When I come across the phrase ‘Digital health literacy’, I feel uneasy. There seems to be ambiguity here and I often wonder if I’m the only one who senses it.
Finally, I have decided to explore whether there is a distinction between the potentially three meanings of the phrase:
- Is it about ‘digital information literacy’ in the world of health?
- Or perhaps we are talking about health literacy in the digital age (digital ‘health literacy’)
- Or is it about people’s ability to engage with digital health (‘digital health’ literacy)?
Or are they the same phenomena? To understand the knot I’ve created for myself, I’ll begin by disentangling these terms.
What is Literacy?
‘Literacy’ is a widely-used term, especially amongst educators. From nurseries to universities, literacy looms as a set of skills and competencies that need mastering.
UNESCO recognises the complexity of meanings the word represents. At a basic level, literacy is about simply being able to read and write. But it is also about being educated and knowledgeable, including knowing how to access, engage with, and share knowledge. Amongst academics, the main buzzword is ‘information literacy’. In this context, people develop the skills to interpret information sources, making ‘informed judgments’. They also learn how to produce information in their own right. Armed with these skills, people are empowered to make critical decisions about key aspects of their lives, including their own health.
Temporarily discarding the ‘digital’ label, this seems a good point at which to consider ‘health literacy’. According to the World Health Organisation (2015), health literacy refers to ‘the cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand and use information in ways which promote and maintain good health.’ This definition of health literacy is very close to the idea of information literacy (as defined above), applied to health domain.
And so, to digital ‘health literacy’. The European Commission’s definition of ‘digital health literacy’ looks very much like a ‘digital’ extension of ‘health literacy’: ‘the ability to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem’. A scan of publically available literature on digital health literacy reveals a common, almost exclusive, focus on using the internet to search for health-related information. This observation is unnerving because it seems to be side-stepping the elephant in my room, which is the one obsessed with digital health.
Digital health involves the application of digital tools (e.g. smartphones, wireless sensors, apps, and social networking) to monitor and help to maintain health. It draws on advances in genomics and mobile technologies to individualise healthcare interventions as well as to understand population health. Self-monitoring becomes a central feature of digital health tools.
In this world of digital health, consumers have access to raw data about their own bodies and they need to develop a new set of literacies around reading and interpreting this information. I was encouraged to see that a summary of ‘digital ambitions’ for healthcare in Wales included developing capability in both staff and patients to engage with smartphones and wearable devices, as well as online records. Engaging with digital health helps to meet the ambitions of providing increasingly personalised care.
This wider application of the term ‘digital health literacy’ can encompass a diverse range of electronic information sources. Greater use of technology-based health tools would open the way for the Internet of Things, as well as the pre-digested information found on the internet. The burgeoning of digital health technologies is no less a challenge for healthcare staff as it is for the general public.
Returning to the puzzle I set for myself, it seems that the first two meanings are practically the same. Most common understandings of ‘digital health literacy’ are about digital ‘health information literacy’, where the focus is mainly on the ability to engage with health-related texts on the internet. This is different to the third meaning, in which the focus is on ‘digital health’ interventions. I would like to see ‘digital health literacy’ represent the broadest range of digital tools, data and information, to keep pace with advances in technology.