The World Health Organization reports that the world population aged 60 and over has exceeded 1 billion and is projected to reach 2.1 billion by 2050, further intensifying the trend of global aging (World Health Organization, 2019). The pace of population aging worldwide is growing dramatically. Many health problems are closely related to aging, causing growing demand for healthcare services and economic burden for older people and society as a whole (Xie, Zhang, Xin, Zhu, Lu, Kit-Han Mo, 2022). Before the advent of electronic information technologies, older patients had limited access to medical protection and few medical service options, such as health management, information counseling and medical consultations. However, thanks to the rapid advancement of information technologies, the Internet has become the most convenient and effective means of obtaining and transmitting health data. The enormous amount of data available online, however, requires a prudent approach, as the quality of information can vary significantly. Therefore, individuals must possess a certain level of critical thinking to effectively navigate and evaluate individual data points. More than 50% of older people face problems accessing reliable and quality health information and lack the ability to distinguish between trustworthy sources (Cai, Liang, Liu, et al., 2024).

The effectiveness of introducing eHealth technologies is limited by the public's level of eHealth literacy. The higher the level of eHealth literacy, the better the ability to obtain and evaluate information (Shiferaw, Tilahun, Endehabtu et al, 2020). The quality, quantity, and scope of healthcare is growing mainly in developed countries, which is associated with increasing financial costs and growing burden on public budgets. Ways are constantly being sought to ensure the necessary quality of healthcare, including the financial sustainability of health systems, even in the context of an aging population in developed countries. The concept of eHealth literacy was first proposed by the scientist Norman. It refers to an individual's ability to obtain, understand, and evaluate health information from various online sources and use it to address health problems (Norman, Skinner, 2006).

The goal of eHealth is to provide healthcare through a targeted approach to the patient based on timely and accurate, but above all comprehensive, information about the patient and their medication history.

Examples of e-health health benefits

  • Reduction of radiation burden by eliminating duplicate X-ray imaging
  • Reduction of medication burden
  • Possibility of faster diagnostics
  • Reduction of errors and mistakes by healthcare professionals
  • Reduction of nosocomial infections (hospital-acquired infections – HAI)
  • Improvement of public health through higher quality and availability of guaranteed health-relevant information, such as support for preventive programs, promotion of healthy lifestyles, better patient awareness (e.g., about their own medication, examinations including history), among other forms (Dexter, Perkins, Maharry, Jones, Mcdonald, et al., 2004; Gartner, 2014).

Examples of e-health social benefits

  • Reduced time burden on patients
  • Improved patient awareness
  • Possibility of care in the home environment through telemedicine
  • Home care for the elderly and immobile
  • Automatic monitoring of the condition of chronic patients
  • Support for medication dosing
  • Social communication using social networks
  • Lower co-payment costs for patients (EMPIRICA, 2005)

The impact of technologies on health information seeking is currently undeniable. Traditional paper-based sources have been replaced by the Internet, which has become the most common tool for acquiring health knowledge. For effective fact-finding, it is important to navigate the world of technologies and know how to distinguish truthful information from disinformation. Digital technologies are transforming healthcare and public health systems worldwide and have great potential to improve the health and well-being of populations and individuals (World Health Organization, 2021). Obtaining health information, booking appointments online, virtual visits, asynchronous digital communication with healthcare professionals, wearable health-monitoring devices and self-monitoring devices — all of these are technologies available today. These systems bring many benefits, enabling scalable information processing, administrative processes, and facilitating access to healthcare through virtual visits. Using video or online appointment booking allows providers to serve hundreds of people who can be treated simultaneously and avoid traveling for in-person meetings that do not require physical examination or tests. The "digital divide" is a term used to encompass a wide range of social disparities in access to and use of digital devices and services, particularly personal computers and smartphones, and in the ability to access the Internet, both in terms of physical connectivity and ease of use. As healthcare becomes increasingly dependent on technological tools, the digital divide may further deepen existing disparities in access to healthcare (Alkureishi, Choo, Rahman, Ho, Benning-Shorb, Lenti et al, 2021).

