Digital Literacy Research Articles

Defining digital health literacy profiles in Spanish adults: a latent class analysis

Abstract Background According to different reports, Spain is among the European countries that use digital health technologies the most. However, to develop inclusive and fair digital health services, there is the need to feature digital health knowledge, skills, confidence, and a positive attitude about their significance. This work aims to draw a picture of digital health literacy levels in Spain. Methods A stratified sample of the Spanish population regarding gender, age group and area of residence was used. Participants were recruited from an online panel and by direct approach to balance quotas. Between May 2021- May 2022, participants filled a self-administered online survey, including the Spanish version of the eHealth Literacy Questionnaire (eHLQ) and the eHealth Literacy Scale (eHEALS). Results Digital health literacy showed similar mean scores, between 2.6-2.7 out of 5 with similar SD on each of the 7 dimensions of the eHLQ. The highest scores were related to knowledge about filling data in digital health services and knowledge about health and how the body works, and feelings about the usefulness of digital technology for health. In contrast, lower scores were related to sharing health information by technology, thinking that using technology gives access to better health services, and the possibility to contact usual health professionals with technology. Latent profile analysis identified 5 user profiles. Significant differences were found according to age, inhabitants per municipality, technology use, self-perceived health status, educational level, socioeconomic index and eHEALS scores; not by gender. Conclusions As the scores are similar in the different subscales, competencies, attitudes and confidence in digital health that they measure are balanced. However, the main challenge appears in granting users access to digital services that work, which involves the definition and monitoring of strategies until the final implementation. Key messages • Digital Health literacy in Spain differs according to different aspects, not only age, educational or socioeconomic level. • Confidence in usefulness is a common denominator among the five digital health service user profiles identified.

Impact of digital health literacy on public health: an umbrella review

Abstract Background Digital health literacy (DHL) is increasingly important for public health initiatives in the digital era. However, its impact on public health outcomes remains unclear. This umbrella review synthesizes evidence on relationships between DHL and public health. Methods Electronic databases were searched from 2010 to January 2024 for reviews evaluating associations between DHL and public health outcomes. Two independent reviewers screened records and extracted data. Results were narratively synthesized and screened respect quality using Amstrar 2 check list. Results 12 reviews met the inclusion criteria. Higher population DHL was consistently linked to positive health behaviors like preventive screening uptake, medical adherence, chronic disease management, and vaccination. However, lower DHL correlated with health disparities and exacerbated risk of mis/disinformation. DHL interventions improved eHealth skills and health status. Conclusions Digital Health Ltieracy shapes engagement with digital public health tools and programs. Integrating DHL assessments into planning can help identify at-risk groups and optimize interventions. Developing population DHL through education represents an avenue to advance health equity and resilience against digital health threats. However, more evidence and more digital maturity of tools appear to be necessary. Key messages • Digital Health Literacy as milestone of next health generation. • Health outcomes are clearly linked to digital and digital health literacy.

Navigating the infodemic through digital health literacy education in schools

Abstract Background High digital health literacy (DHL) can help to navigate the internet’s vast information landscape. This research explores the impact of learning DHL in schools on students’ DHL, and how it might mitigates confusion surrounding health-related information. Moreover, this research sheds light on how learning DHL in schools influences students’ inclinations towards specific sources of health information. Methods 1448 secondary school students aged 9-18 years participated in face-to-face interviews. Associations between learning digital health literacy (DHL) and students’ DHL, comprehension of health information, sense of being informed on health topics, and utilization of diverse health information sources were evaluated using the chi-squared test. Results The learning of DHL within school settings demonstrated a significant correlation with students’ overall DHL (X2 (6) = 120.99, p < .001). Those reporting high levels of DHL learning exhibited reduced confusion regarding health information (X2 (4) = 16.65, p = .002) and felt notably more informed (X2 (4) = 231.06, p < .001). Contrasted with peers who reported insufficient learning of DHL, students with high learning reported learning more about health from parents (X2 (2) = 55.28, p < .001), peer interactions (X2 (2) = 214.51, p < .001), online sources (X2 (2) = 78.54, p < .001), influencer content (X2 (2) = 68.46, p < .001), offline literature (X2 (2) = 24.32, p < .001), television (X2 (2) = 140.36, p < .001), and in school (X2 (2) = 205.53, p < .001). However, they were less reliant on physicians for health information (X2 (2) = 53.62, p < .001). Conclusions Integrating DHL into school curricula holds promise for enhancing students’ DHL and alleviating apprehensions regarding health-related information. Moreover, such educational initiatives have the potential to expand students’ repertoire of resources for accessing health information, encompassing both digital and non-digital sources.

