Factors associated with digital health literacy among adults with chronic conditions in primary care setting in Singapore: a descriptive cross-sectional study

Digital health literacy encompasses health literacy skills such as the ability to obtain and understand health information as well as technological skills. Technology is becoming increasingly common in healthcare and digital health literacy is associated with health outcomes. However, a digital divide still exists, with factors such as age, educational level and familiarity with digital devices impacting digital health literacy. This descriptive cross-sectional study aimed to determine the factors associated with digital health literacy among adults with chronic conditions in primary care. Convenience sampling was used to recruit adults with chronic conditions from a cluster of public primary care clinics in Singapore over a period of 6 months in 2023. Self-administered questionnaires included demographic data, chronic conditions, ownership and usage of internet enabled devices, health literacy as assessed by the Newest Vital Sign (NVS) and digital health literacy as assessed by the eHealth Literacy Scale (eHEALS). Of 311 participants, mean age was 63 years, 52.7% were male, 74.9% Chinese, 75.9% were married, 46.6% had tertiary education, 61.7% were working and 31.9% had three or more chronic conditions. Majority (96.5%) had one or more internet-enabled devices and 75.9% used the internet daily. Only 38% had adequate health literacy. The average eHEALS score was 29.0. There were significant differences in eHEALS scores for age, gender, educational level, employment status and frequency of internet use. Multiple regression found eHEALS score decreased with increasing age (p < 0.001). For every additional increase in age, eHEALS scores decreased by 0.146 points. Digital health literacy was high in this multi-ethnic Asian population with chronic conditions. Sociodemographic factors such as female gender and lower education were associated with lower digital health literacy, while only age was significantly associated digital health literacy in multiple regression. Interventions should focus on groups with lower digital health literacy to bridge the digital divide and reduce health disparities.