EU digital Health Literacy Strategy

Digital HeaLth literacy Strategy

The project “Improving Digital Empowerment for Active Healthy Living (IDEAHL)” has received funding by the Horizon Europe Framework Programme under GA 101057477

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IDEAHL Summary

Objective of the EU dHL Strategy

Mission, Vision and Values

Index

Conceptual framework

Methodology

dHL Strategy results

IDEAHL dHL Strategy toolkit

Ethics & Privacy Toolkit

Monitoring and evaluation of the Strategy

Resources to promote dHL

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IDEAHL Summary

The Improving Digital Empowerment for Active Healthy Living Project (IDEAHL) project, funded by the Horizon Europe programme, aims at developing and testing new models and approaches of digital health literacy (dHL) intervention development and application through the co-creation of a comprehensive and inclusive EU dHL Strategy.

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Project Objective

The ultimately purpose of IDEAHL is to empower EU citizens in using digital tools to take a more activ e role in the management of their own health and well-being, as well as supporting social innovations for person-centred care models.

Participants involved in the project co-creation

Meet our project partners

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Objective of the EU dHL Strategy

To lay down a comprehensive strategy roadmap to improve dHL for the benefit of all European citizens focusing on health promotion, disease prevention, treatment and (self-)care as well as on monitoring its impact on the quality of life, well-being, productivity, and the economy, taking into account geographic, social and economic determinants of inequities in digital health literacy.

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Accessibility

VALUE

VALUES

MISSION

Collaboration

To build a (digital) health literacy Strategy taking as main sources the exhaustive review of existing literature and projects, incorporating a co-creation process with various groups of citizens, stakeholders, health professionals and policy makers.

Equity

Ethics & Privacy

Inclusion

Participation

VISION

Gender Inclusivity

Social Environment

To empower EU citizens in using digital tools to take a more active role in the management of their own health and well-being.

Sustainability

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Conceptual framework

The IDEAHL project has introduced the first European strategy on digital Health Literacy (dHL) following a collaborative effort engaging 1,434 participants. This pioneering strategy, designed to be a benchmark across the European Union, features a dual core integrating digital and health information components.

• The digital framework encompasses training & skills development, content & curriculum, evaluation &, monitoring, and policy according to International Telecommunication Union.
• Aligned with the WHO Health Literacy model, the strategy also focuses on four key pillars, emphasising access, understanding, critical appraisal, and practical application of the health information.

Overall, IDEAHL signifies a ground-breaking initiative fostering a more digitally literate and health-informed European population.

Social Environment

Accessibility

Ethics and privacy

Inclusion

Health Dimension

Training and skills development

Access

Level

Micro

Content and curriculum

Understanding

Self Care

INFORMATION

Meso

Health Promotion

Evaluation and monitoring

Appraisal

Disease Prevention

Macro

Policy and strategy

Application

Health care and treatment

Participation

Sustainability

Equity

Collaboration

Gender

More Info

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Methodology

Several documents were selected and explored by the IDEAHL Consortium to build a comprehensive knowledge base for the development of the EU dHL Strategy.

The review looked at:

External Documents

IDEAHL project deliverables

35 Policy strategy documents

31 EU-funded projects

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Methodology

19 target groups

140 co-creation sessions

Several documents were selected and explored by the IDEAHL Consortium to build a comprehensive knowledge base for the development of the EU dHL Strategy.

co-creation results

Adults with low access to digital tools

Prisoners

DHL and digital health experts

Families with chronic diseases

Policy Makers

Formal and informal caregivers

Healthcare and social work degrees´lecturers

Migrants

Healthcare and social work students

Low-income or low social index citizens

Women

Older people autonomous and in fragile conditions

Pregnant Women

Schoolchildren

Social workers

social agents

Young women

Healthcare and social work professionals

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dHL Strategy results

Accessibility

Social Environment

Inclusion

Ethics and privacy

Find

recommendations

Training and skills development

Access

Health Dimension

Level

to improve dHL in your region!!

Content and curriculum

Understanding

Micro

Self Care

INFORMATION

Meso

Evaluation and monitoring

Appraisal

Health Promotion

Macro

Disease Prevention

Application

Policy and strategy

Health care and treatment

Participation

Sustainability

Equity

Collaboration

Gender

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18 recommendations on TRANSVERSAL ELEMENTS

IDEAHL dHL Strategy Toolkit

Collaboration

Equity

Accessibility

20 recommendations on HEALTH INFORMATION COMPONENTS

20 recommendations on DIGITAL COMPONENTS

Training and Skills development

Access to the information

Sustainability

Ethics and Privacy

Content and curriculum

Understanding the information

Evaluation and monitoring

Critical appraisal of the information

Social environment

Gender

Application of the information

Policy and strategy

Click on the core and transversal elements to know more

Inclusion

Participation

Other recommendations

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ETHICS & PRIVACY TOOLKIT

Gender and inclusion recommendations for policy makers

Gender and inclusion recommendations for health and care providers

Ethics and privacy recommendations for policy makers

Ethics and privacy recommendations for health and care providers

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Monitoring and evaluation (M&E) of the Strategy

Interventions, actions, projects, programmes or policies at local, regional, or national level must be in line with the EU dHL Strategy.

Use the Theory of Change (ToC)

Indicators are fundamental measures that help to track and assess the progress and performance of an intervention. To be effective they should be Specific, Measurable, Achievable, Relevant and Time-bound (SMART) features that provide information on the inputs, activities, outputs, outcomes, and impacts of the intervention.