Measuring digital health literacy in Europe – developing a new tool to capture innovation

Abstract Background Rapid advancement of digital resources for health and healthcare in Europe has widened the scope of opportunities to promote health, but also raises concerns about accessibility and health equity. Measuring digital health literacy (DHL) in populations is critical for assessing digital resource appropriateness in general and specifically among vulnerable populations. The DHL measure used in the M-POHL Health Literacy Survey 2019-2021 (HLS19) in 13 countries showed inadequate DHL in large parts of the population, reflecting a social gradient. As digital resources become increasingly interactive, potentially widening the digital divide, a need to refine the DHL HLS19 tool was evident. Methods Building on the HLS19 tool, an additional measure was developed to assess interactive aspects of DHL by representatives from 16 countries in a co-productive way, based on discussions about the diverse digital challenges. The additional scale was to be generic enough to be relevant for all countries, yet specific enough to discern the diverse needs regarding various public health/healthcare service formats across Europe. Results The new tool is divided into 2 parts: a scale measuring the skills to access, understand, appraise, and apply digital health information as applied and validated in HLS19, and a new set of items assessing the use and ease of use of interactive digital resources including health promotion apps, digital tools for managing health/medical conditions, navigating the healthcare system, and communicating online with health professionals. The tool has been translated into several languages and is currently undergoing piloting/cognitive testing. Conclusions Collaborative work among countries is essential for developing relevant measurement tools on the European level. Just as the technology undergoes rapid change, likewise tools for assessing DHL must be updated acknowledging the diversity of digital resources and needs on country levels.

Youth voices: A participatory approach to promoting mental health literacy through digital means

Abstract A concerning number of young people worldwide experience mental health challenges, often compounded by limited mental health literacy, such as a lack of knowledge about how to recognize mental disorders and strategies for seeking help (Cairns & Rossetto, 2019). Therefore, it is crucial to promote mental health literacy among youth. Due to the scarcity and often high cost of readily available mental health services, as well as concerns about anonymity, digital programs have become an alternative means of reaching youth. To this end, a digital prevention program was developed. The pivotal question now is how to effectively promote young people’s mental health literacy through digital means, more specifically: How to develop (1) evidence-based and (2) target group-specific content? To investigate these questions, two systematic reviews were conducted that analyzed a total of 65 digital evidence-based mental health programs. Since the active use of programs also depends on how suitable and appealing the content is for the target group, a participatory approach was chosen to actively involve the target group in the process of developing the program’s design and content. Therefore, four participatory workshops were conducted in Slovenia, Poland, and Austria, with 12-15-year-old students (N = 182). Selected results from the systematic reviews and cross-national results from the workshops will be presented. It was found that psychoeducation is an important and effective method for promoting mental health literacy among youth and that young people prefer this content to be delivered as briefly and concisely as possible, and in a multimodal format. The discussion will highlight key takeaways regarding the benefits and challenges of this approach, emphasizing the necessity of including student voices in the creation of psychoeducational content for a digital mental health program in order to highlight and recognize young people’s right to participate. Key messages • The value of youth participation - Involving young people in the development of content for a digital mental health literacy program is a means to increase its relevance and appeal to them. • The intricacies of youth participation - Involving young people in the development of a digital mental health literacy program presents challenges that require careful consideration.

Digital divide in access and use of digital health technologies: what do we know from Germany?

Abstract Even though Germany is an industrialised country, health inequalities exist between individuals or population groups due to unequal access to scarce social resources such as money or knowledge. This case study illustrates the extent of the digital divide in access and use of digital health technologies. Data from the Liter@te study, in which 96 adults aged 18-64 years with low reading and writing skills living in Germany were asked about their digital health technology use and their digital health literacy, were compared with two parallel conducted population surveys in Germany (i.e., nationwide telephone survey on digitalisation and health with 1020 internet users aged 18 years and above, online survey on digitalisation in health care with 1839 adults aged 18-80 years insured at a statutory health insurance company). Adults with low reading and writing skills used digital devices in the health context such as computers (23% vs. 71%) or activity trackers (21% vs. 35%) less frequently than the general population, whereas no differences were reported in the use of smartphones (79% vs. 70%). In addition, 18% of adults with low reading and writing skills and 4% of the general population stated that they do not use digital health technologies. Other digital health technologies such as online appointment scheduling (25% vs. 81%) or health websites (32% vs. 45%) were also used less frequently by adults with low reading and writing skills compared to the general population. Participants in the Liter@te study who do not use digital health technologies reported more frequent access problems (e.g., no suitable device, technical problems, poor internet connection) than participants in the population survey. 35% of participants in the Liter@te study have a low digital health literacy (eHEALS score between 8-19/40 points), compared to only 8% in the population survey.

