217 7 Dutch version of the eHealth Literacy Questionnaire Background Digitalization of healthcare The use of digital technologies for health, also called eHealth, is revolutionizing the way we diagnose, treat and manage health and disease. eHealth, defined as “the use of information and communications technology in support of health and health-related fields” spans a range of different digital health technologies and services, including smartphone apps, remote monitoring, smart wearables, patient portals and electronic patient records (1). Given the wide application and spectrum of eHealth, eHealth is often presented as a solution to relevant healthcare challenges, including challenges posed by the ageing population, the increased number of chronic and multi-morbidities and the growing resource gap (2, 3). As a result, eHealth has been stimulated and has shaped the way people engage with their health and how information is exchanged and shared between patients, healthcare providers and across health ecosystems. eHealth literacy This changing healthcare landscape has added complexity in the way community members, healthcare professionals and digital technologies interact. For example, healthcare portals and telehealth systems allow people to remotely communicate with healthcare professionals and caregivers, electronic health records based on cloud storage allow patients to manage diagnostic data with clinicians, and wearables and apps can help people to self-manage their condition. However, this increased complexity requires additional skills and competences from people using eHealth, including patients and people without a medical diagnosis. In the early days of the internet (web 1.0) the additional set of needed skills to navigate the web was introduced as eHealth Literacy: “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem.” However, with the increased complexity of the digital health landscape scholars have called for a more comprehensive view and included elements related to users’ cognitive skills, communication elements, social and cultural context or system level attributes (4-6). Since the web 1.0, eHealth literacy and its association with health outcomes has been investigated extensively (7, 8). However, eHealth literacy as evolved concept in the new digital (health)landscape and its impact on health is a relatively new area that needs to be further investigated (9, 10). eHealth, COVID-19 pandemic and digital divide eHealth literacy has gained attention with the accelerated uptake of eHealth due to the COVID-19 pandemic, mainly with the use of telehealth and remote monitoring systems (11-13). While large scale studies are lagging behind, smaller scale studies indicate that people who have low digital literacy and health literacy have difficulties comprehending and navigating through the information on the internet, downloading and using teleconsultation software, and understanding the already complex security safeguards and privacy policies necessary to effectively interact with telehealth devices (14, 15). Also, studies evaluating use of telehealth during the pandemic observed a lower
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