Use SMART indicators

Data management and processing

See set of indicators & definitions

Results

Activities

Impact

Outputs

Inputs

Outcomes

Know how to define an indicator

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Other aspects to be considered in M&E

Evaluation toolkit

Digital health literacy tools

Evaluation committee

To coordinate the evaluation of the EU dHL Strategy, a specific M&E committee and subcommittees should be established at national, regional and/or local level. Their functions would be:

AUDIT AND FEEDBACK

REMINDERS

Give follow-up instructions in print, email or face-to-face

SUPERVISION

Design a national/regional supervisorMake supervision at at pre-established intervalsCombine it with face-to-face meetings to discuss results

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EVALUATION TOOLKIT

Tailored Analysis Profiles

Algorithmic Responsibility

Integration of Gender and Inclusion

Responsible and Secure Data Practices

Data-Driven Decision-Making

Consider Intersectionality

Thoughtful Data Element Selection

Resource Optimisation

Gender Perspective for Evidence and Equality

Unified Measurement and Baselines

Inclusive Evaluation Approach

Practical Steps for Gender and Inclusion

Data Privacy and Transparency

Health Professional Communication Skills

click on each box to know more

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Resources to promote dHL

Strategy document

Summary of IDEAHL project

Global Atlas of Literacies for Health

www.ideahl.eu

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Glossary

www.ideahl.eu

Scientific and Technical Coordinator: CONSEJERIA DE SALUD – PRINCIPADO DE ASTURIAS Ms. Marta Pisano González, Coordination Team Calle Ciriaco Miguel Vigil, 9, 33005 Oviedo, Asturias, Spain www.astursalud.es/astursalud dgcuidados@asturias.org T. +34 985105500 Ext: 17485

The project “Improving Digital Empowerment for Active Healthy Living (IDEAHL)” has received funding by the Horizon Europe Framework Programme under GA 101057477

Participation

Active participation and involvement of individuals, target groups, and stakeholders in the development, implementation, and evaluation of healthcare initiatives. Prioritise user acceptance, incorporate user experiences and testimonials, and involve diverse stakeholders to ensure patient- centredness, empowerment, and inclusivity.

Integrate health literacy and cultural-specific approaches into communication, cocreation processes, and partnerships. Consider the specific needs of different populations, including older adults and minority groups, and tailor interventions to enhance understanding, engagement, and health competence.

Policy and strategy

Conceptual framework

This component focusses on the importance of establishing clear policies and strategies for digital health literacy. It is recommended that countries establish national digital health literacy plans and involve multiple stakeholders, including governments, civil society, the private sector and local communities.

Target groups in numbers

Content and curriculum

Summary

Integrating digital health literacy into educational curricula, particularly focusing on media literacy and information acquisition in primary schools, is crucial. User-friendly digital platforms emphasising information quality and accuracy are necessary, and future curriculum developers should possess essential digital skills. Emphasising the delivery of concise, targeted, and accessible digital health information to address the immediate needs of individuals seeking health-related content is a key priority.

Micro level: Recommends including media literacy and information acquisition topics in primary school curricula.

Meso level: Participates in the implementation of micro-level programs to turn strategies into action, which promote (digital) health literacy in basic education and encourages cooperation between homes, schools, and other educational institutions.

Recommendations & key ideas

• Develop relevant and evidence-based content and curriculum in collaboration with educational institutions and experts.

• Foster partnerships with technology companies and application developers to create userfriendly and intuitive mobile applications specifically designed for health.
• Establish clear guidelines and standards for online health information, promoting evidencebased content and ensuring that it is easily distinguishable from unreliable sources.
• Include prototypes, such as a demo MOOC, to engage less digitally skilled individuals.

Macro level: Suggests the creation of a centralised platform scientifically endorsed by the competent authority in each country, criteria and/or a quality mark for online health resources to enable people to access reliable and comprehensive health resources, including informative articles, videos, interactive tools and forums for discussion and community support. .

Access to the information

Summary

It's crucial to consider the specific information needs of diverse social groups, adapting content, digital tools, and local service links for enhanced accessibility. Strategies should encompass not only the local population but also migrants, refugees, and vulnerable groups, taking an intersectoral approach to health information. Additionally, promoting basic digital skills for efficient information search, evaluation, and use is essential, emphasising accessibility, truthfulness, and a high-speed infrastructure with open and accessible resources.

Micro level: Stresses the importance of customising online tools and digital solutions for diverse target groups, ensuring accessibility and relevance, establishing linkages with local services, and tailoring health information to the specific needs of various populations, including children and adolescents.

Meso level: Emphasises the use of user-friendly language, visual aids, and audio formats for diverse audiences, addresses health information access for migrants and refugees, advocates for environmental and intersectoral interventions, and encourages community-based approaches for underserved populations.

Recommendations & key ideas

• Ensure that digital health tools and technologies are accessible to all individuals, regardless of their socio-economic status or other demographic factors.

• Develop user-friendly and intuitive mobile applications specifically designed for women's health, providing personalised health tracking, educational resources, and access to support networks.

• Establish clear guidelines and standards for online health information, promoting evidencebased content and ensuring that it is easily distinguishable from unreliable sources.

Macro level: Promotes the development of fundamental digital skills, highlights the significance of reliable digital infrastructure for equal access to health information, and encourages the use of open educational resources and a culture of lifelong learning.

Application of the information

Conceptual framework

This pillar focuses on empowering people to use health-information obtained through digital environments and apply it effectively in their daily lives. The goal is to promote informed decision making and encourage healthy behaviours. Some key aspects related to this pillar are self-care, prevention and informed decision making. The use of health information should be oriented towards informed decision making. Individuals should be able to use information to evaluate different options, understand the associated risks and benefits, and make decisions that promote their well-being.

Critical appraisal of the information

Conceptual framework

This pillar focuses on developing people's capacity to critically appraise digital environments’ health information. It involves analysing and discerning the quality, integrity, timeliness, and relevance of information to make informed health decisions. Some key issues related to this pillar are the reliable and transparent sources. It is very important for individuals to be able to identify trustworthy and verified sources of online health information. This includes assessing the credibility of the source, as well as seeking information backed by solid scientific evidence and issued by recognised organisations in the health field.

EVALUATION TOOLKIT

Algorithmic Responsibility

Embrace algorithmic responsibility by making data and analytical processes open to public scrutiny while safeguarding user privacy. Provide clear, easily comprehensible explanations of data origin, analysis methodologies, and insights for end-users.

Social environment

Develop interventions and services that prioritise well-being, mental illness prevention, and proactive, personalised care. This includes addressing socioeconomic factors, building trust through personal interaction, targeting vulnerable populations, and integrating health and social care into existing systems, taking into account the social environment.

Engaged participation, while considering country-specific variations and adapting to the specific needs and conditions of the involved organisations. This entails promoting dialogue and rethinking informed consent as an outcome of comprehensive, clear, and empathetic communication based on trust.

