Digital health literacy of adults with low reading and writing skills: A mixed-methods study

Abstract Background Around 12% of the adult population living in Germany have low reading and writing skills. Little is known about their digital health literacy and use of digital health technologies. The objectives of the Liter@te study were to assess the digital health literacy of adults with low reading and writing skills and to explore which digital tools they used in everyday life. Methods A cross-sectional survey (n = 96) and five focus groups (n = 39) were conducted with adults aged 18-64 years with low reading and writing skills. Digital health literacy was measured using the eHEALS scale and compared with results from a nationwide sample. Focus group participants completed a task course on digital health information and then discussed their experiences. Survey data were analyzed using descriptive statistics and logistic regression. Qualitative content analysis was applied to analyze the focus group data. Results Survey participants were on average 44 years old, 72% were female and 92% were not born in Germany. Compared to the nationwide survey, use of digital health technologies and digital health literacy were lower. In addition, use of digital health technologies was associated with higher digital health literacy. Lack of technical skills, language problems, and searching and finding health information online were most challenging for focus group participants (mean age 43 years, 87% female). Focus group participants reported that they prefer videos when searching for health information online and seek support from family members or local organizations if they cannot find a solution to their health issue. Conclusions Adults with low reading and writing skills search for health information online, but have difficulties to find the appropriate information. Interventions to promote digital health literacy are needed to ensure that persons with low reading and writing skills are not further left behind. Key messages • Adults with low language skills have a low digital health literacy. • Reading and writing requirements and lack of technical skills make it difficult for them to search health information online.