11.K. Scientific session: Roots of public health: school health literacy to enhance population health outcomes in Europe

Abstract This workshop will present empirical results from three representative studies on health literacy and digital health literacy conducted in primary and secondary schools in Wales and Germany: (1) Digital Health Literacy in Schools, (2), HLCA HL-Kids, (3) WHO HBSC Wales. While research on child and adolescent health literacy has gained traction in the past decade, only a few studies focus on health literacy in schools. While the European Commission and WHO, as well as most European governments, highlight the importance of schools to support children’s health literacy, schools remain neglected as a research context. With only little evidence available, it is difficult to derive strategies and programs to promote health literacy in schools. We aim to provide practical novel knowledge and contribute to closing the school health literacy gap that is prevalent in Europe. In turn, this will also contribute to European public health development and population health outcomes. Levels of health literacy in child and adolescent populations across European countries and age groups are alarmingly low, making low health literacy a severe risk factor for health outcomes. Low health literacy is associated with worse health conditions and unhealthy behaviours, and in turn, impacts school attainment and educational outcomes. Evidence suggests that health literacy acts as a determinant of health and itself is influenced by other social determinants of health, such as education, intertwining health and education. All studies conducted so far provide evidence that low health literacy follows a social gradient, with children from less affluent families being more likely to have lower health literacy, widening preexisting health inequities observed in almost all health domains within Europe. While effective interventions on the individual and system levels are needed to enhance health literacy, implementation and evaluation research concerning children’s health literacy is rare. Workshop objectives The aim of this workshop is to present findings from three representative studies on health literacy and digital health literacy in primary and secondary schools: (i) The 1st speaker will introduce a study on health literacy and health behaviours of children aged 8-11 (ii) The 2nd speaker will discuss the influence of living environments on health literacy in 4th-grader school kids (iii) The 3rd presentation will have its focus on navigating the infodemic through digital health literacy in adolescent students (iv) The 4th speaker will show links between digital health literacy and health behaviour in adolescent students The format of this workshop will be 4x10-minute presentations followed by a 20-minute panel discussion with the audience, reflecting the relevance of the results to public health research, practice, and policy. The chairs will provide a brief introduction to the concept and moderate the presentations and panel discussion. Key messages • Our results show that health literacy should be addressed as early as in primary schools and that the places, households, and environments children grow up are critical social determinants of health. • Digital health literacy has proven to be a valid learning topic in secondary schools and is linked to digital and media literacy, allowing us to define it as a targeted curriculum item.

Digital health literacy and health behaviour of schoolchildren: A representative study in Germany

Abstract Background Health information is increasingly available and plays a crucial role in making health decisions and developing healthy behaviours. Digital health literacy (DHL) enables one to distinguish between true and false health information online. Studies have found higher health literacy to be associated with healthier behaviour. However, there is no research on child DHL and health behaviour. This study aims to investigate the relationship between DHL and selected health behaviour of schoolchildren in Germany. Methods This cross-sectional study is based on a representative sample of (N = 1448) secondary schoolchildren (aged 9-18 years) in Germany across all 16 federal states and school forms. DHL was assessed using the child and adolescent version of the Digital Health Literacy Instrument developed and pretested in this study. Selected health behaviours (eating, teeth brushing, smoking, and alcohol consumption) were measured using self-report scales. Chi-square tests were conducted to measure differences between DHL and health behaviour. Results Associations were found between DHL and all eating behaviours (fruits; vegetables and salad; whole-grain products; other animal-based products; chocolate or other sweets; sugary drinks; fast food), except for eating meat and sausages. Schoolchildren with higher levels of DHL reported more often about regular consumption of fruits and vegetables (X2 (2)=17.06, p = <.001). salads (X2 (2)=56.54 p = <.001) and whole-grain-products (X2 (2)=98.81 p = <.001). While DHL was associated with teeth brushing (X2 (2)=44.46, p = <.001), no differences were observed for smoking (X2 (2)=1.93, p=.381) and drinking alcohol within the last 30 days (X2 (2)=2.62, p=.270). Conclusions These findings indicate that most health behaviours of schoolchildren may benefit from enhancing DHL in schools. Programs should build around these topics. However, more research is needed to investigate associations between DHL and health behaviours comprehensively.

