Koichiro Oka
Faculty of Sport Sciences, Waseda University
This review aimed to examine the social background underlying the growing importance of digital health literacy in the digital and artificial intelligence era, with reference to the current health information environment and policy trends in Japan. Sources of health information have diversified across generations, and Internet use has expanded substantially. However, trust in online information has not been fully established, suggesting a structural condition characterized as “high access, low trust.” Findings from Japan’s Digital Positive Action initiative and the ICT Literacy Survey further indicate that the medical and health domain is particularly vulnerable to the spread of misinformation and disinformation. Moreover, with the advancement of personal health records and generative artificial intelligence, health-related decision-making is increasingly shifting toward a data-driven model. Building on established concepts of health literacy and eHealth literacy, this review argues for the theoretical reconstruction of digital health literacy to encompass competencies such as algorithmic understanding, data agency, and active participation in shared decision-making.
Rina Miyawaki
Meiji University
The current article summarizes the conceptual framework for evaluating digital health literacy (DHL) and outlines the characteristics and potential applications of its assessment measures. While the framework of health literacy is universal, the purpose, content, and methods of evaluation vary depending on the context (e.g., clinical, public health, policy), the domain, and the target population. With advancing digitalization, DHL has become increasingly important as the ability to find, understand, evaluate, and use health information from electronic resources. Initially, eHealth literacy─ the ability to gather and use information (Health 1.0)─ was emphasized, and the eHealth Literacy Scale (eHEALS) was widely used for its assessment. Subsequently, as information transmission and sharing have become easier, diverse skills including interactivity on web sites (Health 2.0) are increasingly required. The Digital Health Literacy Instrument (DHLI) was developed to measure the complete spectrum of Health 1.0 and Health 2.0 skills, and comprehensively measures six skills: operational skills, information searching, evaluating information, navigation skills, adding content, and protecting privacy. Beyond assessment, it will be important to implement concrete solutions, such as developing educational programs and designing communication strategies that are tailored to populations with limited DHL.
Hiroshi Fukuda
Department of Advanced Preventive Medicine and Health Literacy, Graduate School of Medicine, Juntendo University
This article provides an overview of the latest global trends in health literacy, drawing on insights from participation at three major international conferences: the Asian Health Literacy Association, the International Health Literacy Association, and the International Union for Health Promotion and Education. At Asian Health Literacy Association 2024, the theme of health literacy in the digital age was focused on, with discussions regarding the potential and challenges of artificial intelligence in healthcare. Similarly, the keynote address at International Health Literacy Association 2024 emphasized the intersection of digital health literacy and artificial intelligence. In contrast, the theme for International Union for Health Promotion and Education 2025 centered on “settings” for health promotion, advocating for the concept of “health literate settings”. This approach highlights the importance of creating environment─ such as schools, workplaces, and local communities─ where individuals can naturally achieve better health, a concept that also aligns with the framework of organizational health literacy. In the “health and productivity management” framework, enhancing health literacy is a key accreditation criterion, characterizing it as a health literate setting. Evidence of effective practices is growing, including video-based education and information and communication technology-driven literacy programs. Advancing digital health literacy among both professionals and citizens is expected to ensure equitable access to digital health technologies and maximize their societal benefits.
Maki Hirao
Faculty of Sports & Health Science, Department of Health Science, Daito Bunka University
/ Department of Sports and Health Sciences, Graduate School of Sports and Health Sciences, Daito Bunka University Graduate School
This review synthesizes recent progress and challenges in digital health literacy (DHL) with a focus on digitally vulnerable groups (DVG). We propose the A-S-A-G (Access, Skills, Agency, Guardrails) implementation framework, which addresses both access and decision-making inequities. We discuss subscription dark patterns as system-level pitfalls (e.g., roach-motel sign-up/cancel asymmetry) and consumer-protection standards, including click-to-cancel. Measurement should combine validated scales (e.g., the eHealth Literacy Scale (eHEALS), Digital Health Literacy Instrument (DHLI), and eHealth Literacy Questionnaire (eHLQ)) with practical tasks (online booking, consent, settings) and behavioral key performance indicators (KPIs), enabling quarterly plan-do-study-act (PDSA) cycles. As a case example, we outline a “golf × DHL” program that leverages enjoyment and inclusive design to promote sustained engagement while safeguarding privacy and safety.
Naoki Katsuragawa 1)2), Fuko Kisara1)
1) NPO KODOKODO
2) Intractable Disease Research Center, Juntendo University
The advancement of digital technologies has enabled personalized prevention using individual health-related data such as genomic information and health checkup results. However, as health information becomes increasingly complex, digital health literacy is essential for individuals to understand risks and translate information into behavioral change. This pilot intervention study examined the effects of a personalized prevention program combining genetic testing, artificial intelligence-based disease risk prediction, a smartphone application, and nurse-led concierge support on health literacy and lifestyle disease risk. The study was approved by an institutional ethics committee on May 13, 2025. A total of 19 adults participated in a 2 -month intervention. The results showed improvement in health literacy-related understanding among most participants, and the mean predicted risk of five lifestyle-related diseases decreased by 2.5% after the intervention. Although the study was exploratory and limited by its small sample size, the findings suggest that integrating digital health information with human support may promote health behavior change while respecting individual autonomy, contributing to sustainable healthcare for future generations.
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