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.