Identifying facilitators of and barriers to digital health literacy in pediatric rheumatic disease: A scoping review

Digital health (DH) technologies have the potential to benefit pediatric patients with rheumatic diseases and their caregivers. Digital health literacy (DHL) refers to the knowledge and skills necessary to use technology and the internet to manage and communicate about health. The aim of this scoping review is to identify facilitators of and barriers to DHL and map them to the Capability, Opportunity, and Motivation Model of Behavior (COM-B Model) for children and adolescents with rheumatic diseases and their primary caregivers. We searched MEDLINE, CINAHL, Embase, Web of Science, and ProQuest for English full-text primary research studies. Facilitators of and barriers to DHL identified were codified and mapped to the COM-B Model. This review adhered to the JBI scoping review framework and conformed to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Scoping Review guidelines. Of the 5789 unique records, 44 met inclusion criteria. All the included studies did not explicitly address the concept and impact of DHL. However, the studies identified promoting and detracting factors that matched the definition of DHL. Thus, these were coded as facilitators of and barriers to DHL. The COM-B Model domain of psychological capability emerged as a major determinant of DHL. The COM-B Model domain of psychological capability emerged as a prominent source of facilitators of and barriers to DHL. The design, function, language, and presentation of DH crafted to meet the developmental and educational needs of the user were essential to improving DHL. Likewise, providers fostering quality communication and answering medical and technical questions arising from DH use fostered DHL in the domain of physical opportunity. Addressing DHL requires consideration across clinical, administrative, design, and research contexts. Recognizing low DHL and enacting educational interventions are essential to empowering digital health users. Trial Registration Open Science Framework (https://osf.io/g4jbh/).