Mobile applications used by seniors are a widespread tool for easy access to information today. Mobile health applications are offered by several institutions, such as the National Centre of Health Informatics, health insurance companies, and healthcare providers. The official E-health application from the National Centre of Health Informatics allows citizens access to their electronic health records, prescriptions, and vaccination information. Health insurance companies offer their own mobile applications that provide an overview of health services, electronic prescriptions, communication with the insurer, or searching for healthcare providers. The Rescue application (Záchranka), which is linked to emergency medical service operations centers, also plays a significant role in health protection and saving lives. In case of emergency, it automatically sends the caller's location and provides users with first aid instructions. In addition to these applications, commercial solutions are also used, such as LIEKY24 for searching medications or Môj lekár (My Doctor), which enables patients to communicate with their clinic and book examinations. Supporting evidence-based information with voice can provide new ways of interacting with patients, especially those who are vulnerable or living in remote areas.

Voice assistant technology is combined with artificial intelligence innovations and aims to improve remote patient monitoring, clinical education, care delivery, and research. The development of interactive technology that meets all healthcare needs and standards is essential. As technology evolves, there are many possible functions, chatbots, and virtual voice assistants that will likely be added in the coming years, making this type of healthcare technology more holistic and human. It is particularly important to design easy-to-use and reliable interactive devices for seniors. LifePod is a voice-controlled virtual voice assistant based on Alexa. It combines sensors with the Internet and artificial intelligence. This innovation is built specifically for seniors and responds to voice. The LifePod program initiates dialogues based on its settings. Users and caregivers can configure the device menu according to their needs. For example, LifePod can remind users to eat meals or attend medical appointments. It can also record daily activities so that family members can remotely monitor their loved ones' routines and physical condition (Rucker, a. 2025, Rucker, b. 2025).

The concept of literacy is understood as increasing awareness, expanding access when using multiple information sources, guidance, and recommendations. It involves improving the ability to recognize the quality and accuracy of provided information and related understanding (Huták, 2014). A person who is health literate can search for and correctly sort information that maintains and develops their health (Kickbusch et al. 2020). Health literacy is considered an indispensable tool for a healthy society. Health-literate individuals benefit population groups across society. Their contribution is not only in higher awareness, but they also participate in economic prosperity and community activities. Conversely, limited health literacy is associated with a higher risk of workplace injuries and impaired management of chronic diseases. These and other consequences lead to high costs for the healthcare system (Huták, 2014).

For a better understanding of health literacy, the health literacy model by Don Nutbeam (conceptual model of health literacy) is used. This model enables linking dynamic relationships, measurement possibilities, and evaluation of health literacy (Huták, 2014; Kickbusch et al. 2020). The model is divided into 3 levels of health literacy: a) functional health literacy, the essence of which is traditional health education that provides information about health risks and how to behave correctly within the healthcare system. The goal is to expand and deepen people's knowledge of health risk factors and lead to a willingness to take action. This includes, for example, participation in vaccination or adherence to preventive examination schedules, b) interactive health literacy focuses on developing citizens' abilities to act independently and strengthening their motivation and responsibility in following health guidelines. An important aspect is the development of autonomy in decision-making to reinforce internal motivation in the effort to contribute to health improvement. This includes some health education programs — aiming to guide citizens (Holčík, a., 2010, Holčík, b. 2010), c) critical health literacy includes individuals who are able to assess, identify health problems and participate in health improvement within the political system (Holčík, 2010; Huták, 2014; Kickbusch et al. 2020).

The National Consumer Council of the United Kingdom created another model of health literacy, which again divides health literacy areas into three groups. The first group refers to orientation in the healthcare system, the second to active care for one's own health, and the last part is participation in decision-making (Holčík, 2010). Another model of health literacy is the division of health information by the American Department of Health. The model divides health literacy into 3 dimensions.

  • Personal health dimension – information contributing to the protection and reinforcement of an individual's health is focused here. It assists in decision-making within the healthcare system.
  • Healthcare dimension – information intended only for healthcare professionals to improve the quality of services.
  • Population dimension – information intended for the general public about the health status of the population and ways to improve it.

These dimensions, however, cannot be perceived as completely separate, as when applied to everyday life they overlap (Holčík, a., 2010, Holčík, b. 2010). Health literacy is closely related to information literacy as well. The 2003 definition of information literacy by the American Library Association is the first known definition. This new type of health literacy creates added value, allowing individuals to apply critical thinking directly to the healthcare field. The main target group of information literacy in healthcare is not healthcare professionals, but patients. The ability to independently search for, evaluate, and effectively use health information for health status decisions is primarily conditioned by basic literacy, computer literacy, and also so-called consumer informatics or consumer health informatics, which is essential for the ability to use the Internet (Vyčítalová, 2012).

