Effectiveness of Digital Health Literacy Interventions in Older Adults: Single-Arm Meta-Analysis
Authors: Dong Qian , Liu Ting , Liu Ran , Yang Hongxia , Liu Cuiping 
Published: June 2023

Background
In a world of rapid digital technology development, the lack of digital health literacy (DHL) among older people cannot be ignored. DHL is becoming an essential competency that can facilitate the health status and health management of older adults.
DHL interventions that are feasible and appropriate can be implemented on a large scale through the health care system for older people.

Objective
The purpose of this meta-analysis was to assess the effectiveness of DHL interventions for older adults.

Methods
English publications in PubMed, Web of Science, Embase, and the Cochrane Library were searched from inception to November 20, 2022. Two reviewers independently completed the data extraction and quality assessment. Review Manager (version 5.4; Cochrane Informatics & Technology Services) software was used for all meta-analyses.

Results
A total of 7 studies, including 2 randomized controlled trials and 5 quasi-experimental studies, involving 710 older adults were considered eligible. The main outcome was scores on the eHealth Literacy Scale, and secondary outcomes were knowledge, self-efficacy, and skills. Quasi-experimental studies compared baseline and postintervention outcomes, while randomized controlled trials compared pre- and postintervention outcomes in the intervention group. Of the 7 studies, 3 used face-to-face instruction, while 4 adopted web-based interventions. Among them, 4 of the interventions were conducted using theoretical guidance, while 3 were not. Intervention duration varied from 2 to 8 weeks. In addition, the studies included were all conducted in developed countries, mainly in the United States. Pooled analysis presented that DHL interventions had positive effects on eHealth literacy efficacy (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001). Subgroup analysis revealed that DHL interventions that chose face-to-face teaching (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), were guided by a conceptual framework (standardized mean difference 1.15, 95% CI 0.46 to 1.84; P=.001), and were sustained over 4 weeks (standardized mean difference 1.1, 95% CI 0.46 to 1.84; P=.001) had a more significant effect. Moreover, the outcomes showed considerable gains in knowledge (standardized mean difference 0.93, 95% CI 0.54 to 1.31; P<.001) and self-efficacy (standardized mean difference 0.96, 95% CI 0.16 to 1.77; P=.02). No statistically significant effect was found for skills (standardized mean difference 0.77, 95% CI –0.30 to 1.85; P=.16). The small number of studies, variable study quality, and heterogeneity are some limitations of this review.

Conclusions
DHL interventions have positive effects on the health status and health management of older adults. Practical and effective DHL interventions are crucial for the use of modern digital information technology in managing the health of older people.

Trial Registration
PROSPERO International Prospective Register of Systematic Reviews CRD42023410204; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410204