Digital Literacy as a Foundational Element in Public Health Innovation Open Access

Digital literacy, a term first introduced by Paul Gilster^[1] in 1977, refers to the ability to locate, evaluate, and use information effectively in digital environments. As technology evolves to be more innovative and useful while reliance on digital information increases, digital literacy has become more pressing. Many individuals struggle to effectively navigate online content and discern credible information from misinformation. This gap in digital literacy can result in poor decision-making, particularly in resource-limited settings. Enhancing digital literacy skills across diverse populations has therefore become essential to empower individuals to make informed choices, engage critically with digital content, and contribute positively to society in an increasingly digital world.

In recent times, Finland’s priority in digital literacy has been found to significantly contribute to better public health outcomes by enabling effective health communication and access to vital health information.^[2] With over 90% of the population displaying digital proficiency, citizens can easily access reliable health resources, participate in digital health services, and use mobile health (mHealth) applications to monitor their health and wellness. This enables informed decision-making regarding health behaviors, vaccination programs, and disease prevention strategies. Finland has also implemented a robust educational framework to improve digital literacy, integrating technology and digital skills across all levels of schooling. Finland’s “National Curriculum Reform” incorporates digital literacy into the national curriculum, teaching students to navigate digital environments, evaluate online information, and use various digital tools effectively.^[3] The education system emphasizes a hands-on approach through project-based assignments and collaborative tasks, and teachers receive ongoing professional development to effectively coach students in digital skills. Additionally, Finland promotes equal access to technology regardless of socioeconomic background^[4] and has introduced coding and computer science programs to prepare students for the innovative digital era.

These comprehensive efforts have cultivated a population capable of leveraging digital tools for various applications, ultimately contributing to Finland’s high levels of digital literacy and enhanced public health and socioeconomic outcomes. One such innovative public health initiative is the Kanta Services platform, which provides citizens with digital access to their health records, prescriptions, and other essential health information.^[5] This initiative has enhanced patient engagement, allowing individuals to take an active role in managing their health and well-being. Additionally, the Finnish Institute for Health and Welfare uses digital tools to disseminate public health information, track disease outbreaks, and promote health campaigns through various digital channels.^[6] These initiatives leverage high digital literacy levels to improve accessibility to health services and foster informed decision-making, ultimately enhancing public health efficiency and outcomes.

While Finland has enhanced digital literacy through its educational reforms, China presents another case of rapid advancement in digital health through population-wide digital literacy improvements. Over a period spanning 2 decades, China has evolved from having relatively low digital literacy levels to becoming a world leader in digital technology and internet usage. Initially, access to digital tools was limited, particularly in rural areas, where educational resources were scarce. However, concerted government efforts, such as the “Internet Plus” initiative, have aimed to bridge the digital divide by improving infrastructure and providing digital education.^[7] With internet users approaching 1 billion by 2023, China has implemented digital literacy programs aimed at enhancing the skills of its population,^[8] including the “Action Plan for Improving National Digital Literacy and Skills (2022–2035),” fostering a technologically adept workforce that can support the country’s digital health advancements.^[9] Likewise, initiatives like the Digital Silk Road highlight China’s approaches to information and communication technology, in addition to bolstering digital literacy and technologic development with other nations.^[10]

This rise in digital literacy has profoundly affected public health at a national level, with mHealth applications enabling citizens to access information, schedule appointments, and consult professionals remotely. Novel platforms like internet hospitals have also evolved into an integral part of the healthcare system in China. The government has actively promoted their development as part of its healthcare reform, improving access in rural and underserved areas. Over 1000 licensed internet hospitals were operating across China as of 2023,^[11] providing services that range from general consultations to specialized medical advice through chats and messaging services. These platforms utilize artificial intelligence (AI) for diagnosis and treatment recommendations, along with electronic prescriptions and follow-up via mHealth applications. This integration has improved patient convenience, healthcare delivery efficiency, and enhanced public health surveillance and management during health crises,^[12] reflecting China’s efforts to create a more responsive and accessible health system through healthcare digitalization. It requires its users to be digitally literate.

The successful cases of Finland and China illustrate how digital literacy substantially enhances the development of digital health solutions, summarized in Figure 1. Finland’s and China’s initiatives have provided insight into potential replicability of their approaches, especially from a grassroot empowerment perspective, compared to a policy-driven model. Finland’s emphasis on educational reform showcases a framework for continuous improvement in digital literacy, even with challenges such as rapid technologic changes and unequal access to digital devices. Despite these issues, Finland continuously supports digital literacy education through initiatives like the UNICEF webinar focused on developing girls’ digital and AI skills.^[13] China’s approach—establishing internet hospitals to streamline consultations and incentivize digital platform usage—creates a user-friendly environment that drives digital adoption and outreach of its services, improving their public health system efficiency. By learning from these diverse approaches, countries can cultivate effective digital literacy frameworks tailored to their unique needs, ultimately fostering improved public health outcomes. These cases have also displayed a global trend in innovative digital solutions, including mHealth applications and wearable technologies for diagnostics and intervention purposes, as countries aim to improve their public health systems’ efficiency and outcomes, no matter the approach.^[14,15]

However, the broad application of these strategies may depend on the specific nation’s compositional factors, including culture, demographics, economies, social dependencies, and/or historical contexts. The best approaches remain to be seen, as there is not a single generalization strategy, largely dependent on goals and preconditions. Disparities in users’ digital skills remain a challenge, especially in low- and middle-income countries,^[16] and how to proceed in public engagement may be difficult. Furthermore, engagement strategies for specific demographics, especially elderly persons who do not actively use technology, may require further research on their effective integration. Future studies could focus on Indonesia, a country pushed into digital revolution as a response to COVID-19.^[17] Countries with a largely aging population like Japan and South Korea^[18]—issues which must be addressed—can provide further insight on the importance of expanding their population’s rates of digital literacy, along with their difficulties.

In conclusion, integrating digital literacy into national education frameworks is essential for preparing societies for the ongoing digital health revolution. As healthcare becomes more technology-dependent, fostering digital competencies will empower people of all demographics to navigate health information effectively and engage with digital health services. This education must extend among all ages, especially elderly persons, ensuring that they too can take advantage of technologic advancements for improved health outcomes. By prioritizing comprehensive digital literacy education, we can create more inclusive, resilient healthcare systems that benefit everyone, ultimately advancing public health in this era of innovative digital transformation.