[Digital health literacy of pupils. Level and associations with physical activity and dietary behavior]

Digital Health Literacy of Children and Adolescents and Its Association With Sociodemographic Factors: Representative Study Findings From Germany

BACKGROUND

Children and adolescents extensively use the internet in their daily lives, often seeking information related to health and well-being. In modern society, the volume of health information available in digital environments is constantly increasing. This includes both reliable and misleading content, making it challenging to assess trustworthiness. Digital health literacy is essential for navigating the digital information ecosystem, protecting oneself from misinformation, and making informed health decisions.

OBJECTIVE

This representative study aims to examine the digital health literacy of children and adolescents in Germany and its association with sociodemographic factors.

METHODS

A cross-sectional study design with face-to-face interviews was utilized to collect data from 1448 children and adolescents aged 9-18 years in Germany between October and November 2022. Digital health literacy was assessed using an adapted and translated version of the Digital Health Literacy Instrument (DHLI), which comprises 7 subscales: operational skills, navigation skills, information searching, self-generated content, evaluating reliability, protecting privacy, and determining relevance. Bivariate and binary logistic regression analyses were conducted to examine associations between digital health literacy subscales and sociodemographic characteristics (sex, age, migration background, school type, and perceived family affluence).

RESULTS

The study found that 419 out of 1362 (30.76%) children and adolescents had a problematic level of digital health literacy, while 63 out of 1362 (4.63%) had an inadequate level. Overall, the least difficulties were observed in operational skills and determining relevance, whereas the greatest challenges were related to protecting privacy and navigation skills. Age was significantly associated with 6 of the 7 subscales (excluding protecting privacy), with younger children (9-11 years) facing a higher risk of limited skills (operational skills: odds ratio [OR] 5.42, P=.002; navigation skills: OR 4.76, P<.001; information searching: OR 4.68, P<.001; adding self-generated content: OR 7.03, P<.001; evaluating reliability: OR 3.82, P<.001; and determining relevance: OR 4.76.42, P<.001). Migration background was associated with fewer limited digital health literacy skills, while low perceived family affluence was associated with more limited skills. In the subscales of information searching, self-generated content, and evaluating information reliability, a lower risk of limited skills was observed among those with a 2-sided migration background (information searching: OR 0.62, P=.02; adding self-generated content: OR 0.30, P=.003; and evaluating reliability: OR 0.66, P=.03). By contrast, a higher risk was found among those with low perceived family affluence, including in the subscale of determining relevance (information searching: OR 2.18, P<.001; adding self-generated content: OR 1.77, P=.01; evaluating reliability: OR 1.67, P<.001; and determining relevance: OR 1.58, P<.001). Although school type was not associated with any dimension, sex was linked to operational skills, with females having an increased risk of limited skills (OR 1.58, P=.03).

CONCLUSIONS

The results highlight a strong need for interventions to improve digital health literacy among children and adolescents, particularly in protecting privacy, navigation skills, and evaluating the reliability of health information. Effective interventions should be tailored to address the varying needs associated with age, migration background, and family affluence.

[Learning digital health literacy in school: results of a representative survey of pupils in Germany]

BACKGROUND

Digital information sources provide adolescents with quick access to health-related information. Schools are ideal for promoting digital health literacy and enabling students to handle such information safely. The aim of this paper is to present initial results from a representative study on learning digital health literacy in schools, with a focus on sociodemographic and socioeconomic differences.

METHODS

The cross-sectional study was conducted in Germany with 1448 students (aged 9 to 18 years) as part of the DURCHBLICKT!

PROJECT

Bivariate and multivariate analyses were used to examine differences and relationships in the learning of digital health literacy in school and gender, age, migration background, and subjective social status.

RESULTS

Approximately 50% of students reported that they had not (or only to a limited extent) learned digital health literacy in school. The chi-square test reveals significant differences in terms of gender, age, migration background, and social status. Regression analyses indicate that age and subjective social status are significant factors for acquiring digital health literacy.

DISCUSSION

The high number of students who do not learn digital health literacy in school is concerning, especially given their often low levels of digital health literacy. The results highlight the need for targeted educational strategies-especially those tailored to gender and socioeconomic status-to promote digital health literacy and reduce social inequalities.

