Sociodemographic and clinical factors associated with seven domains of digital health literacy: A cross-sectional study (NORFAST).

Introduction Due to limited digital health literacy (DHL), stroke survivors frequently face barriers in using digital health tools essential for post-stroke rehabilitation and self-management. DHL is a multidimensional construct, encompassing several distinct skill domains. Although sociodemographic and clinical characteristics may influence overall DHL, their associations with specific DHL domains remain poorly understood. This study therefore explores how individual DHL domains relate to patient characteristics in stroke survivors. Methods In this cross-sectional NORFAST study, stroke survivors aged 18-80 years with a first-ever stroke in 2021 or 2022 were recruited through the Norwegian Stroke Registry. Registry data included diagnosis, stroke type, aphasia, and scores on the National Institutes of Health Stroke Scale (NIHSS), modified Rankin Scale (mRS), and Barthel Index for Activities of Daily Living. Cognitive function was assessed before inclusion using the Mini/5min MoCA, a brief telephone-administered cognitive screening tool. Participants also completed self-report questionnaires (telephone or electronic), assessing sociodemographics, self-rated health status (EQ-VAS) and fatigue interference (Fatigue Severity Scale, FSS-7). The primary outcomes were DHL dimensions, assessed with the 7-domain eHealth Literacy Questionnaire (eHLQ). Linear regression models examined unadjusted and adjusted associations between patient characteristics and each DHL domain. Results Among 177 stroke survivors (mean age 69), most had experienced minor strokes and cerebral infarction. Patients scored highest on the domain "feel safe and in control", and lowest on "digital services that suit individual needs". In multivariable regression models, older age was associated with lower scores on Using technology, Engage, Motivation, and Needs; female sex with lower scores on Motivation and Needs; college/university education with higher scores on Understanding, Engage, Motivation and Needs; and better health status with higher scores on domains Using technology, Understanding, Motivation, Access and Needs. Living alone, aphasia, cognitive function, and fatigue interference were not significantly associated with any DHL domain after multivariable adjustment. Conclusion This study demonstrates considerable variation in DHL across domains among stroke survivors. After adjustment, age, education level, and self-rated health status were the factors most consistently associated with DHL dimensions. These findings suggest that older stroke survivors, those without college or university education, and those with lower self-rated health may warrant particular attention when designing, implementing, and evaluating digital health interventions. Co-creation with stroke survivors, healthcare professionals, and technology designers may support the development of accessible and clinically meaningful digital solutions.