Impact of Digital Health Interventions on Health Literacy: A Systematic Review with Level Of Evidence Assessment

Abstract

Background: In the digital era, health literacy is essential for informed decision-making and improved outcomes. This PRISMA systematic review evaluates the effectiveness of digital health interventions (DHIs) in enhancing health literacy, using WHO definitions and classification frameworks. Methods: Cross-sectional studies, surveys, and case reports were included, focusing on DHIs such as mobile apps, online platforms, and telehealth services. PubMed, IEEE, and ACM databases were searched for publications from 2013 to 2024. Results: Of 1,029 initial articles, 39 met inclusion criteria. DHIs, including multimedia tools, apps, and remote programs, show potential to improve health literacy across populations, though results vary by age and socioeconomic status. Studies were categorized as follows: mobile apps (10.3%), online platforms (30.8%), multimedia tools (5.1%), telehealth/mHealth (15.4%), EHRs and portals (2.6%), conference proceedings (17.9%), and review studies (17.9%). Regarding the level of evidence, most studies were classified at Oxford Level 4 (64.1%), with fewer reaching Level 1 (20.5%) or Level 2 (10.3%). Conclusion: DHIs show potential to enhance user engagement and health knowledge, though results remain heterogeneous. While user-centered and culturally sensitive designs represent promising strategies, current evidence is insufficient to determine the definitive superiority of specific features, such as gamification. Standardized evaluation methods and targeted efforts to address digital inequities are needed to guide equitable digital-first healthcare policies.