Health Literacy in the Age of Digitalization in Switzerland: Cross-Sectional Representative Study
Journal of Medical Internet Research ·
Background: To cope with the challenges of digital transformation in health and well-being, people need digital health literacy (DHL), namely the competencies to access, understand, appraise, and apply digital health–related information and services for their own and others’ health and well-being. So far, however, there have been no data on the level of DHL in Switzerland. Objective: As part of the international Health Literacy Survey 2019-2021 (HLS 19 ), this study aimed to close this gap by investigating DHL, the population groups particularly affected by low DHL, its health-related consequences, as well as use of digital information sources in the general population in Switzerland. Methods: Participants were recruited from the Swiss Federal Statistical Office sampling frame using stratification by linguistic region, age, and gender. Of the 4764 individuals contacted, 2554 completed the survey (response rate: 53.6%). Responses from 52 participants were excluded because fewer than 80% of the general health literacy items had been completed. Additionally, 168 participants from the overall study sample were excluded from the calculation of the digital health literacy score (HL-DIGI) because of insufficient completion of the DHL items. DHL of 2334 people was assessed between March and April 2020 with an online questionnaire. Descriptive statistical analysis, Pearson chi-square tests, Spearman rank correlations, and multivariable linear regression analyses were performed to examine DHL and its associations with sociodemographic characteristics, health-related consequences, and use of digital information sources. Results: Most of the respondents report inadequate (1034/2334, 44.3%) or problematic (651/2334, 27.9%) DHL levels. DHL resulted to be negatively associated with older age (B=−0.278, 95% CI −0.371 to −0.185), greater financial deprivation (B=−0.101, 95% CI −0.148 to −0.054) and migration background (B=−5.992, 95% CI −8.990 to −2.994), and positively associated with education in the health sector (B=11.337, 95% CI 7.720 to 14.953) and social support (B=1.109, 95% CI 0.308 to 1.909). In addition, lower educational attainment was associated with lower DHL scores compared with having a master’s degree or higher. Higher DHL was associated with better self-assessed general health status (odds ratio [OR] 1.005, 95% CI 1.003-1.007), improved self-management (OR 0.989, 95% CI 0.984-0.993), and lower likelihood of experiencing restrictions of usual activities due to health problems (OR 1.004, 95% CI 1.001-1.007). Furthermore, people with higher DHL tend to rely more on face-to-face information from health care professionals and to use digital sources less frequently. Conclusions: This study offers first insights into the DHL of the population in Switzerland and indicates that almost three-quarters (72.2%) of the population have low DHL. These results are in line with those of other European countries and clearly show the urgency of measures to improve DHL, especially among vulnerable population groups.