Health literacy of seniors

The period of aging is divided into early old age (65–75 years), later old age (after 75 years) and advanced old age (over 90 years). These periods are accompanied by biological and psychological changes. In old age, individuals often tend to talk about their illnesses and are indifferent to the surrounding world (egocentrism). In later age, they are often socially dependent on others and adaptability declines. They rely on stereotypes and resist new things (Studium psychologie, 2023). The document Strategic Framework for Preparing for an Aging Society 2021–2025 states that Czech seniors spend on average 17 years with some health condition. For women, this average is even higher, at 19.5 years. The document addresses these and other problems of Czech seniors, including health prevention, which should focus on chronic diseases that are significantly influenced by lifestyle and social health factors. Among older persons, discrimination is linked to many stereotypes and negative perceptions associated with aging, including uselessness and burden on society, slowness, lower cognitive function, impaired health, dependence on care and help from others, unfamiliarity with modern procedures and, for example, digital and communication technologies (Ministerstvo práce a sociálních věcí, 2018). Within the Slovak Republic, the National Program of Active Aging for 2021–2030 directly continues the expiring document for 2014–2020.

Regarding the highest level of education attained as a contextual prerequisite for active aging, compared to the EU28 average, Slovakia has in particular room for improvement in the lower proportion of older people with university education. Although their share should gradually increase by 2030, the level of education attained by older people will qualitatively strengthen primarily through a higher proportion of older persons with secondary education, especially with a maturity certificate. In this context, findings regarding the digital literacy of older people and mastery of modern communication tools and technologies in the digitalized era are also important. Digital literacy above the basic level in Slovakia is comparable to the EU28 average for persons up to 74 years of age; the lag is present only among persons aged 75+. The absence of digital literacy among older people may reduce their access to public resources and services, to necessary information and tools for social participation, both in paid employment and in the realization of a wide range of individually and socially beneficial activities (National Program of Active Aging for 2021–2030, 2021, p.14). A health-literate senior knows their health status as well as recommendations on how to alleviate their health problems and implements them within their possibilities. They cooperate with specialists to whom they can accurately describe their health condition and are oriented in both basic and specific symptoms of diseases (Národní síť podpory zdraví, 2015). In monitoring health literacy among seniors, a statistically significant correlation between health literacy and health status was demonstrated. Seniors with poorer health literacy often reported worse health status and vice versa. Likewise, more frequent hospitalization in the previous 12 months was demonstrated. The research was conducted using a structured interview based on a standardized questionnaire for identifying population health literacy HLS-EU-Q16 (Hajduchová, kol. 2017).

Paul Gilster first introduced the concept of digital literacy in 1997, defining it as the set of attitudes, understanding, and skills for effectively processing and communicating information and knowledge in various media and formats (Chráska, 2015). In the management of digital health literacy among seniors, the healthcare worker must take into account several aspects. The application of digital technologies such as artificial intelligence, virtual reality, and machine learning is gradually changing the way older adults acquire and share health knowledge. Older adults are disadvantaged in terms of physiological functions, cognitive abilities, social status, and economic standing. The number of digital devices, digital technology skills, attitude toward new things, usefulness, ease of use of the Internet and services have become fundamental factors in creating the digital divide among older adults (Alvarez-Galvez, Salinas-Perez, Montagni, Salvador-Carulla, 2020). Imposing digital health literacy on older adults also affects their ability to use digital technologies for searching, browsing, understanding, and evaluating health information to improve their health status.

Some older adults who are skilled in using technologies master online searching as well as creating and sharing health information. Some seniors have started using smart devices to monitor blood glucose levels. However, if older adults do not have sufficient skills and knowledge in using eHealth, and the quantity and quality of online health information are complicated and uneven, they may be influenced by false information on the Internet if they cannot identify correct sources and facts (Hung, Lyons, Wu., 2020). Objective factors affecting the eHealth literacy of older adults include Internet use, economic pressure, and level of education. Conversely, subjective factors are primarily confidence, anxiety, and pressure experienced by older adults in information technologies. Factors affecting the digital health literacy of seniors have been divided into three dimensions. These are sociodemographic factors, factors related to digital devices, and social support factors (Arcury, Sandberg, Melius, Quandt, Leng, Latulipe et al, 2020, Lee, Kim, Beum, 2020).

