{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:41:12Z","timestamp":1786642872638,"version":"build-2736575974"},"reference-count":35,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"crossref","award":["01GP2115A"],"award-info":[{"award-number":["01GP2115A"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"crossref","award":["01GP2115B"],"award-info":[{"award-number":["01GP2115B"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["www.plosdigitalhealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Digit Health"],"abstract":"<jats:p>The increasing digitalization of healthcare systems presents both opportunities and challenges for patients. A key challenge lies in cultivating e-health literacy, defined as the capacity to locate, comprehend, appraise, and use digital health information and services. This study employs a mixed-methods approach to investigate social and structural factors perceived as shaping patients\u2019 capability to use digital health services. A mixed-method approach guided the design, data collection, data analysis, and synthesis. This included semi-structured interviews and an online survey to corroborate findings and enhance credibility. The objective of the study was to examine the perspectives and dispositions of members and representatives of patient organizations regarding digital health services identifying key factors associated with e-health literacy. Findings indicate that respondents view social factors as crucial. Motivation to engage with digital health services is seen as a pivotal factor to shape the development of e-health literacy. However, motivation is not solely an individual trait; it is shaped by social contexts and trust in digital systems. Ensuring the highest standards of data security and transparency is imperative for cultivating this trust. Furthermore, patients must feel a sense of autonomy regarding their personal health data to engage confidently with digital health services. Structured learning environments, offered by social actors such as governments, patient organizations, and health insurance providers, also play a crucial role. These insights are relevant for practitioners in healthcare and public administration. To develop e-health literacy, it is imperative to establish inclusive learning opportunities, ensure data protection, and cultivate patient empowerment. Government agencies, healthcare providers, and insurance companies should collaborate with relevant stakeholders to design and implement supportive measures that reflect patients\u2019 lived realities. This approach can help ensure that all individuals are equipped to participate meaningfully in a digitalized healthcare environment.<\/jats:p>","DOI":"10.1371\/journal.pdig.0001569","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:21:45Z","timestamp":1786641705000},"page":"e0001569","update-policy":"https:\/\/doi.org\/10.1371\/journal.pdig.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Social factors associated with the development of e-health literacy: A mixed-methods study among patient organization members and representatives"],"prefix":"10.1371","volume":"5","author":[{"given":"Lea","family":"Wiedemann","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jan","family":"Hinrichsen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonas","family":"Lander","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simon","family":"Wallraf","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marie-Luise","family":"Dierks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3444-1280","authenticated-orcid":true,"given":"Henk Jasper","family":"van Gils-Schmidt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabine","family":"W\u00f6hlke","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"pdig.0001569.ref001","volume-title":"Digitale Gesundheitsagenturen: Was k\u00f6nnen wir von anderen L\u00e4ndern lernen?","author":"R Thiel","year":"2025"},{"key":"pdig.0001569.ref002","doi-asserted-by":"crossref","first-page":"1229734","DOI":"10.3389\/fpubh.2023.1229734","article-title":"Investigation of the relationship of general and digital health literacy with various health-related outcomes","volume":"11","author":"\u00c9 B\u00edr\u00f3","year":"2023","journal-title":"Front Public Health"},{"key":"pdig.0001569.ref003","doi-asserted-by":"crossref","DOI":"10.1007\/978-3-658-29816-6","author":"TM Bollweg","year":"2020","journal-title":"Health literacy im Kindes- und Jugendalter. Wiesbaden: Springer Fachmedien"},{"issue":"14","key":"pdig.0001569.ref004","doi-asserted-by":"crossref","first-page":"8309","DOI":"10.3390\/ijerph19148309","article-title":"Approaches to improvement of digital health literacy (eHL) in the context of person-centered care","volume":"19","author":"TS