The Role of Digital Media in Optimizing Project-Based Learning to Practice 21st Century Skills

The utilization of digital media in learning is crucial in the current era of education, especially in training 21st-century skills. This study explores digital media's role in optimizing project-based learning in an Islamic high school in Indonesia. The selection of this school as the research subject is based on the utilization of digital media in the learning process, which has been carried out regularly, so it is beneficial in optimizing project-based learning. This research uses a qualitative approach with a case study design. Data collection was conducted through observation, interview, and document analysis. Data analysis techniques include reduction, display, verification, and conclusion drawing. The results showed that examples of project-based learning activities in this school include learning to make dioramas from recycled paper, resin bed lamps, generator mock-ups, environmental campaign posters, and plant naming signs. These project-based learning activities are instrumental in training students' 21st-century critical thinking, creativity, digital literacy, collaboration, and problem-solving skills. Digital media in this study acts as an idea generator and inspiration to find much scientific information, not least related to making name signs on a plant. This study indirectly contributes insight into examples of teacher creativity regarding the use of digital media to create interesting and meaningful learning.

Barriers and facilitators to remote healthcare services use: perspectives of women and providers

Abstract Background The remote health services (RHS) proliferation raises concerns regarding relatively low use among minorities. Arab women in Israel belong to a minority that experiences health disparities, stigmatization, social and economic marginalization. This study aimed to identify barriers and facilitating means to RHS use relevant to Arab women in Israel from the perspective of women, primary care physicians (PCPs), and nurses. Methods Semi-structured interviews were conducted with 25 Arab women, 18 PCPs, and 4 nurses from different parts in Israel between December 2023-March 2024. We used a positive deviance approach by interviewing 14 women who succeeded in using RHS and 11 who did not. Interviews were audiotaped, transcribed, and thematically analyzed using Atlas qualitative analysis software. Findings The data distilled three main barriers to RHS use: sociocultural- importance of close relations with PCPs, privacy concerns of revealing the body or conversing with unfamiliar physicians, strict supervision by the family (Bedouin society); logistical-limited internet access and infrastructure, personal- unawareness to RHS, digital literacy, normative conceptions of limited quality of care and believing that only some health conditions are suitable for RHS. Facilitating means to RHS use: gender roles-women’s role as family health caretakers, mothers maintaining work-family balance and younger women generation feeling responsible for the older generation RHS adoption, accessibility- wider access to care due to limited transportation. Conclusions It is important to identify facilitating conditions (e.g., training opportunities, social, technological support), cultured elements (gender roles, limited mobility), and trust to adopting RHS by minority populations. The study provide data for developing requirements to ensure more equitable access to RHS to Arab women including addressing privacy concerns, guidelines for RHS-related information dissemination, and for RHS providers. Key messages • The findings help develop approaches and means to improve RHS use for Arab women from diverse backgrounds by identifying barriers associated with access, culture, and normative conceptions. • Developing RHS systems into routine care must ensure equitable use across social groups and address economic, logistical, and sociocultural barriers and guidelines for RHS information dissemination.

STI/HIV care in times of COVID-19 according to Dutch healthcare professionals: A mixed methods study

