Applying the Electronic Health Literacy Lens: Systematic Review of Electronic Health Interventions Targeted at Socially Disadvantaged Groups

Abstract

Background Electronic health (eHealth) has the potential to improve health outcomes. However, eHealth systems need to match the eHealth literacy needs of users to be equitably adopted. Socially disadvantaged groups have lower access and skills to use technologies and are at risk of being digitally marginalized, leading to the potential widening of health disparities. Objective This systematic review aims to explore the role of eHealth literacy and user involvement in developing eHealth interventions targeted at socially disadvantaged groups. Methods A systematic search was conducted across 10 databases for eHealth interventions targeted at older adults, ethnic minority groups, low-income groups, low-literacy groups, and rural communities. The eHealth Literacy Framework was used to examine the eHealth literacy components of reviewed interventions. The results were analyzed using narrative synthesis. Results A total of 51 studies reporting on the results of 48 interventions were evaluated. Most studies were targeted at older adults and ethnic minorities, with only 2 studies focusing on low-literacy groups. eHealth literacy was not considered in the development of any of the studies, and no eHealth literacy assessment was conducted. User involvement in designing interventions was limited, and eHealth intervention developmental frameworks were rarely used. Strategies to assist users in engaging with technical systems were seldom included in the interventions, and accessibility features were limited. The results of the included studies also provided inconclusive evidence on the effectiveness of eHealth interventions. Conclusions The findings highlight that eHealth literacy is generally overlooked in developing eHealth interventions targeted at socially disadvantaged groups, whereas evidence about the effectiveness of such interventions is limited. To ensure equal access and inclusiveness in the age of eHealth, eHealth literacy of disadvantaged groups needs to be addressed to help avoid a digital divide. This will assist the realization of recent technological advancements and, importantly, improve health equity.

Co-designing eHealth and Equity Solutions: Application of the Ophelia (Optimizing Health Literacy and Access) Process

“…Yet, in a recent systematic review of eHealth interventions targeted at socially disadvantaged groups who are most at risk of low eHealth literacy, it was found that user-centered principles were not discussed, and eHealth literacy needs were generally not considered. User involvements were usually in the form of focus groups for needs assessment which involved limited respondents or at usability testing when the intervention was already designed (29). The findings reflect the growing concern that there is a lack of frameworks or guidelines to inform the development of digital health solutions that meet eHealth literacy needs (30), and disadvantaged populations are overlooked in digital health solution design (31).…”

“…The findings reflect the growing concern that there is a lack of frameworks or guidelines to inform the development of digital health solutions that meet eHealth literacy needs (30), and disadvantaged populations are overlooked in digital health solution design (31). As such, vulnerable groups are at risk of becoming marginalized in the digital age (29,32).…”

Social and Demographic Patterns of Health-Related Internet Use Among Adults in the United States: A Secondary Data Analysis of the Health Information National Trends Survey

“…Data from Pew Research Center have shown that internet use for racial and ethnic minorities is comparable to non-Hispanic whites [ 2 ]. As a result, health dissemination has become more streamlined, and use of the internet has become a popular tool for fostering complex conversations, increasing access to health information, and improving medical outcomes [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ]. For example, systematic reviews of digital health interventions have found clinical benefits among individuals with musculoskeletal conditions and improved quality of life and mental health outcomes for cancer patients [ 7 , 8 ].…”

In the digital age: a systematic literature review of the e-health literacy and influencing factors among Chinese older adults

“…The results were consistent with those of previous studies worldwide (Hoogland et al 2020;Shiferaw et al 2020;Villadsen et al 2020). These identified non-modifiable factors can be used to determine which individuals are at risk of poor e-health literacy, and to indentify the vulnerable population that medical staff need to target (Cheng et al 2020). Nokes and Reyes (2019) implemented health education interventions for low-income elderly people (vulnerable population) in America, and the results showed that these interventions improved the elderly's e-health literacy and chronic disease self-management.…”