INTRODUCTION: Digital health information sources are playing an increasingly prominent role in health promotion, public health and in healthcare systems. Consequently, digital health literacy skills are likewise becoming increasingly important. METHODS: Using a concept validation approach, the aim of the study was to validate a digital health literacy measure applied in the European Health Literacy Survey 2019-2021 (HLS19) of the WHO M-POHL Network, analyzing data from 28,057 respondents from 13 European countries. RESULTS: The scale displayed high internal consistency. Confirmatory factor analysis (CFA) strengthened the hypothesized one-factor structure. In most countries, the data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). Pearson correlation with a measure of general health literacy showed sufficient discriminant validity, and a social gradient was found. Testing for predictive validity showed that the scale score predicts health-related outcomes. DISCUSSION: The study shows that considerable proportions of the general adult populations across countries in Europe have limited DHL skills. The level of DHL has direct potential consequences for some forms of health service utilization, in some countries. Implications of the study include recommendations for improving digital health literacy, promoting organizational health literacy and quality assurance for digital health information and resources.

Aix Marseille University APHM INSERM IRD ISSPAM SESSTIM Cancer Biomedicine and Society Group Marseille France

Careum Foundation Careum Center for Health Literacy Zurich Switzerland

Careum School of Health Kalaidos University of Applied Sciences Zurich Switzerland

Católica Research Centre for Psychological Family and Social Well Being Universidade Católica Portuguesa Lisbon Portugal

Communication Unit National Institute of Public Health Ljubljana Slovenia

Competence Centre Health Promotion and Healthcare Austrian National Public Health Institute Vienna Austria

Czech Health Literacy Institute Prague Czechia

Department of Community Health The Norwegian Directorate of Health Oslo Norway

Department of Health and Nursing Sciences Faculty of Social and Health Sciences University of Inland Norway Elverum Norway

Department of Health Dublin Ireland

Department of Health Education and Promotion Clalit Health Services Tel Aviv Israel

Department of Nursing and Health Promotion Faculty of Health Sciences Oslo Metropolitan University Oslo Norway

Department of Public Health and Epidemiology Faculty of Medicine University of Debrecen Debrecen Hungary

Department of Public Health Faculty of Health Care and Social Work Trnava University Trnava Trnava Czechia

Department of Quality Measurement and Patient Survey Austrian National Public Health Institute Vienna Austria

Direção Geral da Saúde Lisbon Portugal

Global Health Literacy Academy Risskov Denmark

Psychological Sciences Research Institute Université Catholique de Louvain Louvain la Neuve Belgium

Public Health and Epidemiology Department of Health Science and Technology Aalborg University Aalborg Denmark

School of Public Health Bielefeld University Bielefeld Germany

School of Public Health University of Haifa Haifa Israel

The Norwegian Centre for Science Education Department The Faculty of Mathematics and Natural Sciences University of Oslo Oslo Norway

Front Public Health. 2025 Aug 06;13:1655721. doi: 10.3389/fpubh.2025.1655721. PubMed

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