Digital Health Literacy: Perceptions, Uses, and Expectations Regarding Healthcare in the Information Age

Patricia Gabryela Moreira Bresser Lang; Márcia Azevedo Coelho

DOI: 10.22167/2675-6528-202603339

Article derived from a Course Conclusion Work (TCC), with content based on the student’s original work and adapted to the editorial format of the E&S Magazine with the support of the ResumeAI tool, an artificial intelligence solution developed by Instituto Pecege for textual synthesis and organization.

Summary

Digital health literacy, essential for informed decision-making and self-care in the information age, faces challenges in the Brazilian context. The study aimed to analyze the level of digital health literacy of adults and their perceptions regarding the use of digital technologies for self-care. An applied, exploratory, and descriptive research was conducted, with a quantitative and qualitative approach, involving 107 adults with prior experience in using digital health technologies. Data were collected via an electronic questionnaire on Google Forms, which included the eHEALS scale. The results revealed high usage of the internet and health applications, with predominantly positive perceptions, especially in supporting self-care. A moderate to high level of digital literacy for information seeking was identified, but with limitations in critical evaluation and confidence for decision-making. It was concluded that digital technologies are relevant for health autonomy, but they demand investment in educational actions and public policies that promote digital literacy, critical thinking, and the safe use of these tools, aiming to reduce inequalities and improve health decision-making.

Keywords: Artificial intelligence in health; Digital literacy; Health literacy.

1. Introduction

In the contemporary context of health sciences, there is a growing appreciation for the individual’s active participation in care processes. This participation implies understanding fundamental concepts such as self-care, health care, health literacy, and digital health literacy. Health is recognized as a dynamic phenomenon, resulting from the interaction between biological, psychological, and social determinants (Engel, 1977; WHO, 2001).

Self-care refers to actions taken by the individual themselves to maintain life, health, and well-being, based on Orem’s theory (2001) as a deliberate and conscious practice to regulate personal functioning and development. On the other hand, healthcare encompasses the set of actions developed by professionals and health systems to promote, prevent, treat, or rehabilitate health conditions, being necessary when the individual does not have sufficient capacity to meet their own needs (Orem, 2001).

The effectiveness of health prevention and promotion actions depends directly on the development of health literacy (HL). HL is the ability to access, understand, evaluate, and use health-related information for informed decision-making, also involving critical thinking in the face of the large volume of available information (WHO, 1998; Carvalho et al., 2025; Peres, 2024). This capacity transforms the individual from a passive figure into an active agent of their own care.

Health literacy is a complex concept, integrating six dimensions, including traditional, numerical, digital, media, informational, and scientific literacy (Norman; Skinner, 2006). Furthermore, it can be understood at three levels: functional, interactive, and critical, which range from basic comprehension of information to autonomy and transformative action (Nutbeam, 1998, 2000).

In the digital age, health literacy has evolved to encompass digital literacy, which is the ability to use technologies critically, effectively, and safely (Gilster, 1997; Eshet-Alkalai, 2004). The integration of these concepts forms eHealth literacy, which allows individuals to search for, understand, and apply health information in digital environments, promoting informed decisions and more effective self-care practices (Norman; Skinner, 2006). In Brazil, the importance of digital literacy is supported by Law nº 14.510/2022 (Kim et al., 2023).

Despite the potential of digital technologies, the Brazilian context presents significant challenges, such as the low availability of educational programs, technical language, and socioeconomic and gender inequalities, which hinder access to and adequate use of health information (from the abstract). The proliferation of inaccurate content on the internet and the complexity of language in educational materials intensify these difficulties (Borges et al., 2019; Sentell; Vamos; Okan, 2020; McQueen, 2020; Federal, 2022; UFMG, 2022). Low levels of health literacy (HL) are associated with difficulties in understanding prescriptions, navigating complex health systems (WHO, 2024; Peres, 2024), frequent hospitalizations, poor treatment adherence, and inadequate medication use, financially impacting health budgets (Carvalho et al., 2025; Eichler et al., 2009; Walters et al., 2020).

The strengthening of health literacy, especially in its digital aspect, is crucial for the promotion of public health, empowering individuals to understand risks and benefits, adhere to treatments, and prevent diseases, positively impacting health systems and reducing costs from preventable diseases (Sorensen et al., 2012; Eichler et al., 2009; Walters et al., 2020). The field of neuroscience, in turn, offers the scientific basis for understanding the brain mechanisms involved in learning, decision-making, and critical information use, guiding the development of evidence-based educational interventions (Kandel et al., 2013). Given this scenario, investing in digital health literacy strategies that promote autonomy, critical thinking, and responsible use of these technologies is essential, and the general objective of this study was to analyze how individuals use the internet and digital technologies in managing their own health, investigating how personal experiences contribute to autonomy and informed decision-making.