EVALUATION TOOLKIT

Responsible and Secure Data Practices

Establish stringent measures for the responsible and secure collection and analysis of data, with a focus on safeguarding user privacy and organisational interests.

Accessibility

Promote accessibility and usability:

Enhance accessibility and usability of interventions, digital platforms, and health-related content by catering to diverse preferences and needs, addressing disparities, and ensuring compliance with accessibility standards and guidelines

Consider physical and cognitive disabilities, digital literacy levels, and the use of user-friendly language, visual aids, and alternative formats to accommodate different audiences.

Foster transparency and stakeholder engagement:

Ensure transparency in data collection, analysis, and privacy protection. Encourage meaningful participation of stakeholders by providing accessible information, fostering a culture of sharing ideas, embracing conflicting opinions, and addressing stakeholder interests.

Develop accessible governance structures, research documentation, and communication services.

INCLUSION

Accessibility Prioritise accessibility in the health literacy strategy for diverse populations, including those with disabilities and varying health literacy levels.

Comprehensive Approach Promote health inclusion with a comprehensive strategy covering education, accessibility, inclusion, and participation.

Education Investment Policymakers should invest in comprehensive education, focusing on literacy and critical information skills for various population groups.

Stakeholder Engagement Involve vulnerable groups in health decisions through stakeholder consultations, considering ethical and social implications.

Universal Digital Access Ensure universal access to digital health solutions, simplify access, and enhance health professionals' digital skills.

EVALUATION TOOLKIT

Gender Perspective for Evidence and Equality

Applying a gender perspective in M&E supports both evidence generation and the pursuit of gender equality goals.

EQUITY

The primary focus should be on ensuring equal access to health interventions and services for everyone, irrespective of their socioeconomic background or demographic group. Challenges arising from digital technologies, such as electronic consent, may impede fair access to clinical trials among different socioeconomic groups, contributing to the digital divide. Overcoming cultural and linguistic barriers is crucial to ensuring equitable participation with digital tools. This involves implementing culturally sensitive strategies throughout the development of tools and interventions. Avoiding assumptions based on age is essential, recognizing that while young people may be proficient in digital technologies, they may still need support in critically evaluating information. Age should not be the sole determinant of digital competencies. To improve healthcare literacy, policymakers should provide user-friendly guidance, consult with stakeholders, and ensure equitable access to services and information. To provide equal access, methods and technologies should address cultural and linguistic obstacles, and recognise the importance of digital literacy and critical information evaluation abilities across age ranges.

Training and Skills development

Adapt digital interventions to users' skills and preferences (use ubiquitous learning systems, MOOC, and gamification features). Provide specific resources and tools for different user groups. Collaborate with technology companies and app developers to create user-friendly mobile apps.

Incorporate dHL into formal curricula, from schools to professional training programs.

• Integrate critical evaluation skills for online health information.
• Promote responsible navigation of digital platforms.

Invest in digital literacy programmes and digital health training for citizens and healthcare professionals.

• Collaborate with educational institutions
• Promote participation in dHL programmes,.
• Stay updated on advancements in digital health tools and technologies.

Utilise evidence-based approaches tailored to specific populations and employing a variety of intervention methods.

• Use interventions supported by scientific research.
• Adapt training programmes to the needs and preferences of target populations.
• Continuously evaluate and improve initiatives through participant feedback.

Foster interdisciplinary collaboration between healthcare professionals and academic and NGOs to enhance digital health education and skill development.

• Establish guidelines and standards for co-creation processes,.
• Promote knowledge transfer.
• Train facilitators and coordinators involved in co-creation initiatives.

EVALUATION TOOLKIT

Data Privacy and Transparency

Maintain the highest standards of privacy, security, and responsible data management. Be fully transparent about data usage and protection practices.

Understand the information

Conceptual framework

It refers to ensuring that people can understand and use the health information they receive. This includes skills like being able to read and understand written information, or the ability to search for and evaluate information online.

Definition (example)

Cost-efectiveness of the strategy action, plan, programme (i.e., ratio of resources invested to results achieved)

Efficiency

Effectiveness

Extent to which the strategy is achieving its objetives (i.e., proportion of the target population reached)

Impact

Positive or negative, primary or secondary long-term effects produced by an intervention, directly or indirectly, intended or unintended, on a population or environment (i.e., dHL level of a population or an increase in individuals' ability to access and understand digital health information)

Input

Financial, human and material resources invested in the activity (i.e., training materials produced)

The likely or achieved short-term and medium-term effects of a programme or policy´s outputs, that is changes or impacts on the participants (i.e., improvements in physical, mental and social health, well-being, (d)HL, or resources for improvement)

Set of indicators

Outcome

The immediate effects or the direct results, products or deliverables of programme/policy activities (i.e., no. of people reached (m/f/o), no. of specific populations (migrants, citizens with low incomes...), no. of actions delivered, no. of products/deliverables of activities)

Output

The intervention's activities and outputs, which together indicate whether it is being implemented as planned (i.e., tasks accomplished, deadline meet...)

Process

Quality

Quality of strategy action delivery (i.e., satisfaction level of participants).

Sustainability

The potential for the strategy to continue after external support has ended (i.e., workforce involved in the implementation of the strategy, the number of replicators interested in the action)

Collaboration

Strengthen cross-sectoral cooperation:

Foster collaboration and engagement:

Encourage collaboration between patients, citizens, healthcare professionals, and stakeholders through shared decision-making, patient engagement, co-creation of health policies, and projects.

Promote cross-sectoral engagement in health literacy policies, facilitate multiprofessional exchange of information, and enhance collaboration between different professional groups.

Establish multidisciplinary care coordination teams, promote knowledge exchange, and nurture collaborations between public and private stakeholders.

Support cooperation between EU-funded projects for cross-fertilisation and synergies.

Maintain public trust by engaging the data subject in health literacy, fostering trust between public and private organisations, and involving patients and the public as central actors in the development of learning health systems

Involve highly engaged healthcare professionals and ensure continuous communication to all relevant stakeholders.

