Association between chronic disease, socioeconomic position and digital health literacy: a danish population-based survey

Abstract Purpose There is social inequity in the distribution of digital health literacy (DHL), and patients with chronic disease have also been shown to have lower general health literacy. The study aimed to examine the associations between low socioeconomic status (SES) [measured by self-reported educational level], chronic disease and low DHL and whether chronic disease modifies the effect between SES and DHL. Methods Cross-sectional study from the Danish HLS 19 survey, a stratified random sample of 3,644 respondents from the Danish population. A questionnaire collected information on educational level and the prevalence of 13 specific chronic diseases. The number of self-reported chronic diseases were counted. DHL was measured using the HLS 19 digital health literacy scale from the WHO-Action Network M-POHL. Linear regression models were used to estimate the association between chronic disease and DHL and between education level and DHL, adjusted for sex and age. The potential effect modification between SES, chronic disease and DHL was analyzed. Results Having two or more chronic diseases was associated with a lower level of DHL (beta (95%CI)) (-3.88 (-5.68; -2.08)) compared to having no chronic disease. Both bachelor-level education (6.49 (4.68; 8.30)) and master-level or above (9.39 (7.43;11.36)) were associated with a higher DHL than respondents with vocational education. No statistically significant interaction was found between chronic diseases and education level on the level of DHL. Conclusions SES and the presence of chronic diseases were independently associated with DHL but did not interact.