Analysis of the Information Environment Impact and Population Digital Literacy on Health Behavior Patterns

Background. The digital transformation of healthcare and the widespread adoption of information and communication technologies have fundamentally reshaped the access to health-related information. Intense information flows have given rise to the “infodemic” phenomenon, where the overwhelming and conflicting health information creates new challenges for the public health.

The aim of the study was to provide a sys­tematic review of current scientific evidence on the influence of population digital literacy and the charac­teristics of the information environment on health behavioral patterns.

Materials and methods. A literature search was conducted in PubMed, Scopus, WoS, eLibrary, and CyberLeninka databases for the period 2019­2025.

Results. Validated tools for assessing digital literacy were identified; the relationship between digital literacy and economic aspects of medical behavior was established. The “cyberchondria paradox”, that is a positive association between digital literacy and health-related anxiety, was revealed. The effects of first-, second-, third-level digital divide, as well as culturally specific perception of digital health recommendations were documented.

Conclusion. Digital literacy is a significant yet non-linear factor shaping health-oriented behavior; its effect is managed by socioeconomic and institutional conditions.

1. Kayser L., Kushniruk A.W., Osborne R.H. et al. Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy: A Framework for Understanding Users’ Needs. JMIR Human Factors. 2015;2(1):e9. https://doi.org/10.2196/humanfactors.3696

2. World Health Organization. Global Strategy on Digital Health 2020-2025. Geneva: WHO; 2021. 56 p. Available from: https://www.who.int/publications/i/item/9789240020924

3. Zarocostas J. How to Fight an Infodemic. The Lancet. 2020;395(10225):676-677. Available from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30461-X/fulltext

4. Robles-Mariños R., Alvarado G.F., Maguiña J.L., Bazo-Alvarez J.C. The short-form of the Cyberchondria Severity Scale (CSS-12): Adaptation and validation of the Spanish version in young Peruvian students. PLoS One. 2023;18(10):e0292459. https://doi.org/10.1371/journal.pone.0292459

5. Sørensen K., Pelikan J.M., Röthlin F. et al. Health Literacy in Europe: Comparative Results of the European Health Literacy Survey (HLS-EU). European Journal of Public Health. 2015;25(6):1053-1058. https://doi.org/10.1093/eurpub/ckv043

6. Vismara M., Caricasole V., Starcevic V. et al.Is Cyberchondria A New Transdiagnostic Digital Compulsive Syndrome? A Systematic Review of the Evidence. Comprehensive Psychiatry. 2020;99: 152167. https://doi.org/10.1016/j.comppsych.2020.152167

7. Norman C.D., Skinner H.A. eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research. 2006;8(4):e27. https://doi.org/10.2196/jmir.8.4.e27

8. Paige S.R., Stellefson M., Krieger J.L. et al. Proposing a Transactional Model of eHealth Literacy: Concept Analysis. JMIR Human Factors. 2018;20(10):e10175. https://doi.org/10.2196/10175

9. Maksimenko A.A., Bogdan I.V., Zolotareva A.A., Gornostalev M.D. Online Literacy Among Russian Population in Matters of Health Information. Social Aspects of Population Health. 2025;71(4):10. https://doi.org/10.21045/2071-5021-2025-71-4-10 (In Russ.)

10. Neter E., Brainin E. eHealth Literacy: Extending the Digital Divide to the Realm of Health Information. Journal of Medical Internet Research. 2012;14(1):e19. https://doi.org/10.2196/jmir.1619

11. Diviani N., van den Putte B., Giani S., van Weert J.C. Low Health Literacy and Evaluation of Online Health Information: A Systematic Review of the Literature. Journal of Medical Internet Research. 2015;17(5):e112. https://doi.org/10.2196/jmir.4018

12. Hong Y.A., Cho J. Has the Digital Health Divide Widened? Trends of Health-Related Internet Use Among older adults from 2003 to 2011. The Journals of Gerontology: Series B. 2017;72(5):856-863. https://doi.org/10.1093/geronb/gbw100

13. Mackert M., Mabery-Flynn A., Champlin S. et al. Health Literacy and Health Information Technology Adoption: The Potential For a New Digital Divide. Journal of Medical Internet Research. 2016;18(10):e264. https://doi.org/10.2196/jmir.6349

14. Schulz P.J., Nakamoto K. Health Literacy and Patient Empowerment in Health Communication: The Importance of Separating Conjoined Twins. Patient Education and Counseling. 2013;90(1):4-11. https://doi.org/10.1016/j.pec.2012.09.006

15. Veselkova A.Yu., Zvonareva E.S., Kornilov M.N. et al. The Impact of Electronic Medical Records in the Modern Primary Health Care System on The Interaction Between Doctor and Patient in Moscow. Healthcare of the Russian Federation. 2021;65(5):405-410. https://doi.org/10.47470/0044-197X-2021-65-5-405-410 (In Russ.)

16. Barke A., Bleichhardt G., Rief W., Doering B.K. The Cyberchondria Severity Scale (CSS): German validation and Development of a Short Form. Journal of Behavioral Medicine. 2016;23):595-605. Available from: https://link.springer.com/article/10.1007/s12529-016-9549-8

17. McMullan R.D., Berle D., Arnáez S., Starcevic V. The Relationships Between Health Anxiety, Online Health Information Seeking, and Cyberchondria: Systematic Review and Meta-Analysis. Journal of Affective Disorders. 2019;245:270-278. https://doi.org/10.1016/j.jad.2018.11.037

18. Biskup D. A. Ambivalence of Healthcare Digitalization: Increase in Accessibility versus Digital Iinequality and Transformation of Trust. Caucasian Science Bridge. 9 (2), P. 153-167. (In Russ.)

19. Van Deursen A.J. Digital Inequality During a Pandemic: Quantitative Study of differences in COVID-19-Related Internet Uses and Outcomes Among the General Population. Journal of Medical Internet Research. 2020;22(8):e20073. https://doi.org/10.2196/20073

20. Huxhold O., Fiori K.L., Windsor T.D. The Dynamic Interplay of Social Network Characteristics, Subjective Well-Being, and Health: The Costs and Benefits of Socio-Emotional Selectivity. Psychology and Aging. 2013;28(1):3-16. https://doi.org/10.1037/a0030170

21. Chesser A.K., Keene Woods N., Smothers K., Rogers N. Health Literacy and Older Adults: A Systematic Review. Gerontology and Geriatric Medicine. 2016;2. https://doi.org/10.1177/2333721416630492

22. Hargittai E., Piper A.M., Morris M.R. From Internet Access to Internet Akills: Digital Inequality Among Older Adults. Universal Access in the Information Society. 2019;18(4):881-890. https://doi.org/10.1007/s10209-018-0617-5

23. Kim H., Xie B. Health Literacy in the eHealth Era: A Systematic Review of the Literature. Patient Education and Counseling. 2017;100(6):1073-1082. https://doi.org/10.1016/j.pec.2017.01.015

24. Kreps G.L., Neuhauser L. New Directions in eHealth Communication: Opportunities and Challenges. Patient Education and Counseling. 2010;78(3):329-336. https://doi.org/10.1016/j.pec.2010.01.013

25. Zarcadoolas C., Pleasant A., Greer D.S. Understanding Health Literacy: An Expanded Model. Health Promotion International. 2005;20(2):195-203. https://doi.org/10.1093/heapro/dah609

26. Nutbeam D. The Evolving Concept of Health Literacy. Social Science & Medicine. 2008;67(12):2072- 2078. https://doi.org/10.1016/j.socscimed.2008.09.050