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.