Health Literacy and Digital Health Engagement

Health literacy is the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions; in digital settings this extends to eHealth literacy, the skills required to find, appraise, and apply health information from electronic sources. Digital health engagement concerns whether and how people actually use consumer health technologies, and both literacy and engagement help explain who benefits from digital health and who is left behind.

Definition

Health literacy is the degree to which individuals can obtain, process, understand, and communicate health information and services to make informed decisions; eHealth literacy is the set of skills, spanning traditional, information, media, and computer literacies, needed to seek, find, understand, and appraise health information from electronic sources and apply it to a health problem.

Scope

This entry covers the concepts of health literacy and eHealth literacy, their relationship to health outcomes, the factors that shape engagement with digital health tools, and the equity concerns captured by the digital divide. It is a methodological and educational overview within consumer health informatics and does not assess individual literacy or provide medical advice.

Core questions

• What are health literacy and eHealth literacy, and how do they differ?
• How is low health literacy associated with health outcomes?
• What determines whether people engage with digital health tools?
• How do literacy and access contribute to digital health inequities?

Key concepts

• Health literacy
• eHealth literacy
• Patient engagement and activation
• Digital divide
• Access and connectivity
• Trust and self-efficacy
• Social media and health communication

Mechanisms

Health literacy and digital engagement work as moderators that sit between consumer health technologies and their benefits. To use a portal, app, or online information source, a person must be able to access the technology, find relevant content, understand it, judge its credibility, and act on it; each step depends on literacy, skills, trust, and self-efficacy. eHealth literacy combines traditional reading and numeracy with information, media, and computer literacies, so deficits in any component can block engagement. Because these capacities and the necessary access are unevenly distributed, the same tool can help some users while excluding others, producing the digital divide.

Clinical relevance

Differences in health and digital literacy influence how well patients understand instructions, navigate digital tools, and participate in their care, and low health literacy is associated with poorer use of services and outcomes. Recognising these differences is important for interpreting why consumer health technologies help some populations more than others. This entry is descriptive and does not provide individualised guidance or assess any person's literacy.

Evidence & guidelines

A systematic review found that low health literacy is consistently associated with a range of poorer health-related outcomes, including greater use of emergency services and worse ability to interpret health information. The eHealth literacy framework articulates the composite skills needed to use electronic health information and underpins measurement tools in the field. Population data on social media use illustrate how digital health communication reaches diverse groups, while foundational accounts of consumer health informatics emphasise that literacy and access shape who benefits.

History

Health literacy emerged as a distinct concern in the 1990s and 2000s as research linked patients' ability to understand health information with their use of care and outcomes. As health information and services moved online, Norman and Skinner's 2006 concept of eHealth literacy extended the idea to electronic environments, and the spread of social media broadened the channels of health communication. Attention to the digital divide grew as it became clear that access and skills were unequally distributed.

Debates

Does digital health engagement reduce or reinforce inequities?

Digital tools can empower informed users, but because health and digital literacy and access are unequally distributed, expanding digital health may benefit the already advantaged more, so whether it narrows or widens disparities is contested.

Key figures

• Nancy Berkman
• Cameron Norman
• Harvey Skinner
• Bradford Hesse

Seminal works

• berkman-2011
• norman-skinner-2006

Frequently asked questions

What is eHealth literacy?

eHealth literacy is the ability to seek, find, understand, and appraise health information from electronic sources and apply it to a health problem; it combines traditional literacy and numeracy with information, media, and computer literacies.

Why does health literacy matter for digital health?

Because using digital health tools requires finding, understanding, appraising, and acting on health information; people with lower health or digital literacy, or limited access, may benefit less, which is central to concerns about the digital divide.