome disparity is to be reduced via digital health technologies, they must be implemented strategically to address digital health literacy needs. Health policy should reflect this approach.

Funding AcknowledgementsType of funding sources: None.BackgroundThe COVID-19 pandemic has highlighted the role of telemedicine in reducing face-to-face visits. Telemedicine requires either the use of digital support methods and a minimum technological knowledge of the patients. Digital health literacy, defined as the use of digital literacy skills to find and use health information and services, may influence the use of telemedicine in most patients, particularly in specific groups such as those with frailty.AimTo explore the association between frailty status, patients' use of digital tools and digital health literacy to determine whether it would be possible to implement control visits in patients followed in a cardiac arrhythmias outpatient clinic.MethodsWe prospectively enrolled consecutive patients referring to arrhythmias outpatient clinics of our department from March to September 2022. Patients were divided according to frailty status as defined by the Edmonton Frail Scale (EFS) into three subgroups: robust, pre-frail, and frail. The degree of health digital literacy was assessed through the Digital Health Literacy Instrument (DHLI) Scale. The DHLI explores 7 digital skill categories measured by 21 self-report questions. The self-report questions require participants to rate on a 4-point scale how difficult different tasks are and how frequently they encounter certain difficulties on the Internet. The total DHLI and each skill category score were calculated by summing the received scores in every single domain (3 questions per each skill category) and reported as mean and median. A multivariable logistic regression analysis was also use to evaluate the association between the non-use of the Internet and frailty status.ResultsA total of 300 patients were enrolled (36.3% females, median age 75 [66-84]) and stratified according to frailty status as: (i) Robust (EFS ≤ 5; n = 212, 70.7%), (ii) Pre-Frail (EFS 6-7; n = 47, 15.7%), and (iii) Frail (EFS ≥ 8; n = 41, 13.7%). Frail patients used less frequently smartphones, PC and emails and had less availability of Wi-Fi at home compared to robust patients (Table 1). At the multivariable logistic regression analysis, frailty was significantly associated with the non-use of the Internet (adjusted odds ratio, 2.58 95% confidence interval 1.92-5.61). Digital health literacy score decreased as the level of frailty increased in all the domains explored (operational skills, navigation skills, information searching, evaluating the reliability of the information, determining the relevance of online information, adding self-generated content and protecting privacy while using the internet, all p<0.001, Table 2).ConclusionsFrail patients are characterized by a lower use of digital tools and access to the Internet even though these patients would benefit the most from telemedicine. Digital skills are strongly influenced by frail status highlighting the need to implement digital health literacy with specific interventions in this population.Internet access and digital toolsDigital Health Literacy Instrument

BackgroundUnderstanding the relationship between digital health literacy and health anxiety is increasingly important in the context of digitised health information environments.ObjectivesThe aim of the study was to describe the levels of digital health literacy and health anxiety among Hungarian adults, and to investigate the background factors influencing both.MethodsA total of 314 participants aged 18 years and older completed an online questionnaire. The survey included the eHealth Literacy Scale (eHEALS), the Short Health Anxiety Inventory (SHAI) and a health self-report item from the Hungarian National Health Interview Survey. Descriptive statistics, analysis of variance (ANOVA), independent samples t-tests, Cohen's d, Pearson and Spearman correlations and a significance threshold of p < 0.05 were used.ResultsWomen reported significantly higher health anxiety scores than men (34.8 vs. 33.0; p < 0.005), especially for the subscale ‘perceived likelihood of getting sick’. The strongest gender difference occurred in the 35-64 age group. Health anxiety increased with age, with the highest scores recorded in the 65+ age group (p = 0.008). Self-rated health was strongly correlated with health anxiety: individuals who rated their health as ‘poor’ scored ∼44 points on the SHAI, while those who rated their health as ‘excellent’ scored ∼30 points (ρ = 0.39; p < 0.001). The mean eHEALS score was 30.2 (SD = 6.3). A significant negative correlation was found between digital health literacy and health anxiety (ρ = -0.18; p = 0.001), suggesting that higher digital health literacy was associated with lower health anxiety.ConclusionsAlthough weak, the association between digital health literacy and health anxiety is statistically significant, particularly when comparing extreme groups. Women, older adults and those with poorer self-rated health tended to report higher health anxiety.Key messages• Higher digital health literacy may serve as a protective factor against health anxiety, although the association is weak and influenced by individual characteristics.• Women, older adults and those with poorer self-rated health are?particularly susceptible to increased health anxiety, highlighting the need for targeted mental and digital health promotion.

Parents make important vaccination decisions for their children and many variables affect parents' decisions to accept or decline vaccines. Parents are tasked with locating, understanding, and applying information to inform health decisions often using online resources; however, the digital health literacy levels of parents are unknown. The purpose of this study was to investigate parents' digital health literacy levels, their sources for vaccine information, and analyze how demographics, digital health literacy, health literacy, parental attitudes and vaccine beliefs, trust, and vaccine information sources predict vaccine acceptance. Quantitative findings of a mixed methods study that examined parental vaccine decision making across the continuum of vaccine hesitant to vaccine accepting is reported. An online survey of parents of young children living in Ontario, Canada was conducted in 2022. Multiple linear regression determined predictors of vaccine acceptance. 219 participants completed the survey and on average reported adequate digital health literacy skill. Healthcare providers were reported as the most commonly used source of vaccine information. Two models were retained that predicted vaccine acceptance, both models predicted about 50% of the variability in vaccine acceptance. Model A identified that trust predicted parent vaccine acceptance and model B identified that digital health literacy, and the vaccine information sources healthcare providers, family and friends, and alternate healthcare providers predicted vaccine acceptance. Family and friends and alternate healthcare providers negatively predicted vaccine acceptance. Most parents in our study had high levels of digital health literacy. Opportunities exist for further research and policy change focused on trust at a systemic public health level. While clinical level implications included the importance of healthcare providers as a vaccine information source and adequate digital health literacy to facilitate parental vaccine decision making. Continued efforts to develop awareness on the importance of digital health literacy among the public and healthcare providers is needed, including further research on the digital health literacy levels of Canadians.