Complex role of digital health literacy in awareness and use of digital sexually transmitted and blood-borne infections testing: a structural equation modelling analysis of the 2022 GetCheckedOnline survey

Clinical Snapshot

Key Findings

• P Value: All significant associations p<0.05, strongest effects p<0.001

• Effect Size: Information Navigation: β=0.162 (awareness), β=0.063 (use); Confidence in Use: β=0.206 (awareness), β=0.115 (use); Resource Appraisal: β=-0.263 (awareness), β=-0.150 (use)

• Primary Outcome: Awareness and use of GetCheckedOnline digital STBBI testing service

• Nnt Or Sensitivity: Standardised beta coefficients indicate moderate effect sizes for digital health literacy components

• Confidence Interval: Not reported in abstract

Clinical Application

Findings applicable to digital health service design and implementation, requiring consideration of multidimensional digital health literacy Highly relevant to Australian digital health initiatives; findings could inform design of MyHealth Record integration and telehealth STBBI services under Medicare Benefits Schedule Sexually active adults seeking STBBI testing, particularly those using or considering digital health services

Abstract

BACKGROUND: Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access disparities remains limited. We applied multidimensional DHL measures to examine inequities in awareness and use of GetCheckedOnline, British Columbia's (BC) publicly funded digital STBBI testing service. METHODS: We analysed data from GetCheckedOnline's 2022 community survey of English-speaking BC residents aged ≥16 years who were sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (yes/no). DHL was measured using latent factors from the eHealth Literacy Scale: Information Navigation, Resource Appraisal and Confidence in Use. Structural equation modelling (SEM) was used to estimate associations and mediation pathways between DHL, sociodemographic characteristics and service outcomes. Model fit was assessed using standard SEM indices. RESULTS: Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (β=0.162, p<0.001) and use (β=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (β=0.206, p=0.014) and use (β=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (β=-0.263, p=0.006) and use (β=-0.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes. CONCLUSIONS: DHL operates as a multidimensional and socially patterned determinant of access to digital STBBI testing services. While information navigation and confidence in use facilitate access, higher resource appraisal may reduce use, potentially reflecting concerns about service fit, privacy or trust. Findings highlight the need for digital interventions that are not only accessible but also contextually relevant, trusted and responsive to the needs of diverse users.

References

1. 1.Iyamu, I., Gorun, P., Bartlett, S., McKee, G., Donelle, L., Chang, H. J., Sierra-Rosales, R., Haag, D., Pedersen, H. N., Lachowsky, N. J., Worthington, C., Grennan, T., Grace, D., & Gilbert, M. (2026). Complex role of digital health literacy in awareness and use of digital sexually transmitted and blood-borne infections testing: a structural equation modelling analysis of the 2022 GetCheckedOnline survey. Sexually Transmitted Infections. https://doi.org/10.1136/sextrans-2025-056638