Document Type
Article
Abstract
Background Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access disparities remains limited. We applied multidimensional DHL measures to examine inequities in awareness and use of GetCheckedOnline, British Columbia’s (BC) publicly funded digital STBBI testing service. Methods We analysed data from GetCheckedOnline’s 2022 community survey of English-speaking BC residents aged ≥16 years who were sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (yes/no). DHL was measured using latent factors from the eHealth Literacy Scale: Information Navigation, Resource Appraisal and Confidence in Use. Structural equation modelling (SEM) was used to estimate associations and mediation pathways between DHL, sociodemographic characteristics and service outcomes. Model fit was assessed using standard SEM indices. Results Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (β=0.162, p<0.001) and use (β=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (β=0.206, p=0.014) and use (β=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (β=−0.263, p=0.006) and use (β=−0.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes. Conclusions DHL operates as a multidimensional and socially patterned determinant of access to digital STBBI testing services. While information navigation and confidence in use facilitate access, higher resource appraisal may reduce use, potentially reflecting concerns about service fit, privacy or trust. Findings highlight the need for digital interventions that are not only accessible but also contextually relevant, trusted and responsive to the needs of diverse users.
Digital Object Identifier (DOI)
Publication Info
Published in Sexually Transmitted Infections, 2025.
APA Citation
Iyamu, I., Gorun, P., Bartlett, S., McKee, G., Donelle, L., Chang, H.-J., Sierra-Rosales, R., Haag, D., Pedersen, H. N., Lachowsky, N. J., Worthington, C., Grennan, T., Grace, D., & Gilbert, M. (2025). Complex role of digital health literacy in awareness and use of digital sexually transmitted and blood-borne infections testing: a structural equation modelling analysis of the 2022 GetCheckedOnline survey. Sexually Transmitted Infections.https://doi.org/10.1136/sextrans-2025-056638
Rights
© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/ This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.