[Health literacy and health behaviour-insights into a developing field of research and action for public health]

The research and action field of health literacy and health behaviour is increasingly differentiating. General health literacy is established and focuses on population-based studies. Specific health literacy for health behaviour offers topic-related starting points for interventions and public health strategies.There are various concepts, definitions and measurement instruments for general health literacy and specific health literacy in the areas of nutrition and physical activity. These differ in terms of the levels of action and areas of application of health literacy.Most studies show a positive association between health literacy and various health behaviours. Higher health literacy is more often associated with improved health-promoting behaviour. This applies to both general as well as specific health literacy regarding nutrition and exercise (physical activity). Some studies found no correlation for certain behaviours, while others only found correlations for certain groups, which may be due to the different measuring instruments and research contexts. This points to the importance of always considering the interaction between behaviour and circumstances in order to improve the fit between the individual and the everyday demands of dealing with health information.The behavioural and cultural insights (BCI) approach can provide insights into how to promote health literacy with regard to various health behaviours, individual barriers and facilitators that arise from life circumstances and conditions, and that take social practice into account. BCI and health literacy complement each other and have the potential to make strategies for improving health behaviour more effective and targeted.

[Problematic digital media use and health literacy among schoolchildren in Germany. Findings of the 2022 HBSC Study]

BACKGROUND

The digital life of children and young people is characterised by frequent use of social media and digital games. Previous research has demonstrated detrimental health effects of problematic media use. However, links with health literacy (HL) have received little attention, although frameworks suggest health literacy to be a determinant of health behaviour.

METHODS

This paper draws on data from the representative Health Behaviour in School-Aged Children (HBSC) Study in Germany from 2022 with n = 6475 pupils. Associations between problematic social media use or gaming intensity with health literacy and socio-demographic and socio-economic characteristics were examined using bivariate and binary-logistic regression analyses.

RESULTS

The prevalence of problematic social media use was 11.1% and approximately one third reported to spend more than nine hours a week playing digital games. Low health literacy was found to be significantly associated with both forms of media use. In addition, problematic social media use was associated with a female and diverse gender, an age of 13 years, a migrant background and belonging to a type of school other than grammar/high school. High gaming intensity was associated with a male and diverse gender, belonging to the 13- and 15-years age group and low family affluence.

DISCUSSION

The results not only provide guidance for identifying adolescents with a high prevention need but also emphasize the relevance of health literacy for media use behaviour. Exemplary recommendations are taken up with reference to the international literature.

Development and effectiveness evaluation of an interactive e-learning environment to enhance digital health literacy in cancer patients: study protocol for a randomized controlled trial

Background

The Internet allows cancer patients to access information about their disease at any time. However, the quality of online information varies widely and is often inaccurate or does not provide all the details patients need to make informed decisions. Additionally, patients' often limited ability to find and evaluate cancer-related online information can lead to misinformation.

Objective

An interactive e-learning environment to promote digital health literacy will be developed and evaluated for effectiveness.

Primary hypothesis

Cancer patients who use the e-learning environment (IG1.1-IG1.3) or the content of the environment as a non-interactive PDF file (IG2) will show greater improvement in their digital health literacy from baseline to 8 weeks after baseline compared to patients who receive no such intervention, but are referred to a standard information brochure.

Methods

The hypothesis will be tested in a stratified randomized controlled superiority trial with five parallel groups and the primary endpoint of digital health literacy. In an e-learning environment, patients will learn strategies to use when searching for reliable cancer-related online information. During development, a prototype will be refined through focus groups and tested for usability by experts and patients. 660 cancer patients will be recruited using convenience sampling and randomly assigned in a 3:1:1 ratio to IG1.1-IG1.3 (three variants of the environment), IG2, or the control group. Two thirds of the 660 participants will be recruited through the German Cancer Information Service (CIS) and one third through non-CIS routes. Allocation will follow stratified randomization, accounting for recruitment route (CIS vs. non-CIS) and cancer type (breast cancer vs. other cancers), with variable block length. The primary outcome, digital health literacy, will be measured at baseline, 2 weeks, and 8 weeks after baseline.

Conclusion

If the results support the primary hypothesis, then the e-learning environment could empower patients to retrieve more reliable information about their disease. Concerns about the generalizability of the results, since a disproportionate number of inquiries to the CIS come from breast cancer patients, are addressed by a proportionally stratified randomization strategy and diversified recruitment routes.