Access to the information

Conceptual framework

This pillar focuses on ensuring that people have access to reliable and relevant health information through digital platforms. It involves providing equitable access to health resources, promoting digital inclusion, and addressing barriers such as connectivity concerns or limited digital literacy skills. By increasing access to health information, people can make informed decisions about their health and well-being.

How to define an indicator

Source of data:

: Frequency of measurement.

Indiators name

Disaggregation: Items on which it is necessary to have specific data by groups, related to gender, inclusion, geographical area, age groups, employment status, level of health literacy...

Observations: Anythings that needs to be added.

Critical appraisal of the information

Summary

Micro level: Emphasises the importance of population verification of health information accuracy, calls for improving the usability of digital platforms for enhanced user satisfaction and critical assessment, and promotes the development of accessible guidelines and resources to support the public in evaluating health information critically.

It is crucial for individuals to discern between accurate and false health information, necessitating systems to evaluate patient comprehension and utilization of healthcare-provided information. Continuous measurement of information issuance, reception, and utilization facilitates ongoing improvement. At the macro level, promoting media literacy and lifelong learning is pivotal for critical evaluation, acknowledging the influence of general education and information technology proficiency. Overall, this comprehensive approach empowers individuals to make informed health decisions through diligent information evaluation.

Meso level: Stresses the importance of tools to assess patients' ability to comprehend and utilise health information, advocates for methods to evaluate patient satisfaction with healthcare and information, and encourages ongoing interventions to continuously assess, refine, and improve the impact and sustainability of tools and interventions over time.

Recommendations & key ideas

• Develop critical appraisal skills among individuals to help them evaluate the quality and reliability of health information.

• Foster partnerships with technology companies and app developers to create user-friendly and intuitive mobile applications specifically designed for women's health, providing personalised health tracking, educational resources, and access to support networks.

• Establish clear guidelines and standards for online health information, promoting evidencebased content and ensuring that it is easily distinguishable from unreliable sources

Macro level: Promotes education and awareness of media literacy for critical evaluation of health information, emphasising the essential role of lifelong learning in developing critical thinking skills and highlighting the impact of general education and information technology skills on individuals' ability to obtain, receive, and evaluate health information.

EVALUATION TOOLKIT

Resource Optimisation

Efficiently manage available resources to ensure the sustainability of interventions. Maximise the utilisation of existing resources to support successful strategy implementation.

GENDER

The importance of gender considerations in the dHL strategy should be stressed. Gender differences in literacy are minimal in adulthood, but it is important to consider gender when developing interventions and addressing health challenges due to the diverse age groups in the target population. Health practitioners and public health groups should take the lead in measures to increase young women's health literacy. This can be accomplished by offering customised health education courses that address women's unique health requirements, such as reproductive health, mental health, and chronic illness management. These programmes should be culturally sensitive and tailored to the specific needs of each community. The strategy should address gender disparities in health literacy and their impact. Gender should also be considered when developing interventions. The different ages of the target populations raise health concerns. Promoting gender equality and a comprehensive approach to health literacy can lead to better health outcomes and more equitable society.

EVALUATION TOOLKIT

Integration of Gender and Inclusion

Incorporate gender and inclusion aspects into the EU dHL Strategy across all stages of planning and monitoring.

EVALUATION TOOLKIT

Tailored Analysis Profiles

Develop analysis profiles – of individuals and/or target groups – to ensure that the strategy is aligned with their specific needs and requirements.

Micro level

Citizen level

In the micro level, patients, citizens, families and Health and social workforce (professionals, researchers, managers…) are included.

Gender

Incorporate gender-specific considerations into health literacy interventions and communication strategies, taking into account the diverse health needs, concerns, and roles of women and men. Tailor the interventions accordingly to ensure effective and inclusive health messaging.

Ensure gender equality and eliminate disparities in healthcare by addressing gender biases, promoting women's entrepreneurship and leadership, and integrating gender considerations into policies and guidelines related to education, training, and the labour market.

SOCIAL ENVIRONMENT

In the social environment, it's vital to consider the context when developing a health literacy strategy, emphasising supportive environments and positive health behaviours. Stress the importance of intersectoral collaboration in health literacy policies, promoting information exchange and respect among professional groups.

Highlight the value of public trust in health literacy initiatives, emphasising collaboration between public and private organisations. Emphasise collaboration and equal access to literacy across ages, including migrants, by investing in digital and health literacy. Address inequalities based on language, disability, and multiculturalism through local learning opportunities and clear information dissemination. Adopt a holistic, community-centred approach, with policy makers considering diverse groups such as people with mental health problems, people intellectual disabilities, older people, and migrants.

Training and skills development

Conceptual framework

This component focuses on the importance of training and skills development for digital literacy. It is recommended that digital health literacy programmes provide hands-on training and focus on the development of practical, life-relevant skills.

EVALUATION TOOLKIT

Consider Intersectionality

When selecting indicators, account for how gender intersects with other forms of discrimination (e.g., age, race, social status) to affect intervention outcomes.

Training and skills development

Summary

Feedback suggests a need to prioritise digital literacy programmes and collaborate with educational institutions to integrate digital health literacy into curricula. This integration aims to make literacy a societal norm. Programmes should focus on equipping vulnerable groups, such as children, older individuals with chronic conditions, and young women, with critical online health evaluation skills. Tailoring interventions to specific populations and utilising diverse learning methods is crucial. Incorporating participant feedback and involving trained professionals, like health educators, enhances the effectiveness of training programmes, highlighting the overall importance of promoting digital health literacy through comprehensive initiatives.

Micro level: Focuses on considering the specific needs of different target groups, such as children and adolescents, to provide tailored and relevant content.

Meso level: Suggests adapting online tools to the interests and uses of each group involved, as well as establishing links between digital solutions and local services to enhance accessibility and relevance for the target population. Incorporate feedback and evaluation to improve the effectiveness of the content and curricula provided.

Recommendations & key ideas

• Use interactive and compelling methods to keep participants engaged and interested in the health material.
• Incorporate feedback and evaluation to improve the effectiveness of the content and curricula provided.

• Involve trained professionals such as non-health and mental health practitioners or health educators to provide valuable expertise in developing effective content and curricula.

