Understanding pregnant women's health literacy strengths and challenges: a cluster-based exploration in the Health Literacy in Pregnancy (HeLP) study.

ObjectiveTo investigate health literacy (HL) and digital health literacy (eHL) among patients hospitalised in surgical and medical wards using a cluster analysis approach.DesignCross‐sectional study using Ward’s hierarchical clustering method to...

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).

BackgroundHealth literacy is an important factor for enabling people to manage their health and live long fulfilling lives. People in prison are frequently from marginalised communities, often out of reach of conventional community based health organisations, and have poorer health outcomes. It is essential to understanding the health literacy profiles of people in prison, and its contribution to the well-established health inequities and outcomes of this population. This study aimed to use a multi-dimensional health literacy measurement tool to describe the strengths and challenges of adults incarcerated in NSW prisons.MethodsA cross-sectional survey was conducted for people in prison across 14 publicly operated metropolitan prisons. Data were collected from 471 participants using the Health Literacy Questionnaire (HLQ). Participant characteristics and health conditions were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between participant characteristic groups.ResultsParticipants’ median age was 38.0 (range 19 – 91) years. Males comprised 81% of the sample, 21% identified as Aboriginal and/or Torres Strait Islander, and 53% reported a health problem. People in prison had lower scores for all nine HLQ scales when compared to the general Australian population. Small to medium ES were seen for mean differences between most demographic groups. Compared to males, females had lower scores for several of the HLQ scales including ‘having sufficient information to manage health’ (ES 0.30 [95% Confidence Interval (CI) 0.07, 0.53]), ‘ability to actively engage with health care professionals’ (ES 0.30 [95% CI 0.06, 0.53]), ‘navigating the healthcare system’ (ES 0.30 [95% CI 0.06, 0.53]), and, ‘ability to find good health information’ (ES 0.33 [95% CI 0.10, 0.57]). Differing health literacy scale scores with small to medium ES were found when comparing participants by legal status. Mainly small ES were seen when comparing other participant characteristic groups.ConclusionsThis study provides insights into the health literacy strengths and challenges for people in NSW prisons. These findings highlight the important role health literacy could have in addressing health disparities in this vulnerable population and can inform prison health services.

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.

BACKGROUND:Health literacy is the capacity to acquire, process, and understand basic information and services necessary for appropriate health decisions. Given the importance of health literacy in women, the aim of the present study was to determine the effect of health literacy level on improving the quality of care during pregnancy in pregnant women.MATERIALS AND METHODS:The present study was a cross-sectional analytical study. In this study, 130 women referred to Yazd health centers were examined. Health literacy questionnaires and a researcher-made checklist of the quality of pregnancy care were used to gather information. The researcher-made checklist of the quality of pregnancy care was in accordance with the standard protocol of the Ministry of Health and Medical Education, entitled Integrated Health Care for Pregnant Mothers, which was validated and reliable. SPSS statistical software version 19 and t-test and ANOVA statistical tests were used to analyze the data.RESULTS:According to the findings, the average score of health literacy in pregnant women was 74.09, which showed that the level of health literacy was in the marginal or border range. People with higher health literacy received significantly more prenatal counseling than other women and had a planned pregnancy (P = 0.04).CONCLUSION:The level of health literacy in pregnant women is unfavorable. Given that the high level of health literacy in women in society can lead to an increase in the quality of pregnancy care, so to increase health literacy in women, it is recommended that regular training in society by health-care providers be given more attention.