Abstract Background Surveillance data from the Netherlands show that STI/HIV testing decreased at the start of the COVID-19 pandemic, suggesting barriers in access to STI/HIV care. However, the impact of the pandemic on STI/HIV care may be more complex, and key populations could be differentially affected. The aim of this study was to gain more insight into the impact of COVID-19 on STI/HIV care in the Netherlands from the perspective of STI/HIV care providers. Methods We investigated whether professionals in STI/HIV care experienced changes compared to pre-COVID in access to care, demand and provision of care, shifts online care, and quality of care. An online survey was completed by 192 STI/HIV care professionals. Additionally, semi-structured interviews were held with 23 STI/HIV care professionals. Results According to participants, specific subgroups of priority populations may have had difficulties accessing STI/HIV care during the pandemic especially during lockdowns and at public sexual health services. Professionals were concerned to have lost sight of subpopulations in vulnerable circumstances and that the pandemic may have magnified inequalities in access to STI/HIV care, which may be related to different levels of health and digital literacy required for telephone and video consultations. Furthermore, participants found online care provision was not up to standards and were concerned about follow-up care for patients using private online providers of remote tests. Conclusions Professionals experienced that COVID-19 measures may have compounded existing disparities. To minimize inequalities in access to STI/HIV care during a pandemic, it is recommended to prioritize services for people in vulnerable circumstances such as recent migrants and people with low health or digital literacy. More collaboration between and within sectors may help in better organizing healthcare and prevent overburdening of specific sectors. Key messages • According to STI/HIV care providers, the COVID-19 pandemic differentially impacted different STI/HIV care sectors, but also increased existing inequalities in access to care for vulnerable groups. • Professionals experienced that COVID-19 measures impacted the provision of STI/HIV care, access to care for vulnerable populations, and quality of care.

Digital health divide in Indonesia: evidence from national-level data

Abstract Indonesia is a country in south-east Asia with a diverse population and context underlined by its geographical condition as an archipelagic country. Due to closer proximity to the capital, the Western regions (e.g., provinces in Sumatra and Java islands) are relatively more developed than the central and eastern parts of Indonesia (e.g., Nusa Tenggara, Sulawesi, and Papua). In the last few years, the country started to embrace digital transformation for public services including the health sector. Accelerated by the COVID-19 pandemic, a proliferation of digital health services through for example the use of telehealth and health apps is now considered important to improve access and availability of health services, especially among marginalized and hard-to-reach populations. Nonetheless, the difference in access to information and technology infrastructure and services as well as in the level of digital literacy across different regions in Indonesia may perpetuate the existing inequity in access to health services. In 2022, data from the Indonesian Central Bureau of Statistics showed that the level of internet access in Indonesia’s capital Jakarta has reached 85%, while the level in the eastern part of Indonesia (i.e., Papua) is only 26%. Similarly, the level of internet access in the Western provinces tend to be higher than their Eastern counterparts. Additionally, a survey performed by the Ministry of Communication and Informatics to assess the level of digital literacy in Indonesia shows that 85% out of 10,000 respondents accessed the internet through smartphones. However, almost all respondents encounter problems when accessing the internet, especially regarding network quality which causes unstable and frequent connections disconnected. In addition, the level of digital literacy varies across different regions, with the Western region performing better than other regions (e.g., digital literacy index of 3.64 in Yogyakarta vs 3.55 in Papua in 2022).

Digital Health in Croatia: Key stakeholders’ perspective of societal and institutional readiness

Abstract Background According to the literature, digital health brings an innovative approach to healthcare and an inevitable transformation and disruption. The potential of digital technologies is far-reaching, from preventive medicine to addressing public health challenges. However, the implementation also significantly depends on the social & cultural context. Methods To research Croatia’s expectations, challenges, and readiness for implementing digital health, interviews were conducted with physicians, patients, hospital managers, policymakers, jurists, and engineers (n = 75). Following identifying key themes, a survey was conducted among Croatian medical students (n = 775) at the end of 2022. Results Key stakeholders believe implementation preparedness is demonstrated through institutional and societal readiness. Prominent characteristics of societal readiness include appropriate infrastructure and legal and financial frameworks. Societal readiness is assessed through digital and health literacy and existing social practices within Croatian society. Only 4.6% of medical students believe Croatia’s healthcare system is ready to implement digital technologies. They perceive the highest readiness regarding digital education (63.7%) and the digital literacy of physicians (60.9%) while negatively evaluating healthcare infrastructure, financial resources, and patient literacy. The results highlight numerous aspects that must be addressed for successful implementation, many of which have been neglected in previous periods. Conclusions The research identifies critical aspects of the social context and presents valuable implications for the digital health transformation. Key stakeholders assess that institutional and societal readiness is not at the level required for the sustainable implementation of digital health, thus necessitating specific actions, ranging from governmental bodies and international organisations to the health system, education system, and media. Key messages • It’s crucial to align digital health implementation with the social & cultural context and capabilities. • The prerequisites for successful implementation necessitate engagement across various societal domains beyond the healthcare system.

