Digital Health Literacy

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Digital Health Literacy

Digital health literacy, or e-Health literacy, is the use of digital literacy skills in health.

It has been defined as the ability to seek, find, understand and appraise health information from electronic resources and apply such knowledge to addressing or solving a health problem[i]

People who are digitally health literate can use a computer, phone or the internet to find and use health services and information. This means they have the skills and knowledge to use these devices and technology. They can also work out if the information they find on the internet is right for them.

Digital health literacy is becoming more important as the Australian health system provides more services and information online or electronically.

Digital health initiatives include:

telehealth
online booking of appointments
My Health Record
providing online health information instead of handouts e.g. information about medicines, instructions for how to get ready for a test or operation and admission forms
providing results of pathology or diagnostic tests online, and
using mobile phone apps to manage chronic conditions e.g. keeping track of blood sugar levels.

Digital health services are useless if health care consumers, or providers, do not have the skills or understanding to use them or don’t have access to the equipment needed.

The ability to find, understand and use e-Health resources is important for consumers to be able to use current and future ACT health services.

The ACT has higher levels of digital access, affordability and skills than other Australian states and territories[ii].

The increasing use of e-Health services could result in a larger gap in health outcomes between people with easy access to digital resources and high digital literacy, compared to people with limited access or lower digital literacy.

Research has shown that people with lower health literacy are less likely to use e-Health tools[iii]. They are also less likely to have access to the internet or to use the internet to get health information. This increases inequality in health access and outcomes.

Online information

Being able to discern good information and facts from false information is critical to digital literacy. This includes knowing when online information is trustworthy.

Find out more about how to assess online information in our Finding good health information page.

Social inequality and eHealth

The increasing use of digital technologies within the health sector may increase the inequalities in our health system. Patients with socioeconomic disadvantage have higher rates of chronic disease and mortality, they also access eHealth services at lower rates.

Across Australia, digital inclusion follows clear economic and social patterns. Australians with low levels of income, education, and employment have significantly lower levels of digital inclusion[iv]

… more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information[v].

What Can I do?

Be aware that digital health literacy skills are important for both consumers and health professionals and don’t assume that anyone has the skills to effectively use e-Health tools.
Build skills in assessing health information from online and digital sources and provide advice to consumers on where to find good sources of information.
Many people at risk of inadequate health literacy do not have access to digital resources, or the confidence to use e-Health services. Make sure you provide alternatives (face-to-face or telephone services) for people who don’t use digital services.

The Digital Divide

The Digital Divide and Digital Inclusion

Digital access is not widespread in Australia. Access to, and use of, digital technologies is closely linked to socioeconomic advantage and geographic location. This is known as the digital divide.

The term digital inclusion describes whether a person can access, afford and use online technologies effectively. Digital inclusion recognises the role of digital skills, attitudes and affordability of access in digital inequality.

Although the digital divide is closing in Australia, many people already facing disadvantage and carrying a higher burden of ill-health also do not have basic internet access or skills[i]:

1.25 million Australian households did not have internet access at home in 2016-17 (14%)

1 in 5 people (20%) over 65 use the internet to access online health services – about half as many as the national average.

18.4% of Australians born in non-English speaking countries do not access the internet compared to a 13.5% national average
8 in 10 (79%) people educated to Year 12 or below use the internet, compared with 97% of people with a tertiary qualification
Only 55 % of people aged over 65 use the internet compared to the national average of 86.5%
More than 1.3 million Australians with disability do not access the internet regularly. One in four (25%) of them report lack of confidence and knowledge as a reason for not accessing the internet.
1 in 4 (25%) Indigenous Australian households do not access the internet from home compared with the national average of 15%.
Levels of home internet access for Indigenous Australian households diminishes further with remoteness – 45% of such households in remote and very remote locations do not access the internet at home.
More than 4 million Australians access the internet solely through a mobile connection. The use of mobile-only connection is higher among socio-economically disadvantaged groups. Mobile connection carries a higher cost than fixed connections, making it a more expensive option.

The ACT has higher levels of digital access, affordability and skills than all other Australian states and territories[ii]. But health providers in the ACT shouldn’t assume that consumers have the digital access and skills necessary to benefit from eHealth initiatives, particularly those most at risk of inadequate health literacy.

Resources

UNESCO, the United Nations Educational, Scientific and Cultural Organisation, has developed the Designing Inclusive Digital Solutions and Developing Digital Skills guidelines to help in the design and development of inclusive digital tools. This guide covers what factors to consider, questions to ask and processes to follow when developing solutions for people with limited literacy skills and low digital skills (referred to as ‘low-skilled users’ in the context of this publication).

References:

[i] https://www.digitalinclusionindex.org.au/what-is-digital-inclusion/

[ii] Thomas, J, Barraket, J, Wilson, CK, Rennie, E, Ewing, S, MacDonald, T, 2019, Measuring Australia’s Digital Divide: The Australian Digital Inclusion Index 2019, RMIT University and Swinburne University of Technology, Melbourne, for Telstra.

The Lily Model of Digital Health Literacy

The Lily model of Digital Health Literacy illustrates that eHealth literacy is a product of a range of different skills^[i]:

Traditional literacy and numeracy – the ability to read and understand written text and to communicate and write coherently. It includes quantitative skills, and the ability to use graphs, scales and forms.
Computer literacy – the basic knowledge and skills needed for using a computer, search the internet, use social media.
Media literacy – the ability to select, interpret, evaluate, contextualise and create meaning from visual, print and audio information.
Science literacy – the familiarity with basic biological concepts and the scientific method, and the ability to understand, evaluate and interpret health research findings using appropriate scientific reasoning.
Information literacy – skills related to defining information needs, locating, evaluating and using the information for knowledge production.
Health literacy – acquisition, evaluation and appropriate application of relevant health information for making health decisions, using health services, and to maintain good health.

[i] Norman CD, Skinner HA. eHealth Literacy: Essential Skills for Consumer Health in a Networked World. J Med Internet Res 2006;8(2):e9. DOI: 10.2196/jmir.8.2.e9

References:

[i] Stellefson, Hanik, Chaney, Chaney, Tennant, Chavarria. (2011) eHealth Literacy Among College Students: A Systematic Review With Implications for eHealth Education. J Med Internet Res

[iii] Mackert M, Mabry-Flynn A, Champlin S, Donovan EE, Pounders K Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide, J Med Internet Res 2016;18(10):e264 DOI: 10.2196/jmir.6349

[iv] Thomas, J, Barraket, J, Wilson, CK, Rennie, E, Ewing, S, MacDonald, T, 2019, Measuring Australia’s Digital Divide: The Australian Digital Inclusion Index 2019, RMIT University and Swinburne University of Technology, Melbourne, for Telstra

[v] Neter E, Brainin E. eHealth literacy: extending the digital divide to the realm of health information. J Med Internet Res. 2012;14(1):e19. Published 2012 Jan 27. doi:10.2196/jmir.1619