Measuring eHealth Literacy in the European Economic Area, Switzerland, and the United Kingdom: Scoping Review

Clinical Snapshot

Key Findings

• P Value: Not applicable for scoping review

• Effect Size: Not applicable for scoping review

• Primary Outcome: Nine self-report eHealth literacy measurement instruments identified, with eHealth Literacy Scale being most frequent (71.21% of studies)

• Nnt Or Sensitivity: 132 studies included from 22 countries, covering 22 languages with sample sizes ranging from ≤50 to >2000 participants

• Confidence Interval: Not applicable for scoping review

Clinical Application

High feasibility for implementation as review provides practical guidance for selecting appropriate eHealth literacy measurement tools Findings relevant to Australian digital health initiatives, particularly for TGA-regulated digital therapeutics and My Health Record engagement strategies Healthcare providers, researchers, and policymakers involved in digital health initiatives across European healthcare systems

Abstract

BACKGROUND: Digital tools continue to evolve and have the potential to improve health care delivery. However, they are associated with challenges, including accessibility issues and health misinformation. Individuals need eHealth literacy (eHL) to reliably use these tools, and providers require appropriate eHL measurement approaches to offer targeted solutions. For around 2 decades, researchers have been operationalizing and measuring eHL. OBJECTIVE: This paper aims to provide an up-to-date overview of how eHL has been assessed in recent years in the European Economic Area, Switzerland, and the United Kingdom and which methodological limitations need to be considered. METHODS: A scoping review was conducted. Records were searched via CINAHL, PubMed, and Google Scholar on January 31, 2025, and January 28, 2026. Peer-reviewed empirical papers published in German or English since 2020 that measured eHL in the European Economic Area, Switzerland, or the United Kingdom were included. The synthesis covered the publication trend, eHL measurement approaches and associated limitations reported in the included papers, eHL measurement frequency, countries and languages, and samples. RESULTS: In the final analysis, 132 papers published between 2020 and 2025 were included. The number of publications per year showed an overall upward trend (2020: 11/132, 8.33%; 2025: 35/132, 26.52%). Nine self-report eHL measurement instruments were used, the eHealth Literacy Scale being the most frequent (94/132, 71.21%). All included papers (132/132, 100%) reported data collection via surveys, and digital surveys were common (71/132, 53.79%). Reported limitations included potential self-report biases (37/132, 28.03%), selection biases due to the data collection modes (26/132, 19.70%), and limitations specific to 5 eHL measurement instruments (18/132, 13.64%). Most included papers (121/132, 91.67%) reported eHL results from a single measurement per participant. Data were collected in 22 countries within the target regions. The distribution of eHL measurement instruments varied considerably between countries. Data were collected in 22 languages within the target regions. Patients or individuals with health problems were a frequent target group (64/132, 48.48%). Most papers (104/132, 78.79%) described studies covering broad adult age ranges. Sample sizes ranged from ≤50 (7/132, 5.30%) to >2000 participants (8/132, 6.06%). CONCLUSIONS: To our knowledge, this is the first scoping review synthesizing eHL measurement limitations reported in empirical papers from the European Economic Area, Switzerland, and the United Kingdom. The identified limitations reported in the included papers potentially lead to biased results. Therefore, health care providers and researchers should take various factors into account when selecting eHL measurement approaches, such as eHL measurement purpose, target population, and data collection setting. Future research should address these constraints by adapting and developing new or revised eHL measurement instruments, including translated and culturally adapted versions. Policymakers should encourage health care providers to conduct methodologically well-founded eHL measurements as a basis for targeted solutions.

References

1. 1.Weist, J. V., Nitsche, J., Ehlers, J. P., & Busse, T. S. (2026). Measuring eHealth Literacy in the European Economic Area, Switzerland, and the United Kingdom: Scoping Review. Journal of Medical Internet Research, 28(5), e87461. https://doi.org/10.2196/87461