Health literacy, digital literacy, and designing for equity

Using health technologies requires the right skills or ‘digital health literacy’, described as "the capabilities required for individuals to use and benefit from digital health resources in terms of linguistic, numeric and technical capabilities". There are 2 factors to digital health literacy. Health literacy and digital literacy.

Health literacy is the ability to assess, understand, and use information, required to access health services and make health decisions.

The WHO defines health literacy as "people’s knowledge, motivation and competences to access, understand, appraise and apply health information in order to make judgements and take decisions in everyday life concerning health care, disease prevention and health promotion to maintain or improve quality of life during the life course."

Effective health technology use requires sufficient health literacy and a comprehension of health information. The European Health Literacy Survey found that 47% of European respondents had limited health literacy. 36% of Americans were found to have basic or below basic health literacy. In the UK, 7.1 million adults have a reading age of under 9 years.

Digital skills are also required, yet a significant number of individuals lack basic digital skills. 16% of the adult population in the UK cannot perform basic activities using digital devices. While there’s been progress in improving digital skills in many countries, differences remain across some population groups. Older adults, in particular, often have lower digital abilities and lifetime technical skills. Age-related decline affects dexterity and an ability to learn, while many telehealth digital systems are not designed with accessibility for older patients in mind.

Limited English Proficiency creates a further barrier to using health technology. This is a particular issue in the US, affecting 22.3 million individuals. Language barriers are thought to explain lower rates of technology use by Spanish-speaking populations and immigrants, associated with a 50% decrease in use. Many digital health apps and platforms are designed in English with complex language aimed at highly educated and advantaged users with high reading levels, which fails to meet the needs of users who don’t fit this user profile.

There is an urgent need to re-examine how we design technology, and how we can better incorporate the needs of people with differing communication barriers, literacy levels or ethnicities. ‘Designing for equity’ is one approach that engages with communities through the design and deployment of health technologies to better understand the barriers different communities face and their needs.