Sociodemographic factors

  • Age, gender, place of residence (urban, rural), health-related factors (depression, health problems, confidence in managing chronic conditions, stress). Several studies have shown that gender, race, age, place of residence, level of education, marital status, socioeconomic status, types of retirement provision, and type of health insurance are the main factors influencing the digital health literacy of older adults. Those who were younger, had higher education and higher socioeconomic status tended to have higher digital health literacy. Research has described lower health literacy among racial and ethnic minorities and adults who are not native speakers of the dominant language in a given country (Wang, Luan, 2022).

Social support factors

  • Social capital, specifically trust in healthcare providers, reliance on the physician's knowledge for medical decisions, structural social capital (what relationships, contacts, and friendships the senior has), cognitive social capital (how they trust each other, what shared values and opinions they hold).
  • Family support, family members in caring for family members' health and aging within the family.

Older people's confidence in their digital health literacy often depends on others. If someone in the family is proficient in digital technologies and can effectively share health information, they can jointly manage their health (Wang, Luan, 2022).

Factors related to digital devices

  • Internet accessibility, including insufficient access, usability problems and attitudes toward technologies, number of personal electronic devices and time spent online, frequency of Internet use, frequency of searching for health information, digital skills.
  • Attitudes toward the Internet and perceptions of online health information, including interest in using the Internet or smart devices, computer use under pressure or without pressure, confidence in current digital skills, attitudes toward online health information, self-efficacy, perceptions of the credibility and reliability of online health information, perception of the risk of insufficient health information online.

Factors such as whether seniors own digital devices, the frequency of using digital devices, and the scope of Internet activities also affect their digital health literacy. Seniors who own digital devices and have a high rate of usage are more likely to have high digital health literacy. A higher number of electronic devices enabling Internet access or health information searching indicates a higher level of digital health literacy. The frequency and time of Internet use also significantly affect the digital health literacy of older adults. Higher frequency of Internet use means a higher level of digital health literacy. Seniors who do not feel pressured to use a computer or consider it relatively easy to operate and are confident in their current digital skills have relatively high digital health literacy. Information self-efficacy, that is, confidence in searching, comparing, and evaluating information, can directly predict their digital health literacy (Shi, Du, Li, Hou, Sun 2024).

Čevela et al. (2014) states which areas are important for the development of health literacy in seniors:

  • education of seniors – in all areas of health literacy;
  • strengthening the ability to use information and communication technology – expanding social contacts and facilitating access to information;
  • mobility of seniors – with increasing age, the possibility of individual mobility decreases (e.g., senior taxi service);
  • employment of seniors – opportunities for engagement in society;
  • healthcare for seniors – managing acute and chronic diseases, healthcare staff sensitivity toward seniors with regard to reduced capabilities;
  • existential security of seniors – forms of support for seniors that help them overcome worries about securing basic living conditions and needs;
  • respect for the roles of seniors in society – due to major transformations of society and the environment, seniors may find it harder to navigate the world; consequently, there is a continuous need on the part of younger generations to improve support for healthy aging.

The approach to seniors in eHealth education should be strictly individual. For an effective education process for seniors, it is necessary to accept some fundamental conditions as stated by Veteška, Vacínová (2011): respect for seniors as mature personalities with established opinions, respect for feelings of fear, anxiety, uselessness, and reduced self-esteem, the influence of the environment, the educator's personality, and the coherence of the educational group. With the aging of the population, the risk of disease increases, and therefore their health status worsens. Therefore, it is important to provide seniors with appropriate intervention programs to improve their eHealth literacy, adapted to their diverse educational needs with different backgrounds (i.e., age, gender, education level, and socioeconomic status), which can eliminate health inequality. In addition, healthcare workers must develop patients' eHealth skills — searching, evaluating, and interpreting online health knowledge that is relevant to them. Family members are encouraged to teach older adults how to appropriately use eHealth resources. However, the considerable expansion of senior Internet users brings pitfalls associated with low information literacy and reduced ability to resist the dangers of the virtual environment, primarily in the context of spam and phishing issues. Education of seniors in IT thus emerges as another challenge for activation workers and their organizations (Alruwaili, Mostafa and Osama, 2023).

Authors: Marcela, Ižová, PhDr., PhD. PhDr. Mgr. Mariana Magerčiaková, PhD., MPH, MBA PhDr. Katarína Zrubáková PhD. PhDr. Mária Novysedláková PhD. PhDr. Mária Novysedláková PhD. Katolícka univerzita v Ružomberku, Fakulta zdravotníctva, Katedra ošetrovateľstva List of bibliographic references

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