Busse","year":"2022","journal-title":"Int J Environ Res Public Health"},{"key":"pdig.0001569.ref005","author":"MA Pfannstiel","year":"2019","journal-title":"Digitale Transformation von Dienstleistungen im Gesundheitswesen VI. Wiesbaden: Springer Fachmedien"},{"key":"pdig.0001569.ref006","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.zefq.2019.05.006","article-title":"Digitale Gesundheitskompetenz in Deutschland \u2013 gefordert, aber nicht gef\u00f6rdert? Ergebnisse der empirischen Studie TK-DiSK","author":"S Samerski","year":"2019","journal-title":"Z Evid Fortbild Qual Gesundhwes"},{"issue":"2","key":"pdig.0001569.ref007","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1515\/pubhef-2022-0014","article-title":"Digitale Gesundheitskompetenz von Studierenden? Ergebnisse aus dem COVID-HL Netzwerk","volume":"30","author":"K Dadaczynski","year":"2022","journal-title":"Public Health Forum"},{"key":"pdig.0001569.ref008","author":"D Schaeffer","year":"2021","journal-title":"Gesundheitskompetenz der Bev\u00f6lkerung in Deutschland vor und w\u00e4hrend der Corona Pandemie: Ergebnisse des HLS-GER 2. Bielefeld: Universit\u00e4t Bielefeld, Interdisziplin\u00e4res Zentrum f\u00fcr Gesundheitskompetenzforschung"},{"key":"pdig.0001569.ref009","article-title":"Digitale Gesundheitskompetenz der Bev\u00f6lkerung in Deutschland: Ergebnisse des HLS-GER 2","author":"D Schaeffer","year":"2021","journal-title":"Gesundwesen"},{"issue":"1","key":"pdig.0001569.ref010","article-title":"Digital health literacy during the COVID-19 pandemic among health care providers in resource-limited settings: cross-sectional study","volume":"5","author":"MH Ahmed","year":"2022","journal-title":"JMIR Nurs"},{"key":"pdig.0001569.ref011","first-page":"1","article-title":"Gesundheitskompetenz und digitale Kompetenzen in Zeiten der Corona-Pandemie.","author":"B Babitsch","year":"2022","journal-title":"Gesundheitskompetenz. Berlin: Springer"},{"key":"pdig.0001569.ref012","article-title":"Die Bedeutung der (digitalen) Gesundheitskompetenz f\u00fcr das Informationshandeln: Ein differenzierter Blick auf die gesundheitsbezogene Informationssuche und -vermeidung.","volume-title":"Gesundheitskompetenz","author":"E Link","year":"2021"},{"key":"pdig.0001569.ref013","doi-asserted-by":"crossref","first-page":"635943","DOI":"10.3389\/fpubh.2021.635943","article-title":"Generation gaps in digital health literacy and their impact on health information seeking behavior and health empowerment in Hungary","volume":"9","author":"O Papp-Zipernovszky","year":"2021","journal-title":"Front Public Health"},{"issue":"6","key":"pdig.0001569.ref014","doi-asserted-by":"crossref","first-page":"3676","DOI":"10.3390\/ijerph19063676","article-title":"Digital health literacy and information-seeking behavior among university college students during the COVID-19 pandemic: a cross-sectional study from Denmark","volume":"19","author":"CK Bak","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pdig.0001569.ref015","doi-asserted-by":"crossref","first-page":"2278","DOI":"10.1186\/s12889-022-14751-z","article-title":"Health literacy and digital health information-seeking behavior - a cross-sectional study among highly educated Swedes","volume":"22","author":"E Sundell","year":"2022","journal-title":"BMC Public Health"},{"issue":"4","key":"pdig.0001569.ref016","doi-asserted-by":"crossref","DOI":"10.2196\/13536","article-title":"Facilitators and barriers to chronic disease self-management and mobile health interventions for people living with diabetes and hypertension in Cambodia: qualitative study","volume":"8","author":"L Steinman","year":"2020","journal-title":"JMIR Mhealth Uhealth"},{"key":"pdig.0001569.ref017","doi-asserted-by":"crossref","DOI":"10.2196\/49982","article-title":"Problems and barriers related to the use of mhealth apps from the perspective of patients: focus group and interview study","volume":"26","author":"GD Giebel","year":"2024","journal-title":"J Med Internet Res"},{"issue":"4","key":"pdig.0001569.ref018","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0266802","article-title":"Understanding undergraduate students\u2019 eHealth usage and views of the patient-provider relationship","volume":"17","author":"MA Reyes","year":"2022","journal-title":"PLoS One"},{"key":"pdig.0001569.ref019","doi-asserted-by":"crossref","DOI":"10.2196\/57108","article-title":"The potential use and value of a wearable monitoring bracelet for patients with chronic obstructive pulmonary disease: qualitative study investigating the patient and health care professional perspectives","volume":"8","author":"SM Debeij","year":"2024","journal-title":"JMIR Form Res"},{"key":"pdig.0001569.ref020","doi-asserted-by":"crossref","first-page":"20552076241245278","DOI":"10.1177\/20552076241245278","article-title":"Patients\u2019 