Monitoring the digital healthcare transition in Italy: Initiatives, metrics and feedback from Primary Care Physicians

Abstract Italy’s healthcare sector has undergone significant digital transformation since 2008, driven by national strategies and reforms overseen by the Ministry of Health, the Ministry of Economy and Finance, and the Agency for Digital Italy. Key initiatives include the establishment of centralized booking systems, electronic health records (EHR), ePrescription, dematerialization of medical reports and disease certificates, patient summary, and telemedicine services. Despite regional variations, progress in the EHR adoption has been notable. Ongoing investments under the 2021 National Recovery Plan aim to further enhance digital healthcare infrastructure by 2025 through the involvement of the Italian National Agency for Regional Healthcare Services (AGENAS). Currently, Italy monitors progress through comprehensive measurement frameworks tracking digital health initiatives’ implementation and impact. These encompass indicators reported quarterly by public healthcare facilities regarding the implementation of patient portals, regional registries, network infrastructure, regional EHR systems (i.e., n° of users), and digital laboratory reports. In parallel, we conducted a cross-sectional survey assessing knowledge, opinions and concerns among primary care physicians (PCPs) following the 2022 reform, which introduced Community Hospitals, Community Houses, and telemedicine in primary care. The survey highlighted mixed opinions and insufficient knowledge among PCPs regarding the novelties. Clearer communication and coordination with territorial services appears necessary. Many GPs are engaging in telemedicine, but digital literacy gaps remain, as only 35.7% believed they had necessary digital literacy. This is an insight into Italy’s digital health roadmap, mainly involving primary care and focusing on achievements, challenges, and future prospects in utilizing digital solutions across healthcare settings.

7.D. Scientific session: Digital health divide in access, use, and effectiveness: Examples from three countries

Abstract The increasing digitalisation of the healthcare system opens up a wide range of opportunities but also poses challenges in reducing inequalities due to unequal technological access as well as social and demographic differences of populations. This so-called digital divide is the opposite of digital inclusion, defined by the United Nations as “equitable, meaningful, and safe access to use, lead, and design of digital technologies, services, and associated opportunities for everyone, everywhere”. Indeed, digitalisation is a global phenomenon that permeates all levels of determinants of health inequities, leading to several populations being more disadvantaged. Age, gender, education, and economic status are significant factors amplifying the digital divide’s impact, with older individuals, women, less educated individuals, and economically deprived populations bearing disproportionate effects. Prior literature suggests three levels of digital divide: 1) access to internet and digital technology, 2) individual cognitive and technical competencies in utilizing digital tools, and 3) effectiveness or the optimal functionality and reach of digital technologies. Although there is less consensus with regards to the scope of the divide in the health sector, the three levels are the common reference. Nonetheless, this lack of agreement resulted in existing literature to be concentrated around digital health literacy, or the cognitive and technical abilities to use digital technologies. In addition, while tools such as the Global Digital Health Monitor are valuable to track, monitor, and assess the enabling environment for digital health worldwide, it does not capture the lived experience of the population, including the disadvantaged population groups. This workshop aims to 1) generate discussion on digital health divide and how it can be operationalized and 2) reflect on potential actions to counteract these injustices. Case studies from Germany, Indonesia and Argentina will be presented to diversely contextualize the inequities in digital health and assess plausible interventions. The workshop will be divided into four parts. First, an introduction to the digital health divide will be presented as well as its public health relevance (10 minutes). Second, researchers representing three countries (i.e., Germany, Indonesia, and Argentina) will present digital health divide case studies within their context of expertise (15 minutes). Third, a case-based discussion will be conducted with participants. Participants will be allocated into groups based on the three levels of the digital health divide (i.e., access, use, and effectiveness) and work on recommendations to best operationalize and narrow the digital health divide (25 minutes). Finally, the workshop will conclude with a wrap-up of the group discussion results (10 minutes). Key messages • The digital health divide affects all regions, regardless of income levels. Narrowing the gap is crucial to reduce health inequity and achieve universal health coverage. • By clearly defining the scope and operationalization of the digital health divide, its measurability and usefulness to inform health policies and programs to address this issue can be enhanced.