• Include the topics of media literacy and information and knowledge acquisition in elementary school curricula.

Macro level: Proposes developing specific strategies for migrants and refugees, as well as environmental and intersectoral interventions. Involves trained professionals, such as mental health practitioners or health educators, who can provide valuable expertise in developing effective content and curricula. .

Evaluation and monitoring

Summary

Micro level: Advocates for monitoring systems in digital health interventions at the population level and emphasises user involvement in face-to-face co-creation activities. Also highlights the necessity of assessing healthcare workers' communication skills for diverse health literacy levels.

Continuous evaluation and monitoring of health literacy programmes are crucial for impact assessment, necessitating culturally appropriate tools and assessing healthcare professionals' communication proficiency. Emphasising the need for evaluation experts, the overall focus is on establishing a comprehensive system for assessing the effectiveness of health literacy interventions.

Meso level: Recommends continuous evaluation and monitoring mechanisms for assessing the effectiveness of health interventions, information dissemination, and existing health literacy policies, emphasising periodic reviews to ensure relevance and alignment with emerging research and global initiatives.

Recommendations & key ideas

• Continuously evaluate the impact and sustainability of interventions to refine and improve their effectiveness over time.

• Create monitoring systems that track the progress and outcomes of digital health interventions at a population level.

• Implement evaluation and monitoring mechanisms to assess the effectiveness of health initiatives and information dissemination.

Macro level: Implement a comprehensive evaluation and monitoring system to assess the impact of health literacy interventions, including evaluating intersectoral cooperation and treatment pathways, while emphasizing a holistic vision of the health system and recognizing interdependencies between its components.

EVALUATION TOOLKIT

Health Professional Communication Skills

Evaluate the communication skills of health professionals to effectively engage individuals with varying health literacy levels.

OTHER RELEVANT INFORMATION

Health literacy

HL Atlas

Cultural and religious acceptance

Enhance the HL Atlas by regularly updating and expanding its content, collaborating with international organisations and research institutions to gather comprehensive data from a wider range of countries. Improve language support for broader accessibility and provide user-friendly summaries of (d)HL policies and initiatives. Enhance the platform's design, engage in user testing, and actively promote the Atlas to raise awareness among key stakeholders. Establish a systematic process for data collection and verification to ensure up-to-date and accurate information.

Enhance health education through accessible and multimedia-based approaches:

• Simplify written materials to a 5th-grade reading level,
• Incorporate multimedia principles in video formats, and
• Utilise clear visuals with captions.

These strategies aim to improve comprehension, particularly in the context of mobile technologies and diverse literacy levels.

Promote cross-cultural research and enhance communication in healthcare by:

• Fostering cultural understanding,
• Capturing patient backgrounds,
• Supporting relevant projects, and
• Improving coordination between health information systems.

Application of the information

Empower individuals in healthcareEncourage active participation in healthcare by asking questions and seeking clarification from healthcare professionals. Design and disseminate practical tools and resources that facilitate the application of health information in real-life contexts. Develop initiatives and programmes that empower individuals and patients to apply health information in their decision-making processes

Enhance health literacy Promote source verification, encourage reading and storytelling about the positive meanings of HL, and strengthen media and literature education. Identify and promote the meaning of HL in society to enrich HL for all. Strengthen cooperation and expertise of professionals in HL-related areas. Develop concrete action models for multi-professional exchange of information and integrate the health information system to minimise delays and reduce implementation costs.

Streamline human-technology interaction Simplify the interface between humans and technology, prioritizing user-centred design principles. This includes creating visually appealing and intuitive interfaces, incorporating multiple information channels, and providing quick and simple user support.

Foster collaboration and data management: Collaborate with information experts and enhance information application capabilities of telemedicine tools. Invest in health data management systems to process clinical, administrative, and research data.

Understanding the information

Ensure effective communication and comprehension: Tailor information to individual abilities and learning styles, using interactive and multimedia resources while avoiding information overload. Encourage teachback-method and other strategies to ensure patients understand the information provided by healthcare professionals.

Promote health literacy awareness and understanding: Develop clear and accessible communication materials and tools in multiple languages, utilising plain language, visual aids, and culturally appropriate approaches to empower individuals to make informed decisions about their health

Enhance digital health literacy and competence: Provide training and support for healthcare professionals and individuals to effectively navigate and use digital health tools and technologies, as well as user participation in the design process.

Evaluate, monitor, and improve understanding of information: Regularly evaluate health literacy levels and the effectiveness of health literacy initiatives. Develop standardised assessment tools, measure outcomes, and implementcontinuous im provement strategies to promote lifelong learning and continuous development of health literacy competences.

Foster collaboration and stakeholder involvement: Engage NGOs, policy makers, and healthcare providers as key stakeholders to promote health literacy, provide digital support, and prevention services. Emphasise the importance of cooperation and expertise sharing among professionals.

Social environment

Promote integration and adoption within the healthcare system:

Encourage the creation of new businesses, research and development activities, and the utilisation of digital tools and technologies to improve healthcare infrastructure. Reinvest cost savings achieved through the implementation of these tools back into the healthcare system, promoting efficiency and sustainability.

Support the utilisation of data-enabled research and innovation

Integrate measuring instruments and data recording into existing electronic medical systems and records.

Ensure explicit commitment from relevant authorities to adopt and integrate programs into the healthcare system norm.

Develop transition plans, guidelines, and training to facilitate smooth integration and widespread adoption.

SMART definitions

Specific

The objective must be precise, clear and unambiguous. It answers the question What is to be measured?

It refers to the need to measure the target variable and the results. It answers the question how much, and allows to determine whether the objective is met.

Measurable

Achievable

The goal must be ambitious but not impossible.

Realistic

Adapted to current conditions.

Time-bound

A specific timeframe should be set to achieve the objective (hour, weeks, months...). It answers to when?

Meso level

Health institution level

It includes health and social care organisations (healthcare providers, hospitals, academia, NGOs, health industry…).

Inclusion

Tailor interventions and outreach efforts to address the specific needs of different target groups, including the elderly, women in remote areas, and underprivileged populations. Consider factors such as language, culture, socioeconomic status, and accessibility to ensure inclusivity and effectiveness.

