Review articleHealth literacy in the eHealth era: A systematic review of the literature
Introduction
Information and communication technologies (ICTs) are now used widely to support and deliver health care for patients and the general public. Electronic Health (eHealth) refers to “health services and information delivered or enhanced through the Internet and related technologies” [1]. Internet-based health services include electronic communication between patients and providers, electronic medical records, personal health records, health education programs, patient portals, and Web-based applications for patients [2]. Mobile Health (mHealth) represents a subset of eHealth and can be defined as “the use of mobile computing and communication technologies in health care and public health” [3]. It features a wide variety of services provided through mobile networks, including patient education, remote monitoring, communication and training, disease and outbreak tracking, and diagnostic and treatment decisional support [4], [5], [6].
With the increasing adoption of eHealth services, individuals are increasingly expected to engage in appropriate self-care and self-management of their conditions through eHealth [7]. Health consumers must therefore have sufficient health literacy within the context of eHealth. Health literacy can be defined as “people’s knowledge, motivation and competences to access, understand, appraise, and apply health information in order to make judgments and take decisions in everyday life concerning healthcare, disease prevention and health promotion” [8]. eHealth literacy comprises “a set of skills and knowledge that are essential for productive interactions with technology-based health tools” [9].
Unfortunately, over 90 million Americans have low health literacy [10]. Individuals with limited health literacy experience disparities in their health and access to health care resources [11]. Individuals with low health literacy tend to use fewer preventive services and less eHealth, which are associated with poor health outcomes [12]. Low health literacy is related to delayed diagnoses, poor adherence to treatment regimens, increased morbidity and mortality [13], and increased rates of hospitalization and poor health outcomes [14]. Individuals with low health literacy have difficulties in effectively utilizing and interacting with eHealth [15], [16].
Although ICTs are providing new opportunities for accessing health information and self-management of health conditions, no comprehensive reviews have focused on the relationship between patients’ health literacy and their use of Internet-based health services. We conducted a systematic review of the literature to address this gap. The study aim was to examine whether or not existing studies have addressed health literacy within the context of Internet-based services, and if so, how they have done so, including whether or not they have considered both web-based and mobile applications (apps). The findings could provide insights into how health literacy has been, and should be, addressed in the eHealth era.
Section snippets
Method
Between February–March of 2014, we performed four rounds of searches to identify relevant publications published since 2010.
Results
Forty five (61%) studies investigated a variety of special populations (e.g., older adults with heart failure, low-literacy patients with diabetes, and low-income parents whose children have special health care needs). Target groups with low health literacy varied according to demographics (age, race, and economic status) and health conditions. Individuals with limited health literacy were prevalent among those of age 65 years or older, African Americans or Hispanics, non-English speakers, and
Discussion
Based on the review of 74 empirical studies, we have identified five key themes and suggest future directions for research and practice related to health literacy in the eHealth era.
Conflict of interest
The authors have no potential conflicts of interests to declare, including relevant financial interests, activities, relationships, and affiliations.
Acknowledgements
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
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