Without digital literacy, health tech could deepen inequality

As digital health technologies reshape modern healthcare, the gap between innovation and accessibility continues to widen. A landmark study published in Frontiers in Digital Health, titled “Digital Health Literacy—A Key Factor in Realizing the Value of Digital Transformation in Healthcare”, warns that without universal digital health literacy (dHL), the benefits of virtual care, AI-driven diagnostics, and wearable tech may bypass the most vulnerable populations.

Authored by Sarah Wamala Andersson and Marta Pisano Gonzalez on behalf of the IDEAHL Consortium, the study introduces a new conceptual framework and shares lessons from a comprehensive, EU-funded initiative spanning 10 countries. It concludes that dHL is not merely an accessory to digital health - it is a “super determinant” of health equity and a prerequisite for inclusive innovation.

Why is digital health literacy critical to the success of health innovation?

Digital Health Technologies (DHTs), ranging from telemedicine platforms to AI-enhanced clinical tools, are accelerating access to care and improving personalized treatment outcomes. But the study underscores that this transformation is only as effective as the population’s ability to understand and navigate it. Digital health literacy, defined by the WHO as the ability to seek, find, evaluate, and apply health information from electronic sources, is essential for meaningful engagement with digital tools.

Despite this, dHL remains a weak link in many health systems. Many people, particularly the elderly, the socioeconomically disadvantaged, and those with chronic conditions or disabilities, are digitally excluded. These populations often lack the necessary technical and cognitive skills to use digital tools, compounding their existing health burdens.

Moreover, the study notes that only half of the countries in Europe and Central Asia have adopted national policies or inclusion plans to promote dHL. Without adequate policies and training, DHTs risk reinforcing disparities rather than closing them. The lack of standardized, population-wide dHL measurement tools also impedes targeted interventions.

To address these challenges, the study introduces a multilayered conceptual framework that maps dHL across five skill domains: overall literacy, information literacy, health literacy, digital literacy, and scientific literacy. This model illustrates how upstream structural factors (like public policy, access, education, and infrastructure) interact with downstream individual behaviors and literacy levels to shape digital engagement and health outcomes.

What lessons does the IDEAHL project offer for bridging the literacy gap?

The EU-funded IDEAHL project, supported by Horizon Europe, sought to address dHL gaps across 10 European countries. It brought together 14 partners and conducted 140 co-creation sessions with 1,434 participants from 19 different target groups. These included patients, health professionals, policymakers, and underrepresented communities.

The project identified four key strategies:

1. Cross-Border Interdisciplinary Collaboration: Effective dHL strategies must integrate insights from public health, technology, education, and social sciences. The IDEAHL project emphasized the importance of multi-stakeholder participation, including civil society and non-health sectors, to design context-sensitive digital interventions.

2. Standardized Measurement Tools: The study found no existing tool adequate for assessing dHL at the population level across the EU. While eHEALS (eHealth Literacy Scale) is commonly used, it lacks contextual adaptability. Future tools must incorporate digital trends, platform usability, and social determinants of health while prioritizing ethical safeguards like data privacy.

3. Co-Creation with Vulnerable Groups: IDEAHL adopted participatory research to design interventions aligned with lived realities. In culturally and linguistically sensitive workshops, participants shared their beliefs, fears, and technology experiences, enabling the development of inclusive solutions. These findings informed the design of a comprehensive EU dHL strategy.

4. Multi-Level Strategic Framework: The EU dHL strategy, developed through IDEAHL, addresses interventions at micro (individual), meso (organizational), and macro (policy) levels. It calls for integration of dHL into professional training, public health planning, and cross-sector collaboration. A monitoring and evaluation system was also proposed, incorporating tools like the Global Atlas of Literacies for Health (GALH) to guide long-term implementation.

What must policymakers and health systems do to ensure equitable digital transformation?

The study’s final section outlines a call to action for governments and institutions. First, it emphasizes the urgent need for “fit-for-purpose” training of healthcare professionals. Many frontline workers lack digital competencies, limiting their ability to guide patients through tech-enabled systems. Integrating dHL into medical education and ongoing professional development is essential to ensure inclusive, patient-centered care.

Second, the paper advocates for governance models grounded in the Quadruple Helix framework, uniting public institutions, academia, industry, and civil society. This approach promotes holistic, transparent, and inclusive digital health innovation. It encourages systems thinking, bridging silos between care providers, data architects, and community advocates to co-create solutions that serve all segments of the population.

Finally, the authors stress that digital health equity requires long-term planning and adaptability. Lifelong learning must be embedded in national education systems, especially as emerging tools like AI, wearables, and remote diagnostics become standard. Failure to integrate dHL into core policies risks creating a two-tier health system, where those with digital fluency thrive and those without fall further behind.