Background Digital health information appears inadequate of providing medical expertise and clinical guidelines in IBD, including optimized accessibility, relevance and understandability for effective self-management. This study examines IBD patients’ health literacy (HL) and digital health literacy (DHL) and their covariance with various patient characteristics as implications for a digital health information platform. Methods IBD patients at a Norwegian university hospital underwent a cross-sectional survey. Clinical data were extracted from EHR. Other data were reported via questionnaire with the following instruments: HL – Health Literacy Questionnaire; DHL – eHealth Literacy Questionnaire; Quality of Life (QoL) – EQ-5D-5L; Self-efficacy (GSE) - General Self-Efficacy Scale; Illness perception (IP) – Brief Illness Perception Questionnaire; Medication adherence (MA) – The OsloMet Adherence to medication Survey tool. Data underwent a canonical correlation analysis (CCA) followed by hierarchical clustering. Variables omitted from CCA underwent bivariate analyses and logistic regression to assess cluster affiliation. Results Of 380 patients, 173 had UC and 53 % were male. Mean age was 43.6 years. No diagnose-specific PROM differences were found. CCA demonstrated positive associations for GSE, IP and health status against having sufficient capability to understand, assess and act upon health information and digital health services (p < .001). CCA also proved a negative association for age and actively engaging with digital health services (p < .001). Two clusters were identified (p <. 05). Cluster 1 embodied the oldest patients, lowest levels of HL, DHL, GSE, health status, IP and longest disease duration. Compared to Cluster 2, Cluster 1 significantly demonstrated lower MA (p <.05), higher shares of unemployment (p <.05), active disease (p <.001), and more severe QoL problems in terms of mobility (p < .05), usual activities (p < .001), pain/discomfort (p < .001) and anxiety/depression (p < .001). Disease activity (p <. 01) and biological treatment (p < .001) proved to be the strongest factors for cluster affiliation in a logistic model. Conclusion Our results imply a relation between health status, age, self-efficacy, biological treatment, disease perception and disease activity for IBD patients with low HL and DHL. The findings are implicative for a targeted intervention addressing digital health information dissemination for IBD patients.

BackgroundWeb-based personal health records (PHRs) have the potential to improve the quality, accuracy, and timeliness of health care. However, the international uptake of web-based PHRs has been slow. Populations experiencing disadvantages are less likely to use web-based PHRs, potentially widening health inequities within and among countries.ObjectiveWith limited understanding of the predictors of community uptake and use of web-based PHR, the aim of this study was to identify the predictors of awareness, engagement, and use of the Australian national web-based PHR, My Health Record (MyHR).MethodsA population-based survey of adult participants residing in regional Victoria, Australia, was conducted in 2018 using telephone interviews. Logistic regression, adjusted for age, was used to assess the relationship among digital health literacy, health literacy, and demographic characteristics, and the 3 dependent variables of MyHR: awareness, engagement, and use. Digital health literacy and health literacy were measured using multidimensional tools, using all 7 scales of the eHealth Literacy Questionnaire and 4 out of the 9 scales of the Health Literacy Questionnaire.ResultsA total of 998 responses were analyzed. Many elements of digital health literacy were strongly associated with MyHR awareness, engagement, and use. A 1-unit increase in each of the 7 eHealth Literacy Questionnaire scales was associated with a 2- to 4-fold increase in the odds of using MyHR: using technology to process health information (odds ratio [OR] 4.14, 95% CI 2.34-7.31), understanding of health concepts and language (OR 2.25, 95% CI 1.08-4.69), ability to actively engage with digital services (OR 4.44, 95% CI 2.55-7.75), feel safe and in control (OR 2.36, 95% CI 1.43-3.88), motivated to engage with digital services (OR 4.24, 95% CI 2.36-7.61), access to digital services that work (OR 2.49, 95% CI 1.32-4.69), and digital services that suit individual needs (OR 3.48, 95% CI 1.97-6.15). The Health Literacy Questionnaire scales of health care support, actively managing health, and social support were also associated with a 1- to 2-fold increase in the odds of using MyHR. Using the internet to search for health information was another strong predictor; however, older people and those with less education were less likely to use MyHR.ConclusionsThis study revealed strong and consistent patterns of association between digital health literacy and the use of a web-based PHR. The results indicate potential actions for promoting PHR uptake, including improving digital technology and skill experiences that may improve digital health literacy and willingness to engage in web-based PHR. Uptake may also be improved through more responsive digital services, strengthened health care, and better social support. A holistic approach, including targeted solutions, is needed to ensure that web-based PHR can realize its full potential to help reduce health inequities.

