Impact of Digital Health Interventions on Health Literacy: A Systematic Review with Quality Appraisal

In the digital era, health literacy is crucial for informed health decisions and improved outcomes. This systematic review examines the effectiveness of digital health interventions (DHIs) in improving health literacy, as defined by the WHO. We included studies (cross-sectional, surveys, and case reports), focusing on interventions like mobile health apps, online platforms, and telehealth services. Our search, adhering to PRISMA guidelines, spanned databases PubMed, IEEE, and ACM, covering publications from 2013 to 2024. From 1.029 initial articles, 39 met our inclusion criteria. Our findings highlight that DHIs, including multimedia tools and remote sessions, have been reported to improve health literacy across diverse populations. However, the impact varies due to the digital divide, influenced by factors like age and socioeconomic status. This review categorizes the included studies by digital intervention type, including: 10.3 % on mobile apps (n = 4), 30.8 % on websites and online platforms (n = 12), 5.1 % on multimedia tools (n = 2), 15.4 % on telehealth and mHealth (n = 6), 2.6 % on electronic health records and patient portals (n = 1), 17.9 % conference proceedings (n = 7), and 17.9 % review studies (n = 7). This study highlights the complex nature of DHIs designed to enhance health literacy and engagement, aiming to reduce health disparities and ensure equitable access to healthcare benefits regardless of socioeconomic background or digital literacy. It underscores the importance of user-centered design, cultural sensitivity, and ongoing support for maximizing the effectiveness of DHIs. Incorporating theoretical frameworks is shown to boost engagement and promote behavioral change, particularly by addressing intrinsic motivations and cultural factors. The findings emphasize the necessity of sustained strategies, such as gamification, to maintain improvements in health literacy, and advocate for standardized evaluation methods to guide policy and advance the global transition to digital-first healthcare. Author SummaryHow effective are digital health interventions in improving health literacy? This review of 39 studies found that digital health interventions, including mobile apps, websites, and telehealth, are reported to improve health literacy. Effectiveness of these tools depended on age, digital skills, and socioeconomic factors, with user-centered design, cultural competence, and sustained engagement being key to success. In summary, digital health interventions can improve health literacy but require cultural relevance and sustained engagement for success. The three main takeaways from this collaborative work are: O_LIWell-designed digital health interventions can improve health literacy. C_LIO_LIThe digital divide limits access, especially for vulnerable groups. C_LIO_LILong-term success requires support, user focus, and cultural relevance. C_LI