Digital health literacy among primary and secondary school teachers-a quantitative study

Introduction

Digital health literacy (DHL) is a key competency for individuals' daily decisions toward their health behavior and wellbeing. While there is much focus on health literacy (HL) among the general population, teachers have been rarely addressed. Given the shortages in the teaching workforce in Europe and the impact of demanding working conditions on their health, it is important to address DHL in teachers. This paper examines the DHL of primary and secondary teachers and its associations with sociodemographic and school-related factors.

Methods

An online cross-sectional study was conducted with 1,600 German primary and secondary school teachers between October and December 2022. To assess DHL, the Digital Health Literacy Instrument (DHLI) including seven subscales was used. Statistical analyses were conducted on item and subscale level and an overall DHL score was calculated. Next to descriptive analyses, bivariate and regression analyses were conducted to explore potential associations with sociodemographic and school-related factors.

Results

The frequency of difficulty in using digital health information varied across DHL dimensions and was greatest for protecting privacy (70.9%) and evaluating reliability (40.0%). In multivariate analysis, females more often reported a sufficient ability of adding content (OR = 1.61, CI = 1.05-2.48), while males more often reported a sufficient ability to protect their privacy (OR = 0.45, CI = 0.27-0.75). Teachers with leadership positions more often reported a sufficient ability in adding content (OR = 1.78, CI = 1.07-2.98). Regarding the ability to determine the relevance of online health-related information, no associations with a predictor variable were found.

Discussion

The results suggest that it is important to examine the individual dimensions of DHL and their distinct associations with sociodemographic and school-level factors, rather than just to rely on the overall level of DHL. The differential patterns identified in this study suggest a greater intervention need for teachers from higher age groups, primary and secondary general schools, and those without leadership roles. However, based on the limited predictive power of the variables included, further individual and school-level factors and their potential association with DHL should be investigated in the future. The promotion of DHL should be integrated into both teacher education and in-service training.

[Digital health literacy in Germany: current status, concepts, and challenges]

A key prerequisite for the successful digital transformation of the healthcare system is a well-developed level of digital health literacy (DHL) among the population. DHL is the ability to deal with health-relevant digital information and information options with the aim of promoting and maintaining health and well-being for oneself and one's environment. This article examines the discussions about digital health literacy, the existing studies and measurement tools used in them, the data situation in Germany, and current challenges.DHL consists of various sub-competencies that reflect current digital information behavior, opportunities, and risks. The data situation is very heterogeneous due to different study designs and instruments, which limits the informative value. Two representative studies, HLS-Ger‑2 by Bielefeld University and the study by AOK Rheinland/Hamburg and the Leibniz-WissenschaftsCampus, both indicate a high proportion of people with low DHL despite different methods. Both nationally and internationally, DHL is subject to a social gradient and is associated with educational level, social status, financial deprivation, and age.According to the current empirical data, the acquisition of DHL in Germany is still insufficient, so there is a great need for action. The necessary legal framework conditions have been established, but there is still a lack of reliable and financial resources, as well as a solid data basis on DHL at population level. This is essential to identify vulnerability factors and to prepare and evaluate the implementation of measures. In addition, there is a need for an in-depth conceptual discussion on DHL that builds on the established health literacy concept and addresses the emerging health-related infodemic and its consequences for DHL.

Health literacy of students in Germany - Results of the HBSC study 2022

Background

Health literacy (HL) encompasses knowledge and skills for dealing critically and confidently with health information in individual and social contexts. Current studies show that a high proportion of children and adolescents have limited health literacy, depending on aspects of their social background. Health literacy is considered an important factor influencing health. Little is known about the development of health literacy over time and its connection with psychosomatic complaints in young people.

Methods

Based on the results of the Health Behaviour in School-aged Children (HBSC) study, this article focusses on the level of HL in 11-, 13-, and 15-year-old students (N = 6,475) over time and taking social differences into account. Finally, the relationship between HL and psychosomatic complaints is analysed. Univariate, bivariate, and multivariate analyses were carried out for this purpose.

Results

At 24.4 %, slightly more students have low HL in 2022 than in 2017/18 (21.4 %). There are differences in HL according to gender, age, type of school, and family affluence. Low HL is associated with a high psychosomatic burden.

Conclusions

The results highlight the need for target group-specific measures to promote young people's HL, which address individual and organisational aspects of HL.