Measuring Digital Health Literacy in older people. A scoping review (Preprint)

Abstract

BACKGROUND The increasing availability of digital health resources and applications poses a growing demand on the skills needed to fully use these technologies. Without a contextual assessment of people's proficiency with electronic resources, or digital health literacy (DHL), the existing digital divide may widen, particularly among disadvantaged groups such as older people. The presence of valid and reliable tools for measuring DHL among older adults is crucial. OBJECTIVE The purpose of this scoping review is to explore the current research on tools used to assess seniors’ DHL and their psychometric properties. METHODS An extensive search was conducted on February 16, 2024, using four databases: PubMed, Web of Science, Embase, and Scopus. A language filter was applied to include only articles written in English and Italian, and publications from any year were considered. The review focused on primary studies involving participants aged 60 and older, where DHL was quantitatively measured using tools that provided numerical values. The psychometric properties of each tool, where available, were collected, and the quality of all included studies was assessed. RESULTS The search yielded 6879 records; of the 211 studies assessed for eligibility, 37 were ultimately included in the review. A substantial number of these studies were conducted in Asia (25/37) and the United States (8/37), with cross-sectional design being the most prevalent (29/37). Most studies used the eHealth Literacy Scale (eHEALS), a monodimensional, 8-item tool which proved high internal consistency (Cronbach's alpha 0.85-0.99) and good test-retest reliability. Digital Health Literacy Instrument (DHLI) is a 5-dimension, 21-item tool developed to reflect the wider concept of DHL. Other tools included were the Digital Health Literacy Assessment Scale (DHLAS) and the EHealth Literacy Questionnaire (EHLQ). Overall, older adults exhibited relatively low DHL, with no relevant differences observed between Eastern and Western countries. Quality appraisal revealed good reporting quality but also highlighted the presence of common biases, such as reliance on self-reported measures, which can lead to information, recall, and social desirability bias, and selection bias due to convenience sampling or other non-randomized approaches. CONCLUSIONS DHL is an evolving, process-oriented skill shaped by technological and contextual changes, yet many researchers still rely on tools developed before the present technological era, when digital skills were primarily limited to searching and appraising online information. Research on DHL among older adults is still limited and prone to bias. The eHEALS is still the most frequently used tool: although valid and transculturally validated, the eHEALS, developed almost 20 years ago, assesses only self-reported online searching abilities. More recent tools, developed and validated to assess a wider range of skills and, in some cases, to provide an objective assessment of DHL, should be considered for further studies in this rapidly evolving field of research.