acceptability of self-selected digital health services to support diet and exercise among people with complex chronic conditions: mixed methods study","volume":"10","author":"A Barnett","year":"2024","journal-title":"Digit Health"},{"key":"pdig.0001569.ref021","first-page":"1","article-title":"Schl\u00fcsselqualifikation digitale Gesundheitskompetenz \u2013 empirische Daten aus Deutschland.","author":"H Zeeb","year":"2022","journal-title":"Gesundheitskompetenz. Berlin: Springer"},{"issue":"13","key":"pdig.0001569.ref022","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1108\/K-07-2021-0547","article-title":"Addressing health literacy in the digital domain: insights from a literature review","volume":"51","author":"R Palumbo","year":"2021","journal-title":"Kybernetes"},{"issue":"12","key":"pdig.0001569.ref023","doi-asserted-by":"crossref","first-page":"7276","DOI":"10.3390\/ijerph19127276","article-title":"The use of the exploratory sequential approach in mixed-method research: a case of contextual top leadership interventions in construction H&S","volume":"19","author":"S Gogo","year":"2022","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"pdig.0001569.ref024","doi-asserted-by":"crossref","first-page":"106","DOI":"10.31265\/jcsw.v4i1.48","article-title":"The use of triangulation in social sciences research: can qualitative and quantitative methods be combined?","volume":"4","author":"A Hussein","year":"2009","journal-title":"J Comp Soc Work"},{"key":"pdig.0001569.ref025","article-title":"Three techniques for integrating data in mixed methods studies","volume":"341","author":"A O\u2019Cathain","year":"2010","journal-title":"BMJ"},{"key":"pdig.0001569.ref026","volume-title":"Qualitative methods in health research","author":"I Bourgeault","year":"2011"},{"key":"pdig.0001569.ref027","doi-asserted-by":"crossref","DOI":"10.2196\/58566","article-title":"Patient organizations\u2019 digital responses to the COVID-19 pandemic: scoping review","volume":"26","author":"S Wallraf","year":"2024","journal-title":"J Med Internet Res"},{"key":"pdig.0001569.ref028","doi-asserted-by":"crossref","DOI":"10.2196\/62750","article-title":"Digital transformation in patient organizations: interview and focus group study","volume":"27","author":"S Wallraf","year":"2025","journal-title":"J Med Internet Res"},{"key":"pdig.0001569.ref029","doi-asserted-by":"crossref","first-page":"20552076241278926","DOI":"10.1177\/20552076241278926","article-title":"Digital health literacy and its determinants among community dwelling elderly people in Taiwan","volume":"10","author":"TT Tran","year":"2024","journal-title":"Digit Health"},{"key":"pdig.0001569.ref030","volume-title":"Autonomie in der biomedizinischen Ethik. Genetische Diagnostik und selbstbestimmte Lebensgestaltung","author":"E Hildt","year":"2006"},{"issue":"12","key":"pdig.0001569.ref031","doi-asserted-by":"crossref","first-page":"2267","DOI":"10.1007\/s10389-023-02034-9","article-title":"Correction to: Impact of shared decision making on healthcare in recent literature: a scoping review using a novel taxonomy","volume":"32","author":"F Wehking","year":"2023","journal-title":"J Public Health (Berl)"},{"issue":"9","key":"pdig.0001569.ref032","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pdig.0000573","article-title":"Digital health and equitable access to care","volume":"3","author":"J Shaw","year":"2024","journal-title":"PLOS Digit Health"},{"key":"pdig.0001569.ref033","doi-asserted-by":"crossref","first-page":"1264780","DOI":"10.3389\/fdgth.2023.1264780","article-title":"Improving health literacy using the power of digital communications to achieve better health outcomes for patients and practitioners","volume":"5","author":"PJ Fitzpatrick","year":"2023","journal-title":"Front Digit Health"},{"key":"pdig.0001569.ref034","doi-asserted-by":"crossref","DOI":"10.2196\/36964","article-title":"The empowering role of web-based help seeking on depressive symptoms: systematic review and meta-analysis","volume":"25","author":"N Bizzotto","year":"2023","journal-title":"J Med Internet Res"},{"key":"pdig.0001569.ref035","author":"Patienten Universit\u00e4t","year":"2024"}],"container-title":["PLOS Digital Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001569","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:21:53Z","timestamp":1786641713000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pdig.0001569"}},"subtitle":[],"editor":[{"given":"Po-Chih","family":"Kuo","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":35,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8,13]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pdig.0001569","relation":{},"ISSN":["2767-3170"],"issn-type":[{"value":"2767-3170","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]}}}