2. Material and Methods

This study was characterized as an applied research, with a quantitative approach complemented by a qualitative one, adopting an exploratory and descriptive design. This methodology sought to understand the participants’ level of digital health literacy and analyze their perceptions regarding the use of digital technologies. The research was approved by the Ethics Committee of the PECEGE – Continuing Education Program in Economics and Management (CAAE: 95144525.6.0000.9927), following the principles of the National Health Council (BRASIL, 2012).

The unit of analysis was composed of 107 adults, selected by convenience sampling. As an inclusion criterion, individuals who had already used digital technologies for health self-care were considered. This choice aimed at the participation of real users of these tools, allowing an evaluation of digital health literacy applied to the context of use. Participants who did not answer the questionnaire in full or who presented difficulties in reading and understanding the instrument were excluded.

Data collection was carried out using an electronic questionnaire, developed on the Google Forms platform. The instrument included the eHealth Literacy Scale (eHEALS), created by Cameron Norman and Harvey Skinner (Norman; Skinner, 2006). This scale is composed of eight items that assess individuals’ perception of their ability to search for, understand, and use electronic health-related information.

Each item of the eHEALS scale was assessed using a five-point Likert-type scale, with response options ranging from “completely disagree” to “completely agree”. Additionally, the form contained three open-ended questions. These questions aimed to explore digital health information search and use habits, investigate the practical use of self-care technologies, and relate the self-perception of digital health literacy with eHEALS.

Data collection procedures occurred in March 2026. The questionnaire was distributed to participants through personal contacts and social media. Before starting to fill it out, all participants agreed to the Informed Consent Form (ICF), being informed about the research objectives, data confidentiality, and the possibility of withdrawal at any time, without prejudice.

Regarding the data analysis, the quantitative information collected was submitted to descriptive statistics. This approach allowed for the organization and summarization of numerical data, providing an overview of the sample characteristics and the responses obtained on the eHEALS scale, without, however, presenting interpretations or inferences about the results.

The qualitative data, from the three open-ended questions of the questionnaire, were examined through qualitative content analysis methods. For this stage, two complementary methodological approaches were used, aiming for an in-depth understanding of the participants’ perceptions. The approaches employed were Thematic Analysis and Content Analysis.

Thematic Analysis, as proposed by Virginia Braun and Victoria Clarke (2006), consisted of a method for identifying, analyzing, and interpreting patterns of meaning, or themes, present in qualitative data. The analytical process involved six steps: familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the analytical report.

Complementarily, Content Analysis, systematized by Laurence Bardin (2011), was employed. This technique was used for the systematic organization and interpretation of communications. Bardin’s approach is structured in three fundamental phases: pre-analysis, exploration of the material, and treatment of results, inference, and interpretation.

The combination of these methodological approaches enabled a more in-depth and systematic analysis of the qualitative data. This integration allowed for both the identification of thematic patterns and the structured organization of the content of the responses, contributing to a comprehensive understanding of the participants’ perceptions regarding the use of digital technologies in healthcare.

3. Results and Discussion

The data analysis revealed a detailed panorama of digital health literacy and participants’ perceptions regarding the use of digital technologies for self-care. The study involved 107 adults, predominantly women (71%), with an average age of 39.9 years, ranging from 18 to 69 years. The majority of participants (55.1%) had completed higher education, indicating a sample profile with a good educational level. It was observed that 80.4% of participants use the internet or applications to seek health information, while 19.6% do not. This high initial usage rate already signals the relevance of digital platforms as a source of health information for this group.

The choice of a convenience sample, composed of users already familiar with digital health technologies, allowed for an applied assessment of digital literacy. However, this methodological characteristic implies a limitation in generalizing the results to the general Brazilian population. It is crucial to note that, even in a group with high education and technological familiarity, significant gaps were identified in critical judgment and confidence for decision-making. This suggests that informational and cognitive vulnerability may be even more pronounced in populations with lower education and restricted access to technologies, reinforcing the importance of targeted interventions.

The results of the eHEALS scale, an internationally validated instrument for mapping eHealth literacy indicators, revealed a mean global score of 28.9 points, with a standard deviation of 5.2, on a theoretical range of 8 to 40 points. This score indicates a generally moderate to high level of digital health literacy in the sample. However, a more in-depth analysis of the scale items showed important asymmetries between the ability to search for information and the skill for critical analysis and decision-making, as detailed in the participants’ responses.

In the eHEALS scale items related to the ability to find and use health resources on the internet, such as “I know how to find useful health resources on the Internet” and “I know how to use the Internet to answer my health questions”, most responses focused on the “Agree” and “Strongly Agree” categories. For example, 86 participants agreed or strongly agreed with the ability to find useful resources, and 83 stated they knew how to use the internet to answer health questions. This data demonstrates a good familiarity of the participants with searching for health information in the digital environment, indicating a functional competence for information access.