The workshop aims to explore innovative approaches to promoting health literacy and digital health literacy and their impact on individual and community health outcomes at different stages of life. This initiative is driven by the recognition that digital platforms and tools offer unprecedented opportunities to improve population health through health education and behavior change. The workshop will feature a dynamic and interactive format starting from plenary sessions in which speakers will provide insights into digital health promotion best practices and their outcomes, offering diverse perspectives. The added value of organizing this workshop lies in its comprehensive approach to integrating digital tools into health prevention strategies, particularly for addressing childhood smoking. By examining innovative digital interventions, the workshop provides a platform for sharing insights and strategies that leverage technology to promote healthier lifestyles among youth. This is increasingly pertinent as digital platforms become central in the daily interactions of young people. The coherence between the presentations revolves around the theme of enhancing digital health literacy as a preventive measure against health issues. The first presentation sets the stage by exploring digital tools that educate and engage young people about the dangers of smoking. The subsequent session builds on this by assessing the current state of digital health education and literacy, emphasizing the need for curriculum integration and better training for educators to support these initiatives effectively. Finally, the meta-analysis presentation ties everything together by evaluating the effectiveness of these digital interventions across various demographics, offering evidence-based recommendations for tailoring health literacy programs to diverse needs. Together, these presentations form a cohesive narrative on the critical role of digital literacy in health prevention, illustrating a clear pathway from educational content to educational infrastructure, and culminating in broad-based intervention strategies that can be adapted to different settings and populations. This coherence enhances the workshop’s impact, providing attendees with a well-rounded understanding of how digital tools can be harnessed to foster long-term health improvements from an early age. Live Q&A sessions will encourage dialogue between speakers and attendees, enhancing the learning experience. By combining expert knowledge with interactive discussions, the workshop aims to share insights needed to implement effective digital health promotion strategies. Key messages • The role of health literacy and digital health literacy in improving health outcomes demands that the efficacy of the most effective strategies be evaluated. • Digital tools offer opportunities for innovative health promotion approaches and tools.

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.

BackgroundThere is growing appreciation of the role health literacy plays in population health and health care design. Health literacy encompasses an individual’s capacity to manage their health and the responsiveness of the health system. Our aim was to identify the health literacy strengths and challenges in an Australian cohort living with motor neurone disease (MND), including both people living with the disease and their carers.MethodsThis study used the Health Literacy Questionnaire and eHealth Literacy Questionnaire for health literacy assessment. Using a secure online platform, an anonymous survey was disseminated which included demographic data and clinical measurements. Descriptive statistical analysis and cluster analysis were employed to describe the sample and to identify different health literacy patterns in subgroups of people living with MND and their carers.ResultsA total of 227 people participated (171 people living with MND and 56 carers). Cluster analysis generated fifteen cluster profiles for the cohort living with MND and seven cluster profiles for carers. The variability and potential significance of patterns of health literacy strengths and challenges within the MND community are described. There was extensive diversity within the sampled population, with a mix of sociodemographic backgrounds across each cluster profile.ConclusionsThe health literacy cluster profiles created from this study provide insight into the full spectrum of where the challenges and strengths exist for individuals and subgroups of people managing this fatal disease. The results from this study pave the way for generating system wide interventions that address health literacy diversity, to create more enabling health care environments for all those affected by MND.

