The six components of the eHealth literacy model are briefly outlined below.
Traditional Literacy
This concept is most familiar to the public and encompasses basic (or prose) literacy skills such as the ability to read text, understand written passages, and speak and write a language coherently[19]. Technologies such as the World Wide Web are still text dominant, despite the potential use of sound and visual images on websites. Basic reading and writing skills are essential in order to make meaning from text-laden resources. A related issue is language itself. Over 65% of the World Wide Web’s content is in English[20], meaning that English-speakers are more likely to find an eHealth resource that is understandable and meets their needs.
Information Literacy
The American Library Association suggests that an information literate person knows “how knowledge is organized, how to find information, and how to use information in such a way that others can learn from them” [21]. Like other literacies, this definition must be considered within the context of the social processes involved in information production, not just its application [19]. An information literate person knows what potential resources to consult to find information on a specific topic, can develop appropriate search strategies, and can filter results to extract relevant knowledge. If one views the Web as a library, with search tools (eg, Google) and a catalogue of over eight billion resources, the need for Web users to know how to develop and execute search strategies as well as comprehend how this knowledge is organized becomes imperative.
Media Literacy
The wide proliferation of available media sources has spawned an entire field of research in the area of media literacy and media studies. Media literacy is a means of critically thinking about media content and is defined as a process to “develop metacognitive reflective strategies by means of study” [22] about media content and context. Media literacy is a skill that enables people to place information in a social and political context and to consider issues such as the marketplace, audience relations, and how media forms in themselves shape the message that gets conveyed. This skill is generally viewed as a combination of cognitive processes and critical thinking skills applied to media and the messages that media deliver [23].
Health Literacy
As discussed earlier, health literacy pertains to the skills required to interact with the health system and engage in appropriate self-care. The American Medical Association considers a health literate person as having “a constellation of skills, including theability to perform basic reading and numerical tasks required to function in the health care environment. Patients with adequate health literacy can read, understand, and act on health care information” [24]. Consumers need to understand relevant health terms and place health information into the appropriate context in order to make appropriate health decisions. Without such skills, a person may have difficulty following directions or engaging appropriate self-care activities as needed.
Computer Literacy
Computer literacy is the ability to use computers to solve problems[25]. Given the relative ubiquity of computers in our society, it is often assumed that people know how to use them. Yet, computer literacy is nearly impossible without quality access to computers and current information technology. For example, it is not helpful to learn PC-based commands on a Mac, to learn Windows 98 if one requires Windows XP, or be trained on a laptop when a personal digital assistant (PDA) is required for a task. Computer literacy includes the ability to adapt to new technologies and software and includes both absolute and relative access to eHealth resources. To illustrate this, Skinner and colleagues found that while nearly every Canadian teenager has access to the Internet, far fewer have the quality of access or the ability to fully utilize it for health [26,27].
Scientific Literacy
This is broadly conceived as an understanding of the nature, aims, methods, application, limitations, and politics of creating knowledge in a systematic manner [28]. The latter-mentioned political and sociological aspects of science are in response to earlier conceptions of science as a value-free enterprise, a position that has been vigorously challenged [28-30]. For those who do not have the educational experience of exposure to scientific thought, understanding science-based online health information may present a formidable challenge. Science literacy places health research findings in appropriate context, allowing consumers to understand how science is done, the largely incremental process of discovery, and the limitations—and opportunities—that research can present.
The Six Literacy Types
Taken together, these six literacy types combine to form the foundational skills required to fully optimize consumers’ experiences with eHealth. A profile of each literacy type with examples of the problems patient-clients might present is summarized in Table 1. Also included is a list of resources, many of them Web-based, that can be consulted to help health practitioners support patient-clients in improving their literacy skills across each domain. Although it would not be unexpected to find that older adults and those from nonindustrialized countries report greater difficulties in certain domains, particularly those that are context-specific, it is the authors’ experience that few assumptions about which groups or individuals are likely to encounter difficulties can be made. As work with highly Internet-connected populations (like North American adolescents) shows, many of whom we would expect to be skilled users, there is a lack of skills, opportunity, and environments to use eHealth to its fullest potential