In contrast, the item addressing knowledge about the variety of health resources available on the internet (“I know what health resources are available on the Internet”) showed a more dispersed distribution, with 34 participants responding “Neither agree nor disagree”. This result suggests uncertainty or partial knowledge about the diversity of digital tools and sources available, even among those who consider themselves capable of seeking information. This gap may limit the exploration of more qualified or suitable options for their specific health needs.

The critical evaluation of the quality of digital health information revealed greater limitations. In the items “I have the necessary skills to evaluate health resources I find on the Internet” and “I can distinguish high-quality health resources from low-quality ones on the Internet”, the responses were more balanced and dispersed. In the first item, 55 participants agreed or fully agreed, while 52 were distributed between disagreement or neutrality. In the second, although 66 participants indicated agreement or full agreement, a considerable portion still expressed neutrality or disagreement, evidencing that critical evaluation skills are less developed than search skills.

The greatest insecurity was observed in the item “I feel confident using information from the Internet to make decisions about my health”, where 72 participants were distributed between disagreement or neutrality, and only 35 indicated agreement or total agreement. This finding is particularly relevant, as it points to a significant gap in individuals’ confidence in applying online information for health decisions. The disparity between the ease of searching and the insecurity in critical evaluation and decision-making can be understood in light of neurobiological models of information processing, which distinguish between System 1 (fast and intuitive) and System 2 (analytical and reflective).

Navigation on digital platforms, with their fluid usability and engagement-focused algorithms, tends to predominantly activate System 1, promoting quick and intuitive searching. However, validating scientific evidence and making informed decisions require the engagement of System 2, which relies on the prefrontal cortex and more elaborate cognitive processes. The massive volume of unstructured data on the internet can overload working memory and lead to decision fatigue, resulting in the insecurity observed in item 8 of the eHEALS scale. This cognitive overload hinders in-depth analysis and the consideration of different information sources.

Digital search often ignores the perspective of the Biopsychosocial Assessment, as proposed by Engel (1977) and the World Health Organization (WHO, 2001). Health is a complex and dynamic phenomenon, influenced by biological factors, psychological states such as anxiety and emotional self-regulation, and social determinants such as family support, income, gender, and education. When digital resources offer answers focused strictly on the organic symptom, decontextualizing the individual, they fail to contemplate the biopsychosocial dimension, which intensifies users’ disorientation and decision-making stress, hindering the making of truly informed and safe decisions.

The first open question, which explored digital health information seeking and usage habits, corroborated the trend of widespread use. Of the 107 respondents, 82 (80.4%) stated they use digital resources to seek health information. The main motivation for this search was investigating symptoms or self-diagnosis, accounting for 34% of responses. Subsequently, 20% of participants sought information about treatments and medications, which, without professional guidance, can entail risks. Only 15% mentioned seeking qualified information, such as scientific articles or guidelines, indicating a possible gap in health literacy.

The use of more advanced digital technologies, such as applications and artificial intelligence (AI), was mentioned by 17% of participants, reflecting the growing digitalization of care. Safer behavior was observed in 15% of responses, which indicated using these tools as a complement to medical consultation. Overall, these findings reveal a high digitalization of healthcare, but with a predominantly self-diagnostic use, which reinforces the need for greater guidance, critical information mediation, and validation by health professionals to ensure the safety and effectiveness of self-care practices.

The quality of information in digital environments is a critical point, as it is often mediated by algorithmic recommendation logics that prioritize content with higher engagement over scientific accuracy. This scenario can amplify exposure to incomplete, imprecise, or mistaken information, reinforcing practices of self-diagnosis and self-medication without professional support. Mediation by commercial recommendation algorithms can aggravate this risk by prioritizing sensationalist or unvalidated content, disregarding the subject’s life context and boosting confirmation bias.

The second open-ended question investigated the practical use of self-care technologies, revealing that 77 out of 107 participants (72%) had already used applications or digital tools to assist in health care, while 30 (28%) had not. The general perception of the experience was predominantly positive, with 63% of responses classified as “positive”, 22% as “moderate/mixed”, and 15% as “negative/no use”. Words such as “good”, “great”, “positive”, “wonderful”, and “enriching” were recurrent, evidencing satisfaction, a sense of organization, discipline, and greater control over one’s own health.

Participants highlighted the usefulness of apps for remembering to take medications, monitoring physical activities, controlling weight, tracking the menstrual cycle, and supporting healthy eating habits. However, it is essential to differentiate self-care from self-diagnosis. Self-care, according to Orem (2001), is a deliberate, continuous, and reflective practice, aimed at maintaining health and preventing worsening conditions, integrating the biopsychosocial perspective. Self-diagnosis, on the other hand, is a reactive and isolated attempt to label illnesses and indicate therapy based on biomedical reductionism, driven by somatic anxiety (cyberchondria) and confirmation bias, bypassing qualified clinical evaluation.

