{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T13:13:35Z","timestamp":1779196415404,"version":"3.51.4"},"reference-count":34,"publisher":"BMJ","issue":"4","license":[{"start":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T00:00:00Z","timestamp":1759622400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000245","name":"Michael Smith Health Research BC","doi-asserted-by":"publisher","award":["HSIF-2024-04465"],"award-info":[{"award-number":["HSIF-2024-04465"]}],"id":[{"id":"10.13039\/501100000245","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["CTW-1553878"],"award-info":[{"award-number":["CTW-1553878"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","award":["PP6-170676"],"award-info":[{"award-number":["PP6-170676"]}],"id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100002879","name":"Canadian HIV Trials Network, Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100002879","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000037","name":"Institute of Health Services and Policy Research","doi-asserted-by":"publisher","award":["521442"],"award-info":[{"award-number":["521442"]}],"id":[{"id":"10.13039\/501100000037","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Sex Transm Infect"],"accepted":{"date-parts":[[2025,9,8]]},"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019s (BC) publicly funded digital STBBI testing service.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We analysed data from GetCheckedOnline\u2019s 2022 community survey of English-speaking BC residents aged \u226516 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (\u03b2=0.162, p&lt;0.001) and use (\u03b2=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (\u03b2=0.206, p=0.014) and use (\u03b2=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (\u03b2=\u22120.263, p=0.006) and use (\u03b2=\u22120.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/sextrans-2025-056638","type":"journal-article","created":{"date-parts":[[2025,10,5]],"date-time":"2025-10-05T17:20:45Z","timestamp":1759684845000},"page":"217-224","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["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"],"prefix":"10.1136","volume":"102","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0271-9468","authenticated-orcid":false,"given":"Ihoghosa","family":"Iyamu","sequence":"first","affiliation":[{"name":"School of Population and Public Health, The University of British Columbia, 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British Columbia, Canada"},{"name":"BC Centre for Disease Control, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lorie","family":"Donelle","sequence":"additional","affiliation":[{"name":"College of Nursing, University of South Carolina, Columbia, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiu-Ju","family":"Chang","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rodrigo","family":"Sierra-Rosales","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Devon","family":"Haag","sequence":"additional","affiliation":[{"name":"BC Centre for Disease Control, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heather Nicole","family":"Pedersen","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6336-8780","authenticated-orcid":false,"given":"Nathan John","family":"Lachowsky","sequence":"additional","affiliation":[{"name":"School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Catherine","family":"Worthington","sequence":"additional","affiliation":[{"name":"School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troy","family":"Grennan","sequence":"additional","affiliation":[{"name":"BC Centre for Disease Control, Vancouver, British Columbia, Canada"},{"name":"Department of Infectious diseases, BC Centre for Disease Control, Vancouver, British Columbia, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Grace","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5978-6843","authenticated-orcid":false,"given":"Mark","family":"Gilbert","sequence":"additional","affiliation":[{"name":"School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"},{"name":"BC Centre for Disease Control, Vancouver, British Columbia, 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Identifying and validating a revised multidimensional digital health literacy scale: a secondary analysis of the 2022 getcheckedonline community survey (preprint). 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Does survey recruitment channel influence evaluation of awareness and use of digital stbbi testing services? insights from getcheckedonline\u2019s 2022 community survey in british columbia. 34th Canadian Conference on HIV\/AIDS Research (CAHR 2025); Halifax, Nova Scotia, 2025"}],"container-title":["Sexually Transmitted Infections"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/sextrans-2025-056638","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T12:45:57Z","timestamp":1779194757000},"score":1,"resource":{"primary":{"URL":"https:\/\/sti.bmj.com\/lookup\/doi\/10.1136\/sextrans-2025-056638"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,5]]},"references-count":34,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,5,19]]},"published-print":{"date-parts":[[2026,6]]}},"alternative-id":["10.1136\/sextrans-2025-056638"],"URL":"https:\/\/doi.org\/10.1136\/sextrans-2025-056638","relation":{},"ISSN":["1368-4973","1472-3263"],"issn-type":[{"value":"1368-4973","type":"print"},{"value":"1472-3263","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,5]]}}}