Include minority groups and individuals with disabilities, in the planning, development, and delivery of digital services and health literacy programs. Promote personalized approaches, cultural sensitivity, and address factors such as age, gender, and cognitive abilities to enhance inclusivity and equitable outcomes.

COLLABORATION

Collaboration Focus: Emphasising networked collaboration and a multi-agency approach for development and co-design.

Innovative Data Collection: Exploring novel data collection methods for improved accuracy and completeness, reducing burdens.

Stakeholder Engagement: Collaborating with diverse organisations ensures the delivery of high-quality outcomes.

Organisational Support: Enhancing elements to promote dHL implementation includes visibility, orientation, and attraction mechanisms.

Target Population Involvement Encouraging the active involvement in data collection to address their unique needs and ideas.

Leadership Commitment within the organization is crucial for advancing dHL.

Expert Engagement: Ensuring the participation of experts from relevant fields throughout the process for a comprehensive, multidisciplinary approach.

Core Principles: Fostering collaboration, improving organisational support, exploring innovative data collection, involving target populations, and engaging experts collectively contribute to the success of digital health literacy initiatives.

Access to the information

Tailor content to specific target groups, considering their unique information needs and interests. Provide relevant and personalised health information, especially for children, adolescents, and other participants.

Enhance the accessibility and user-friendliness of online tools and platforms to ensure easier access to health information and services for the regions adopting them and the target population.

Involve citizens in usability testing and feedback processes to improve the usability and effectiveness of eHealth tools. Actively engage users to enhance user experience and adapt tools accordingly.

Foster collaboration, interoperability, and integration among healthcare systems and providers. Establish partnerships with community organisations, influencers, and educational institutions to expand the reach of interventions and promote the access to digital health literacy

Promote digital health literacy and the use of reliable health resources. Provide guidance on effectively using health apps distinguishing trustworthy information sources, and addressing language barriers to ensure individuals can make informed decisions about their well-being.

EVALUATION TOOLKIT

Inclusive Evaluation Approach

Ensure diverse perspectives in the evaluation process, involving actors from strategy creation to implementation and utilisation. Incorporate both qualitative and quantitative indicators, particularly for new strategies.

Evaluation and monitoring

Conduct comprehensive evaluation and monitoring: Establish robust evaluation and monitoring mechanisms to assess the impact, effectiveness, and sustainability of interventions, including pre- and post-intervention assessments, surveys, focus groups, observations, program records, and health outcomes data.

Engage with the target audience and seek feedback: Actively involve the target audience in interventions by conducting surveys, seeking user suggestions, and incorporating their feedback to enhance the relevance and effectiveness of interventions.

Utilise technology for assessment and monitoring: Leverage technology, such as health apps and wearable devices, to assess participants' comprehension, monitor risk levels, facilitate physical activity monitoring, and evaluate symptoms and behavioral patterns.

Implement policy development and cross-sector cooperation: Assess the impact and effectiveness of existing health literacy policies, strategies, and action plans. Promote cross-sector cooperation, establish monitoring systems, and regularly evaluate and adjust initiatives to ensure relevance, effectiveness, and successful outcomes.

Assess and address health literacy: Evaluate and monitor health literacy levels among patients and healthcare professionals, apply screening methodologies, and adapt interventions to fill health literacy gaps. Assess the quality of health information provided and prioritise the evaluation of the usability of digital health tools.

Macro level

Health policy level

Government and European and International institutions are involved in this level.

It gives the possibility to

• plan in advance or
• adapt based on emergencies

Use the Theory of Change (ToC)

Different levels of intervention:

• micro,
• meso, and
• macro

It can identify:

• specific evaluation questions,
• relevant variables for data collection,
• intermediate outcomes,
• aspects of implementation, and
• potentially relevant contextual factors

It can be used for

• strategic planning of a project or
• for analysing an ongoing initiative

1434

Participants

The IDEAHL Project has involved 1434 participants, from citiens and patients to health and care and social sevices, policy maker, non-health sectors, academia, etc.

Critical appraisal of the information

Promote effective communication and understanding: Tailor communication to different age groups and cultural backgrounds, foster cross-cultural communication, emphasise the dialogue and trust-building aspects of informed consent, and provide clear and comprehensible information to patients.

Enhance usability and safety of digital health tools and technologies: Improve the usability of digital platforms, involve users in the design process, validate eHealth tools, establish mechanisms for information appraisal within healthcare organisations, and monitor the safety and effectiveness of digital apps.

Ensure accuracy and evaluation of health information: Encourage individuals to verify the accuracy of health information before making decisions, provide guidelines for critically evaluating sources, and develop measures to assess the credibility of online information.

Foster collaboration and cooperation: Encourage collaboration between public health organisations, healthcare professionals, policymakers, and researchers to promote health literacy, ensure credibility of digital health information, and enhance cooperation between education/academia and the workforce.

Evaluate, monitor, and improve relevance and quality: Conduct long-term studies to assess adherence and effectiveness of digital interventions, evaluate health literacy initiatives, develop standardised assessment tools, and continuously evaluate and improve health literacy work and levels in different populations. .

Content and curriculum

Enhance the effectiveness of digital health interventions by incorporating interactive and engaging content, i.e.,

• demos,
• role plays,
• group discussions,
• case studies,
• videos, or
• animations.

Integrate HL and dHL into educational curricula for healthcare professionals, researchers, teachers, and students at all levels, ensuring continuous and planned education in these areas.

Collaborate with tech companies and app developers to create and provide personalised health tracking, educational resources, and access to support networks.

Foster partnerships and collaborations among various stakeholders (healthcare professionals, educators, policy makers, tech companies, and community leaders) to

• develop relevant and evidence-based content,
• conduct capacity building workshops, and
• assess and improve HL initiatives.

Ensure the reliability and usability of digital health tools and platforms by

• utilizing established usability scales and criteria.
• complying with relevant medical device regulations, and
• regularly reviewing and updating the content and curriculum of apps.

Participation

Efforts in HL should focus on active involvement and commitment. Engaging special groups, professionals, and stakeholders in digital health services is crucial. Universal access to these services must be ensured, overcoming barriers like digital identification.

