Month: August 2017

Digital Health Literacy – An introduction

On August 9, 2017 we will be holding a Digital Health Literacy Convening in conjunction with the Literacy Education and Second Language Learning for Adults (LESLLA) Symposium.  People from across the country who are interested in digital health literacy will be attending this convening in person and virtually in order to discuss the future of research in digital health literacy.  We are bringing together this group of scholars because we believe that digital devices and access to the internet can serve as a vital link to health information that may ultimately contribute to an improvement in health care outcomes. As Santos, Handley, Omark, and Schillinger (2014) noted, “reducing health disparities in U.S. immigrant communities represents a complex task that will require interdisciplinary problem-solving and community partnership” (p. 89).

To help set the stage for this convening, we are using this post to share some emerging thoughts about digital health literacy. Our definition of digital health literacy is grounded in the work of Norman and Skinner (2006) and Bodie and Dutta (2008).  Norman and Skinner suggested that ehealth literacy includes basic reading and writing skills, working knowledge of using computers, a basic knowledge of science, and appreciation of the social context of how online health information is produced, transmitted, and received. Bodie and Dutta argued that it requires “a combination of context-specific and analytical skills,” the ability to use a computer, and the ability navigate the internet in order to make informed decisions about one’s health.

Our growing interest in digital health literacy is connected to the idea that health literacy in general can contribute to participation in programs aimed at health promotion, disease prevention, and screening (Rudd, 2014).  According to Rudd (2014), “there is an established link between patients’ literacy skills and health outcomes.  For example, literacy levels have been shown to have an effect on knowledge, behaviors, risk factors, morbidity, and mortality” (Chapter 2, Paragraph 2). However, there can be a mismatch between the demands of health systems and the literacy of the population, which can limit access to information, services, and care.  We suggest that improving individuals’ digital skills is one step toward removing barriers to health information.

Improving digital skills is especially important as the increased reliance on digital technology in healthcare also may lead to an increase in health disparities (Bodie & Dutta, 2008; Klecan, 2010).  This is especially apparent as health care providers have come to expect patients to come to medical appointments prepared with informed questions, that they know how to access information using all available tools, including the internet, and that they use digital tools to track compliance to care, including preventative care and medication use. (Basics of HealthIt). To date, little has been done to help healthcare providers support patients in their quest to use the digital tools now required for full engagement in healthcare (Sheon, 2017).

It is within this environment that individuals with less experience with and access to digital tools can struggle with equity of services, validity of information, access to the hardware, knowledge of how to navigate information retrieval systems, reading levels, website design, and knowledge of what is online. Part of the problem is home internet penetration rates, which were 73% in 2015 (Turner, 2016) and the fact that 36% of low-income Americans also lack a smartphone (Turner, 2016).  There is also a correlation between race/ethnicity and internet access as well as gaps marked by age and educational attainment (Turner, 2016). Access, however, is only part of the picture.  As Klecan (2010) suggested, there are those who may not be able to achieve the needed digital literacy and ehealth literacy skills because of lack of access or support; therefore, they would benefit from the presence of someone to help them access the material online and make sense of that material. What this material might look like and how it should be delivered is an area of interest to the team at Portland State.

Thus far there are too few studies to claim a strong relationship between ehealth engagement and health status, although Stellefson et al. (2013) showed weak associations between long-term health maintenance and the use of ehealth resources.  We are intrigued, however, by Stellefson et al.’s finding that as participants in their study used health online resources, they grew more comfortable with using computers and the internet. The success of this model can be seen in the Richmond Digital Health Literacy Project (Communities in Collaboration, 2016). Our previous research has shown that as individuals gain confidence in using computers and the internet, they begin using it to meet life goals of which health information seeking is one (Jacobs et al., 2015).

Our overarching concern is that individuals who have little access to the internet and have low digital literacy skills may be less able to access health information and be active participants in their health care.  Our hypothesis is that as individuals build digital literacy skills they will be able to increase their health information seeking behaviors and build their capacity for improved engagement in their health care. Ultimately, we hope that this improvement would result in decreasing health disparities among vulnerable populations. We hope that by collaborating with others who also are interested in these questions that we can begin to build opportunities for those who have thus far been excluded from the digitization of healthcare to engage with health services and information in order to improve health outcomes and continue learning.



Basics of health IT. (2013, January 15). Retrieved from

Bodie, G. D., & Dutta, M. J. (2008). Understanding health literacy for strategic health marketing: Ehealth literacy, health disparities, and the digital divide. Health Marketing Quarterly, 25(1–2), 175–203.

Communities in Collaboration, (2016)  Summative evaluation, City of Richmond Digital Health Literacy Program.

Jacobs, G., Castek, J., Pizzolato, D., Pendell, K., Withers, E., & Reder, S. (2015). Executive Summary: Tutor-facilitated digital literacy acquisition in hard-to-serve populations, a research project.

Klecun, E. (2010). Digital literacy for health: The promise of health 2.0. International Journal of Digital Literacy and Digital Competence, 1(3), 48–57.

Norman, C. D., & Skinner, H. A. (2006). Ehealth literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research, 8(2), e9.

Rudd, R. (2014). Public Health Literacy. In Institute of Medicine, Board on Population Health and Public Health Practice, Roundtable on Health Literacy (Eds.), Implications of Health Literacy for Public Health: Workshop Summary. Retrieved from

Santos, M. G., Handley, M. A., Omark, K., & Schillinger, D. (2014). ESL Participation as a Mechanism for Advancing Health Literacy in Immigrant Communities, Journal of Health Communication: International Perspectives, 19:S2, 89-105, DOI:10.1080/10810730.2014.934935

Sheon, A. R., Bolen, S. D., Callahan, B., Shick, S., Perzynski, A. T. (2017). Addressing disparities in diabetes management through novel approaches to encourage technology adoption and use. JMIR Diabetes, 2(2), e16. DOI: 10.2196/diabetes.6751

Stellefson, M., Chaney, B., Barry, A. E., Chavarria, E., Tennant, B., Walsh-Childers, K., … Zagora, J. (2013). Web 2.0 chronic disease self-management for older adults: A systematic review. Journal of Medical Internet Research, 15(2), e35.

Turner, D. (2016). Digital denied: The impact of systemic racial discrimination on home-internet adoption. Retrieved from