Usability Insights from the BUMPER Cancer Prevention App Pilot Study: A Mixed-Methods Approach

Abstract Introduction As the second leading cause of death in the EU, cancer is expected to see a 55% rise in new cases globally over the next two decades. The European Code Against Cancer (ECAC) and the EU’s Beating Cancer Plan (EBCP) provide resources for understanding and preventing cancer. The BUMPER project aims to develop a cancer prevention App to make the ECAC more accessible to the public. Objectives Understand the factors influencing the use of a cancer prevention app among users with different digital health literacy levels and to evaluate the app’s usability. Methods Mixed-methods approach was used to gather user feedback. FGDs explored user perspectives on app usage, while a cross-sectional survey assessed usability through task completion on an initial app wireframe. The pilot was conducted across seven EU countries in late 2023. Results 77 participants participated in the pilots and FGDs across seven EU countries. The average task completion time was approximately 79 seconds. Participants rated their confidence to complete the tasks at 3.96 and difficulty at 2.28 on a scale of 1 to 5. The average task pass rate was 92.11%. Qualitative findings highlighted the need for evidence-based content, user-friendly design, language accessibility, offline functionality, and data security. Participants also stressed the importance of clear instructions, regular updates, and robust tracking features. Despite some challenges, the app was generally well-received, with users appreciating its educational potential and tracking capabilities. Conclusions The BUMPER project’s pilot study demonstrated the cancer prevention App being developed as a potential tool for cancer education and awareness. Despite navigational and language challenges, the app was favorably received by a diverse user base, underscoring the need for ongoing improvements in user guidance, comprehension, and functionality to enhance accessibility. Key messages • BUMPER project’s cancer prevention app shows promise in pilot study, enhancing cancer education and awareness. • Despite challenges, the app was well-received, highlighting the need for ongoing improvements to enhance accessibility.

Vaccine conspiracy beliefs are the main determinant of adult vaccine hesitancy

Abstract Background Many factors influence the level of vaccine hesitancy. The COVID-19 pandemic demonstrated that conspiracy beliefs are an important element of overwhelming misinformation. The main aim of the study was to assess the relationship between vaccine hesitancy (VH) and vaccine conspiracy beliefs (VCB) in Polish society. Methods The analysis was conducted using data from an online survey of 2189 Internet users conducted in November 2021. Uni- (ULRM) and multivariable linear regression (MLRM) models were developed for vaccine hesitancy as a dependent variable. The independent variables included VCB score (VCBS), health (HL) and e-health literacy (eHL), Internet (IU) and social media use (SMU), political views (PV), and sociodemographic variables. Results The VCBS, eHL, HL, age, income, vocational and marital status, place of residence, PV, IU, and SMU were significant predictors of VH in ULRMs. A significant relationship with VH was maintained in MLRM for all independent variables enlisted earlier, apart from age, income, and vocational status. Respondents with higher VCBS were more likely to have higher VH (B, 95%CI: 0.38, 0.37-0.40). Those with undetermined HL had higher VH than persons with sufficient HL (B, 95%CI: 0.13, 0.06-0.20). A higher level of eHL predicted a lower level of VH (B, 95%CI: -0.01, -0.012 - -0.03). Lower IU and higher SMU were associated with higher VH (B, 95%CI: 0.16, 0.02-0.30, and 0.10, 0.03-0.17, respectively). Supporters of far right-wing party showed higher HV than supporters of the governmental party (B, 95%CI: 0.16, 0.07-0.27). Finally, singles showed higher HV than married (B, 95%CI: 0.07, 0.01-0.13), and residents of small cities had higher HV than residents of rural areas (B, 95%CI: 0.08, 0.004-0.15). Conclusions The vaccine conspiracy beliefs play a major role in the development of VH. The interventions aimed at the change of antivaccination attitudes should address the problem of widespread conspiracy beliefs. Key messages • Conspiracy beliefs are an important determinant of attitudes toward vaccination. • The development of adequate digital health literacy may be a protective factor against vaccine hesitancy.