Occupational health care is key, especially for high-risk individuals like those with intellectual disabilities.

Educating professionals about minority groups is vital for fostering inclusion.

Targeting stakeholders effectively, including minority groups and those with low HL is paramount.

Specific differences within populations must not be overlooked in digital solutions, requiring support and adaptations.

Addressing individual factors such as cognitive and emotional aspects is essential in personalized strategies.

Collaboration among stakeholders is recommended, including parents, employers, and health care providers, to promote digital health literacy and participation.

Tailoring tools for specific user groups is crucial, involving them in design and implementation.

End reports and conclusions are important for acknowledging participation and assessing impact.

Parents influence children's HL and should be engaged accordingly.

Ethics and Privacy

Ethical and privacy considerations:

Improve informed consent processes:

Implement dynamic consent platforms that accommodate changes in information and attitudes throughout the process.

Health literacy strategies should incorporate ethical and social aspects, including gender, inclusion, privacy, and ethics.

Utilise electronic media and mixed-format approaches to support the informed consent process.

Emphasise the importance of confidentiality and ensure proper collection and use of health information while respecting individuals' rights to opt out and safeguarding personal data confidentiality and security.

Consider data collection and accessibility early on to ensure effective use and presentation to users.

SUSTAINABILTY

Reinvestment for Sustainability: Reinvest cost savings from digital tools to promote self-care and optimise healthcare resource utilisation.

Infrastructure Enhancement: Establish new spaces and engage in dedicated research for infrastructure development.

Reinvestment for Sustainability: Reinvest cost savings from digital tools to promote self-care and optimise healthcare resource utilisation.

Inclusive Health Practices:

• Actively involve target groups for long-term sustainability.
• Prioritise nationwide solutions for improved health information accessibility.
• Provide comprehensive fact sheets in both digital and paper formats.
• Avoid costly and discriminatory special digital solutions

Digital and Green Transitions:

• Prioritise support for digital and green transitions.
• Maximise data-driven research and innovation in digitised health systems.
• Encourage the establishment of the European Health Data Space.

Digitalisation of health services: Taking into account the high degree of digital literacy of the younger generation, it will lead to greater sustainability of health interventions.

ETHICS AND PRIVACY

Comprehensive Consideration: Emphasise ethical and social aspects like gender, inclusion, privacy, and ethics across the health literacy strategy.

Accessibility and Inclusion: Improve digital accessibility for vulnerable populations, facilitating autonomous decision-making.

Confidentiality Priority: Stress the importance of confidentiality for all cohorts, ensuring privacy and confidentiality in health information.

Privacy Guidelines: Provide clear privacy and data security guidelines to safeguard patients' personal information.

Legal Adaptation: Adapt laws for patient data management, focusing on privacy legislation and interoperability.

Communication and Collaboration: Promote collaboration with health professionals for equal access to health information.

Anonymization Techniques: Recommend unique identifiers and anonymization in research and digital tools to enhance privacy.

Respect for Rights: Uphold individuals' rights, equality, and dignity by protecting privacy and confidentiality.

Bioethical Principles: Integrate basic bioethical principles into strategies for ethical standards.

Implementation in Policy: Integrate these recommendations into health care ethics and privacy policies for equitable access to quality health services.

Informed Consent and Autonomy: Prioritize informed consent and patient autonomy in healthcare decision-making.

EVALUATION TOOLKIT

Unified Measurement and Baselines

To unify digital health literacy measurements, adopt internationally recognised indicators and tools. Establish baseline values and success-linked objectives for interventions, especially new implementations.

Evaluation and monitoring

Conceptual framework

This component focusses on the importance of the evaluation and monitoring of digital health literacy programs. It is recommended that programmes conduct on going evaluation of program effectiveness and make adjustments as needed.

Lead Partner/ Coordinator

Partners

Policy and strategy

Foster collaboration and synergy among different stakeholders, such as governments, businesses, and civil society, to address technological challenges together.

Enable active participation of individuals in decision-making processes related to technology, providing them with greater control and autonomy in its use.

Promote digital literacy and ensure that everyone has access to the skills and knowledge necessary to take advantage of the benefits of technology.

Implement policies and strategies that improve the quality of life for the population, taking into account the social, economic, and environmental impacts of technology.

Align technological research and innovation with user expectations and needs, focusing on developing solutions that address real-world problems and generate a positive impact on society.

EVALUATION TOOLKIT

Thoughtful Data Element Selection

Carefully determine the data elements to be collected, avoiding data overload that could overwhelm the system and stakeholders. Align data collection with the overarching strategy's objectives and parameters

Understanding the information

Summary

Promotion of general population and patient understanding through clear, concise health information using simple language and visual aids is essential. Health professionals need competencies to effectively communicate information, and health literacy assessment tools can guide interventions. The incorporation of digital literacy skills in school curricula and ensuring the accuracy and reliability of information are crucial considerations.

Micro level: Emphasizes the necessity of delivering clear, truthful, and concise health information using simple language, visual aids, and developing interventions targeting individual-level barriers to health literacy.

Meso level: Stresses the importance of training health professionals in effective communication, advocates for the development of health literacy assessment tools for targeted interventions, and encourages the adoption of patient-centred communication strategies to enhance understanding.

Recommendations & key ideas

• Digital health literacy is essential for individuals to navigate digital platforms and critically evaluate health information online.

• Policies and strategies should be developed to promote digital health literacy at a systemic level and address skills gaps.

• Critical appraisal skills should be developed among individuals to help them evaluate the quality and reliability of health information.

Macro level: Advocates for integrating health literacy into educational curricula from an early age, underscores the importance of promoting media literacy for critical evaluation of health information across various platforms, and emphasizes the necessity for policies and initiatives to ensure the accuracy and reliability of health information.

Application of the information

Summary

Micro level: Prioritises simplifying the human-technology interface for health information application and encourages individuals to actively engage in their healthcare by asking questions and seeking clarification from professionals, with the ultimate goal of empowering people to make informed health decisions based on received information.

