What is eHealth literacy?

In a nutshell: Health information delivered through the Internet or mobile phone is receiving growing attention. This also accounts for Switzerland. However, particular skills are required from individuals to realize the potential of electronic health resources. Read this blog in order to gain knowledge about “eHealth literacy”.

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eHealth literacy 

The concept “eHealth literacy” pertains to an individual’s skills related to health and technology. More specifically it refers to:

“The ability to seek, find, understand and appraise health information from electronic sources and apply the knowledge gained to address or solve a health problem”. ==> Norman & Skinner, 2006, Norgaard & colleagues, 2015.

eHealth literacy is closely linked to the concept of health literacy. Health literacy refers to a person‘s ability to find, understand and actively use health information in relation to ones own health (WHO, 2013). It is known that people with low level of health literacy often do not benefit from health care to the same extent as health literate people do. This is because health competences contribute to informing and engaging people in their own health.

Baseballcap vor Gitarre, neben Karteikasten und Smartphone
Picture from: http://deathtothestockphoto.com/

The use of electronic health resources

Electronic possibilities have expanded greatly during the last decade. Amongst other things, this has changed the way of distributing and using health information. One pathway of delivering health is through electronic means such as the Internet or mobile devices. Electronic health, or eHealth, has several potential benefits:

  • Improve health related outcomes such as re-hospitalization and level of physical activity
  • Reach a large number of people at the same time
  • Easily tailored to a specific patient population
If you want to read more about electronic health:

This blogpost describes a multi-national project named «USE cases for informal CARE» (USECARE AAL) funded by the European Ambient Assisted Living Program. Another blogpost addresses technology acceptance.

The number of people across European countries using the Internet for health purposes has risen. Furthermore, using the Internet in an interactive way has increased. One example is online interaction of patients with physicians or peers for health purposes.

Swiss attitudes towards electronic health records

Starting from 2017 the entire Swiss population will have the possibility to open an individual electronic health record. Such health records can be accessible across multiple health care settings. However, each individual has to actively provide acceptance in order to make it a reality.

The attitude towards electronic resources and in particular electronic health records are mixed. The annual survey “Swiss electronic health barometer” was last carried out in January 2016. It included a representative sample of 1.212 people reflecting the general Swiss population. These people answered questions related to the topic of electronic health and electronic health records.

The survey reflected an overall positive attitude towards electronic health records. Two out of three people saw the value and benefit in opening one. However, a quarter of the population expressed that they either were “certainly/rather against” opening an electronic health record. This recent survey reflects the so far highest number of people having a negative attitude since January 2013. Issues related to data security seem to influence the attitudes in the Swiss population. In general, it is known that a skeptical attitude towards electronic resources can partly be explained by lack of specific knowlegde. As well as people finding them difficult to use. Whether or not a person finds the elctronic resources too difficult to use relates to the individual’s level of eHealth literacy.

The Swiss electronic health barometer Graphik

Figure 1. Source: gfs.Bern, 2016, Glaubwürdiger Datenschutz als Schlüssel für den Erfolg von eHealth. Schlussbericht Swiss eHealth Barometer 2016: Öffentliche Meinung, page 9. Answers to the question: “Overall, do you support the introduction of the electronic patient record? Are you..” (translated from German: “Unterstützen Sie grundsätzlich die Einführung des elektronischen Patientendossiers? Sind Sie…”)

eHealth literacy is not only related to individual skills

In 2015 Norgaard and colleagues suggested “The Electronic Health Literacy Framework”. This framework attempts to describe the dimensions involved in eHealth competences on a theoretical level. The Electronic Health Literacy Framework was developed with extensive involvement of patients and health care professionals. It includes seven closely related domains (see Figure 2). The framework reflects the dynamic occurring when an individual use an electronic system such as the electronic health record. The framework underscores that electronic health competence not merely relates to an individual’s abilities and resources. It also strongly relates to the context and the complexity of the technology. As example, it is important that the user easily can learn to use the technology and apply it in everyday life.

electronic health Literacy framework, Graphik

Figure 2. Source: Norgaard et al., 2015. The e-health literacy framework: a conceptual framework for characterizing e-health users and their interaction with e-health Systems.

Level of eHealth literacy in the population

Without moderate skills across these seven domains in The Electronic Health Literacy Framework, effective engagement in electronic health resources will be unlikely. So, a scale has been developed in order to measure the level of eHealth literacy (eHEALS). This brings the possibility to identify potential groups not having adequate eHealth skills. It should be highlighted that eHealth skills are not static. Yet, they should  be seen as a set of competences, which can evolve over time. In order to realize the full potential of electronic health resources such as electronic patient record, the aim is to support, empower and enable individuals to fully engage and realize this potential. In particular valuable sub-groups with known low electronic health literacy should be supported to counteract inequalities.

How to advance the field of eHealth literacy?

In order to make sure that all sub-groups in the population have equal possibilities for engaging in their own health the following points should be considered:

  • eHealth competences do not merely reflect the skills of an individual but also aspects of the technology itself
  • Intended users should be involved in the development of new electronic solutions
  • The complexity of a particular system should be taken into consideration
  • Valuable sub-groups should be identified and supportive initiatives on community level should be developed to increase knowledge and strengthen skills

Arbeitstisch mit Ipad, Brille, Iphone, Make up-Utensilien

Picture from: http://deathtothestockphoto.com/

Want to learn more about eHealth literacy?

In the end of September 2016 (28.09.2016), a half-day symposium related to the questions of health literacy and electronic patient records will be held in a cooperation between different stakeholders. The Center of Competence for Patient Education from Careum Research supports the Departement Gesundheit und Soziales, Kanton Aargau, together with the Verein Stammgemeinschaft eHealth Aargau and Pro Senectute Aargau in planning this symposium. Read more here.

Your feedback and thoughts? Let’s discuss!

  • How do you experience the need for electronic health competences in your everyday life?
  • What is your thoughts about opening an electronic health record?
  • What could be the barriers for you not to open an electronic health record?

Further reading

Teaching electronic skills in a safe hands-on environment

eHEALS: measurement of the level of eHealth literacy skills

Level of eHealth literacy in the population


Mette Iversen

As a trained midwife and health scientist, I worked on self-management of older adults living with chronic illness at Careum Research, with a particular focus on mixed methods research as part of my PhD program at the Institute of Nursing Science, University of Basel

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