Organizational health literacy responsiveness in community pharmacies in Serbia

Abstract Background The Faculty of Pharmacy at the University of Belgrade conducted a pilot study at community pharmacies in Serbia in 2023 in the framework of the M-POHL organizational health literacy (OHL) project. Community pharmacies in Serbia are considered relevant settings where people’s health can be promoted within the organization. Methods The validated and culturally adopted Serbian version of the International Self-Assessment Tool for Organizational Health Literacy in Primary Health Care Services (OHL-PHC) was used. We recruited employees from 3 pharmacy chains with pharmacists from different units. A preparatory workshop was organized to explain the procedure and the concept of OHL. First, the self-assessment was performed in a small group of 5 persons individually, and then the results were discussed in a joint assessment. The self-assessment was based on the degree of fulfillment of 4 categories offered for each indicator: not fulfilled (0-25%), predominantly not fulfilled (26-50%), predominantly fulfilled (51-75%), and completely fulfilled (76-100%). The same scale was applied for the indicators, sub-standards and standards and the final score was the mean of the individual scores (min. 0, max. 4). Results The overall score of the OHL on the sample level was 1.93±0.86, with the highest score for providing of easy access to primary care service and facilitating navigation (2.3±0.5). The least fulfilled standards were related to promotion of digital health literacy and promoting health literacy with the same score values of 1.7±1.0. Out of 69 indicators 1 had been self-assessed as not fulfilled and 15 reached low consensus (SD ≤ 1), and needed to be discussed further. Conclusions Improvements in OHL in the piloted institutions are necessary for successful healthcare and health promotion and could be tailed in further usage of the OHL-PHC on a broader scope. More pilot studies are needed in other healthcare settings at primary level in Serbia.

The EU-funded action to strengthen health information systems

Abstract The European Commission initiative to build a European Health Union recognizes the need to address in a coordinated fashion the effects of the pandemic in health and social sectors and to strengthen the resilience, accessibility and effectiveness of health systems through co-operation, best practice exchange, training schemes, technical support and improved data and knowledge management. To make the most of the potential of health data, the European Health Data Space (EHDS) is being established as one of the central building blocks of a strong European Health Union. The EHDS sets out rules, common standards, infrastructures and a governance framework for the use of electronic health data for healthcare, research, innovation and policy making. In line with these policy goals, the European Commission is funding the Action ‘Supporting Member States in the WHO European Region in strengthening health information systems and boosting health data governance’. This Action will be implemented by WHO Regional Office for Europe and aims to boost the use and reuse of health data, including by promoting, where possible, the principles and solutions developed and implemented for the EHDS. It will also contribute to the objectives of the EU Global Health Strategy to improve global health security and deliver better health for all in a changing world. In addition, the Action is designed to strengthen countries’ capacity across critical programmatic areas of health data and digital health such as data quality (including appropriate data management and analytics) and digital health literacy across the 53 Member States in the WHO European region. The main objectives of the Action are to establish a Health Information Network for strategic guidance; and develop and implement tools and capacities to strengthen health information systems, health data governance, data quality and interoperability in countries.

Assessing cyberchondria and eHealth literacy differences in urban and rural China

Abstract Background and Objectives This study aimed to explore the association between cyberchondria and eHealth literacy in the general Chinese population, and to assess how this relationship changes between urban and rural residents. Methods Data obtained from a web-based, cross-sectional survey that evaluate cyberchondria and its impact on health in February 2024. The Cyberchondria Severity Scale - 12 item was used to measure the cyberchondria, while the eHealth Literacy Scale was used to evaluate eHealth literacy. Descriptive analysis was used to describe the background characteristics of the participants. Then, a multivariable linear regression model was then performed for urban and rural subsample to examine the relationship between cyberchondria and eHealth literacy, respectively, providing a comparative analysis between the urban and rural populations. Results A total of 634 individuals completed the questionnaire. The average age was 33.2 years (SD = 7.4), with approximately 50.3% (n = 319) being female. Urban residents made up 71.4% (n = 451) of the participants. The mean eHEALS scores for urban and rural residents were 31.9 (SD = 4.3) and 30.4 (SD = 4.2), respectively. The CSS-12 scores for urban residents were 40.3 (SD = 7.58) and for rural residents were 39.1 (SD = 7.2). Linear regression analyses showed a significant association between eHealth literacy and cyberchondria for urban residents (Beta = 0.30, p < 0.001), but age and education level had no significant impact. For rural residents, a statistically significant association between eHealth literacy and cyberchondria was also observed (Beta = 0.40, p = 0.002). Conclusions Overall, eHealth literacy consistently predicts cyberchondria severity in both urban and rural samples. Higher eHealth literacy is linked to greater cyberchondria, especially in rural areas. Future research should explore other potential mediators, including psychological factors, internet usage patterns, and access to healthcare services. Key messages • eHealth literacy strongly predicts cyberchondria severity in both urban and rural populations, with a notably stronger impact observed in rural settings. • Urban and rural differences highlight the need for customized digital health literacy programs to effectively address region-specific challenges and behaviors.