Ensuring citizens can discern truthful health information is crucial, requiring comprehensive systems for evaluating patient comprehension and utilization. Simultaneously, assessing information dissemination and patient application becomes pivotal for continuous enhancements. The approach prioritises cultivating enduring erudition and aims to empower individuals through accessible health information, utilising optimised digital platforms, comprehensive evaluation guidelines, media literacy, perpetual learning, and acknowledgment of education and technology expertise. This strategy empowers individuals to make judicious health decisions through the discerning appraisal of pertinent information.

Meso level: Stresses the importance of collaboration between health professionals and patients, recognising the need for effective communication and shared decision-making, while promoting interventions to support individuals in applying health information in their daily lives.

Recommendations & key ideas

• Encourage individuals to apply the knowledge and skills gained through digital health literacy programs to make competent decisions about their health and well-being.

• Foster partnerships with technology companies and app developers to create user-friendly and intuitive mobile applications specifically designed for health, providing personalised health tracking, educational resources, and access to support networks.

• Develop policies and strategies that promote the use of digital health tools and technologies to improve health outcomes and reduce healthcare costs.

Macro level: Highlights the crucial role of policymakers in establishing an enabling environment for the application of health information, emphasising the importance of policies promoting patient-centred care and supporting individuals in utilising health information while addressing health inequalities and ensuring equitable access to health services.

EVALUATION TOOLKIT

Data-Driven Decision-Making

Leverage digital solutions to continuously monitor user activity, consumption, and content creation. Analyse usage data to inform effective system management and contribute to strategy monitoring and evaluation.

Content and curriculum

Conceptual framework

This component focusses on the development of high-quality content and effective curricula for digital health literacy. It is recommended that content is tailored to the needs and capabilities of the target audience and delivered in an accessible and relevant format.

Equity

Improve accessibility and promote health equity:

Promote equity and respect autonomy:

Enhance accessibility of healthcare services and facilities to ensure equitable access for all individuals, including vulnerable populations and those with socioeconomic disadvantages.

Recognise the importance of equity in health literacy and ensure that all citizens have the right to self-determination and equal access to care and services.

Respect the health interests of participants in research and communicate new information in an understandable and respectful manner

Design policies and programs that reduce literacy gaps and address cultural barriers.

Prioritise equal representation and inclusion of people of all ages, genders, and backgrounds in clinical research to provide equal opportunities and benefits.

Involve citizens and participating individuals in formulating research questions to address their health needs.

Pay attention to the specific needs of different social groups, such as disabled individuals, the elderly, and those in poverty, and overcome barriers related to digital skills, devices, and support.

Strengthen social dialogue and cooperation among stakeholders to identify and address equity-related challenges.

Periodically, make audits and give feedback

Suggests recommendations for improvement (use print materials, face-to-face or through group discussions)

Identify and overcome barriers

Ensure that ​intervention

programme activities are being implemented as planned

target the intended audience

desired outcomes are achieved

analyse the impact on target population

propose solutions and adjustments

EVALUATION TOOLKIT

Practical Steps for Gender and Inclusion

Implement practical measures, including

• inclusive stakeholder engagement,
• analysis of intersectional barriers,
• consideration of the intervention's contextual interactions, and
• data disaggregation by gender and other inclusivity factors where relevant.

Evaluate from multiple points of view: involve actors to evaluate the creation, development, implementation and final uses

Respect the legislation in force at the different levels

Establish an appropriate procedure for collecting and analysing

Consider ethical aspects

Ensure that parties involved know and follow procedures

Include quantitative and qualitative indicators

Follow best practices in data protection

Use minimum data elements needed according to objectives

Make data and analytical processes open to general public

Be transparent in the use of data

Systematise the data collection. Use technology.

Ensure privacy, security and responsibility in data management

Evaluation and monitoring

Summary

Micro level: Emphasises the importance of involving citizens in the co-creation, design, planning, implementation, and evaluation of the digital health literacy strategy.

Developing robust policies and strategies for digital health literacy is crucial, involving stakeholders like governments, healthcare organisations, educational institutions, and civil society. Comprehensive strategies should address challenges like the digital divide and inequality in technology access, emphasising collaboration. Sustainable funding mechanisms and accountability in policy implementation are also essential considerations for promoting digital health literacy.

Meso level: Recommends continuous evaluation and monitoring mechanisms for assessing the effectiveness of health interventions, information dissemination, and existing health literacy policies, emphasising periodic reviews to ensure relevance and alignment with emerging research and global initiatives.

Recommendations & key ideas

• Develop policies and strategies that promote digital health literacy and ensure equitable access to digital health tools and technologies.

• Foster collaboration between stakeholders, including policymakers, healthcare providers, and technology companies, to promote digital health literacy.

Macro level: Stresses the importance of a nationwide focus on digital health literacy, ensuring the relevance of health literacy in politics and the healthcare system, with special attention to the key role of municipalities in health promotion and literacy.

ACCESSIBILITY

In the context of a European-level dHL strategy, the following recommendations and considerations are crucial for creating accessible content and services:

• Diverse formats: Ensure that health-related information and services are available in a variety of formats to accommodate different preferences and needs.

• Readability: Prioritise readability by using user-friendly language, clear fonts, and uncluttered graphical interfaces.

• User-centric approach: Simplify procedures for accessing online services and avoid constant changes, promoting user-friendliness and reducing complexity.

• Uniformity and coherence: Maintain consistency in service access to prevent the proliferation of platforms and diverse procedures.

• Reduction of bureaucracy: Minimise unnecessary bureaucracy in both digital and traditional services to enhance efficiency.

Enhancing accessibility to health interventions is crucial for reaching diverse audiences. Making interventions available in various formats, using user-friendly language, visual aids, and audio, is essential. Recognising readability issues in online health searches is imperative, necessitating the integration of accessibility in the co-creation process and designing healthcare platforms with accessibility in mind. Additionally, promoting the adoption of accessibility standards ensures equal access for people with disabilities, fostering inclusion in vital health information and services.

By following these recommendations, a European dHL strategy can guarantee universal access to content and services, irrespective of abilities or disabilities, fostering inclusivity and usability. This underscores the paramount importance of enhancing accessibility through interventions in various formats, tackling readability issues, integrating usability and accessibility in the co-creation process, and advocating for the adoption of accessibility standards in healthcare institutions.

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