Some reports also indicated experiences with artificial intelligence, such as the use of ChatGPT for diet planning. However, limitations were pointed out, including free applications with restricted functionalities, lack of precision in monitoring, and intermittent user engagement. These observations highlight that, although digital technologies offer valuable support, their effectiveness and safety depend on the quality of the tool and the user’s ability to use it critically and consciously, avoiding excessive reliance on solutions that may not be fully adequate or validated.

The third open-ended question sought to verify participants’ confidence in understanding and applying health information found online, relating this perception to digital health literacy. The analysis of 101 responses revealed a predominantly cautious perception, marked by different levels of confidence and the adoption of information validation strategies. Approximately 20% of participants demonstrated high confidence, associating it with the ability to comprehend the information or with prior experience, especially when they had a background in the health field.

About 50% of participants showed moderate or partial confidence, recognizing the usefulness of digital information but adopting a critical stance. On the other hand, approximately 30% demonstrated low confidence, justifying it by the perception of misinformation and lack of technical knowledge. These confidence categories indicate that individuals adjust their confidence level according to the perceived credibility of sources, which is a positive aspect of developing digital literacy.

The “verification strategy” category identified that many participants do not use information passively. The main strategies reported include searching multiple sources, comparing content, consulting health professionals, and verifying the credibility of websites, especially those linked to recognized institutions, such as government agencies, hospitals, and scientific literature. This behavior suggests the development of critical skills in the use of health information, although there is still room for improvement in the consistent and systematic application of these strategies.

However, the analysis also evidenced the presence of “perceived limitations”, in which participants highlight the existence of false, incomplete, or contradictory information, in addition to the difficulty of applying generalized content to individual situations. These limitations contribute to the reported insecurity and reinforce the need for validation with health professionals. In general, the results indicate that, although there is widespread use of digital technologies for health information, user trust is moderate, evidenced by a critical sense and the need for confirmation, pointing to a developing process in the field of digital health literacy.

The analyzed data reveal a scenario of dualities. On one hand, there are elements that strengthen literacy, such as the active search for information, the use of multiple sources, and concern about the credibility of sources. On the other hand, significant fragilities persist, such as the predominance of symptom searching, often associated with self-diagnosis, low prioritization of scientific sources, and insecurity in the practical application of information. The adoption of more advanced digital technologies is still limited, which highlights the need for greater dissemination, familiarization, and training of users for the safe and effective use of these tools, in order to maximize their benefits and mitigate the risks associated with misinformation.

In summary, the results of this research demonstrate that participants possess a moderate to high level of digital health literacy regarding information seeking, but face significant limitations in critical evaluation and confidence for informed decision-making. Digital technologies are widely used and perceived as useful for self-care, but the predominant use for self-diagnosis and insecurity in validating information highlight the urgency of educational strategies that promote digital literacy, critical thinking, and the safe use of these tools, aligning with the objective of strengthening autonomy and informed health decision-making.

4. Conclusion

The present study aimed to analyze the level of digital health literacy in adults and their perceptions about the use of digital technologies for self-care, investigating how personal experiences contribute to autonomy and informed decision-making. It was found that the majority of participants widely use the internet and applications to search for health information, with predominantly positive perceptions regarding self-care support. A moderate to high level of digital literacy for information seeking was identified, according to the mean score of the eHEALS scale. However, a significant gap was observed in critical evaluation skills of information quality and in confidence for health decision-making. The search for symptoms and initial self-diagnosis were the main motivations, while prioritizing qualified sources was less frequent. This disparity between ease of search and insecurity in critical evaluation and decision-making is explained by neurobiological models, which distinguish the rapid and intuitive processing of digital navigation from the analytical and reflective processing necessary for evidence validation, often overloaded by the volume of unstructured information and the disregard for biopsychosocial evaluation.

The main contribution of this work lies in reinforcing the relevance of digital technologies for strengthening health autonomy, while also highlighting the urgency of educational actions and public policies that promote digital literacy, critical thinking, and the safe use of these tools. Although the convenience sample, composed of individuals already familiar with digital technologies, restricts the generalization of results to the Brazilian population, the findings indicate that limitations in critical evaluation may be even more pronounced in groups with lower education. It is suggested that future studies deepen the investigation of gaps in critical analysis and information application skills, as well as develop and evaluate educational strategies based on neuroscientific evidence to strengthen digital health literacy. Such initiatives are essential to reduce inequalities and improve informed decision-making, differentiating health-promoting self-care from reductionist self-diagnosis.

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