ObjectiveThe MAMAACT intervention aims to reduce ethnic and social disparities in stillbirth and infant death by improving communication between pregnant women and midwives regarding warning signs of pregnancy complications. This study evaluates the effect of the intervention on pregnant women's health literacy (two domains from the Health Literacy Questionnaire) and complication management — interpreted as improved health literacy responsiveness among midwives. DesignCluster randomized controlled trial, 2018–2019. Setting19 of 20 Danish maternity wards. ParticipantsCross-sectional survey data were collected using telephone interviews (n = 4150 pregnant women including 670 women with a non-Western immigrant background). InterventionA six-hour training session for midwives in intercultural communication and cultural competence, two follow-up dialog meetings, and health education materials for pregnant women on warning signs of pregnancy complications — in six languages. Main outcome measuresDifferences in mean scores at post-implementation of the domains Active engagement with healthcare providers (Active engagement) and Navigating the healthcare system from the Health Literacy Questionnaire, and differences in the certainty of how to respond to pregnancy complication signs between women in the intervention and control group. ResultsNo difference was observed in women's level of Active engagement or Navigating the healthcare system. Women from the intervention group were more certain of how to respond to complication signs: Redness, swelling, and heat in one leg: 69.4 % vs 59.1 %; aOR 1.57 (95 % CI 1.32–1.88), Severe headache: 75.6 % vs 67.3 %; aOR 1.50 (95 % CI 1.24–1.82), and Vaginal bleeding: 97.3 % vs 95.1 %; aOR 1.67 (95 % CI 1.04–2.66). ConclusionThe intervention improved women's certainty of how to respond to complication signs, but was unable to improve pregnant women's health literacy levels of Active engagement and Navigating the healthcare system, likely due to barriers related to the organization of antenatal care. A reorganization of antenatal care and a care model sensitive to diversity within the entire healthcare system might help reduce disparities in perinatal health. Trial registrationClinicalTrials.gov identifier: NCT03751774.

The main purpose of this article is to describe the importance and the challenges of digital health literacy as recognized during the COVID-19 pandemic. First, basic definitions of health literacy and digital health literacy are provided, followed by, and matched against digital competence frameworks, and health literacy skills content and scales. Based on that, a compatibility analysis is provided, against the expectations for satisfactory levels definition for the respective competences and skills. For the approbation of the approach, results received from the participation of computing students at the Sofia University St. Kliment Ohridski in the COVID-19 Health Literacy Survey are used.

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.

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

Patients with long-term health needs are often expected to actively participate in outpatient care, assuming that they have appropriate health literacy and digital health literacy. However, the association between participation in a digital outpatient service and health literacy remain unclear. This study aims to evaluate whether digital outpatient care for 6 months improved health literacy, health-related quality of life (HRQoL), digital/eHealth literacy, and the use of health care services compared with usual care. We conducted a multicenter nonrandomized trial with 1 intervention arm and 1 control arm. Patients aged ≥18 years receiving outpatient care in the pain, lung, neurology, or cancer departments at 2 Norwegian university hospitals were allocated in a 1:2 ratio, favoring the intervention arm. The intervention arm received digital outpatient care using tailored patient-reported outcome measures, self-monitoring, and chats for timely contact with the outpatient clinic. Patient responses were assessed by health care workers via a dashboard with a traffic light system to draw attention to the most urgent reports. The control arm received usual care. The data were collected at baseline and after 3 and 6 months. The primary outcome was the change in health literacy according to the Health Literacy Questionnaire domain understanding health information well enough to know what to do from baseline to 6 months. The mean difference in change between the 2 treatment arms was the effect measure. The secondary outcomes were additional domains from the Health Literacy Questionnaire, digital/eHealth literacy, HRQoL, acceptability of the digital intervention, and health service use. Overall, 162 patients were recruited, 55 (34%) in the control arm and 107 (66%) in the intervention arm, with a 17.3% attrition rate after 6 months. There was no statistically significant difference in the primary outcome, "understanding health information well enough to know what to do," between the arms at 6 months (mean difference -0.05, 95% CI -0.20 to 0.10; P=.53). After 3 months, the health literacy domains actively managing my own health (-0.15, 95% CI -0.30 to -0.00; P=.048) and understanding health information well enough to know what to do (-0.17, 95% CI -0.34 to -0.00; P=.03), as well as both physical (-3.29, 95% CI -5.62 to -0.96; P=.006) and mental HRQoL (-3.08, 95% CI -5.64 to -0.52; P=.02), improved in the digital outpatient intervention arm compared with the control arm. This study explored digital outpatient care. Although no statistical differences were observed in patients' health literacy after 6 months, our data indicate an improvement in health literacy domains and HRQoL at 3 months. The participants reported high satisfaction with the digital outpatient care intervention, and our findings highlight the potential of digital interventions in outpatient care. ClinicalTrials.gov NCT05068869; https://clinicaltrials.gov/ct2/show/NCT05068869. RR2-10.2196/46649.