Digital Health Literacy and Its Impact on Patient Engagement in Telemedicine Services: A Cross-Sectional Study

Digital health literacy (DHL) has been recognized as a significant determinant of telemedicine engagement, however, the pathways that link DHL with telemedicine engagement have not been sufficiently quantified. This cross-sectional study aims to establish the relationship between digital health literacy and patient engagement among 412 adults utilizing telemedicine services at an urban academic health system during the period from January to December 2025. DHL has been assessed by means of eHealth Literacy Scale (eHEALS), whereas patient engagement was measured via Patient Health Engagement Scale (PHE-s) and behavioral measures of telemedicine use. Logistic regression and explainable machine learning (CatBoost with SHAP) have been used to determine DHL engagement associations and the most important predictors. Adequate DHL levels were detected in 58.7% of subjects. Increased eHEALS scores were positively correlated with increased PHE-s positions (adjusted OR = 3.42; 95% CI: 2.18-5.37) and completed telemedicine sessions (adjusted OR = 2.89; 95% CI: 1.76-4.74) when adjusted for age, education, income, and chronic conditions presence. SHAP analysis showed self-care confidence, health information searching behavior and number of digital devices as the most influential predictors of high patient engagement level.