{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T20:04:07Z","timestamp":1790280247274,"version":"4.1.0"},"reference-count":42,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Health literacy (HL) is a crucial determinant of population health; however, disparities persist in multilingual settings. In South Tyrol, Italy, where German- and Italian-speaking populations coexist within a unified health care system, HL disparities may reflect differences in language, culture, and digital engagement.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n This study investigated whether the usage of digital health information mediates the relationship between language group and HL and examined informational trust and other sociodemographic factors as covariates of HL.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Data were obtained from a population-based survey conducted in South Tyrol, Italy. The analytical sample comprised 1500 participants with adequate responses to the 16-item Health Literacy Survey European Union Questionnaire (HLS-EU-Q16) instrument and an identified language group. Mediation analysis was performed using PROCESS Model 4 (5000 bootstrap samples), with use of digital health information as the mediator, language group as the predictor, and HL as the outcome. Covariates included age, sex, education, self-rated health, trust in professional information sources, and trust in health information on the internet.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Italian-speaking participants showed significantly higher HL scores (mean 12.54, SD 3.31 vs mean 11.56, SD 3.48 on a 0-16 scale;\n P<\/jats:italic>\n <.001) and reported more frequent digital health information use (\n P<\/jats:italic>\n =.003) compared with German-speaking participants. Digital health information use was weakly positively correlated with HL in bivariate analyses (\n r<\/jats:italic>\n =0.11). In the fully adjusted mediation model, the indirect effect of language group on HL through digital health information use was not significant (\n B<\/jats:italic>\n =0.018, 95% bootstrap CI \u22120.035 to 0.074; partially standardized effect=0.005), whereas the direct effect of language group remained robust (\n B<\/jats:italic>\n =0.96;\n P<\/jats:italic>\n <.001). Trust in professional health information (\n B<\/jats:italic>\n =0.39;\n P<\/jats:italic>\n <.001) and trust in health information on the internet (\n B<\/jats:italic>\n =0.61;\n P<\/jats:italic>\n <.001) were both positively associated with HL.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Although digital engagement and online trust are related to HL, they do not explain the persistent language-based disparities in HL observed in South Tyrol. Public health strategies should prioritize strengthening critical appraisal skills, fostering trust in professional health information sources, and improving digital access to effectively address HL inequalities in multilingual populations.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/80934","type":"journal-article","created":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T14:55:10Z","timestamp":1784559310000},"page":"e80934-e80934","source":"Crossref","is-referenced-by-count":0,"title":["Digital Health Information Use, Trust, and Language-Related Disparities in Health Literacy in South Tyrol, Italy: Cross-Sectional Survey Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0319-4766","authenticated-orcid":false,"given":"Dietmar","family":"Ausserhofer","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5934-9472","authenticated-orcid":false,"given":"Verena","family":"Barbieri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-8034-8480","authenticated-orcid":false,"given":"Stefano","family":"Lombardo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6187-5159","authenticated-orcid":false,"given":"Timon","family":"G\u00e4rtner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8234-9964","authenticated-orcid":false,"given":"Klaus","family":"Eisendle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1974-4184","authenticated-orcid":false,"given":"Giuliano","family":"Piccoliori","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2720-001X","authenticated-orcid":false,"given":"Adolf","family":"Engl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4639-8195","authenticated-orcid":false,"given":"Christian Josef","family":"Wiedermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,24]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-12-80","article-title":"Health literacy and public health: a systematic review and integration of definitions and models","volume":"12","author":"S\u00f8rensen","journal-title":"BMC Public Health"},{"issue":"5","key":"R2","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1007\/s00038-009-0058-2","article-title":"The costs of limited health literacy: a systematic review","volume":"54","author":"Eichler","journal-title":"Int J Public Health"},{"issue":"2","key":"R3","doi-asserted-by":"publisher","first-page":"97","DOI":"10.7326\/0003-4819-155-2-201107190-00005","article-title":"Low health literacy and health outcomes: an updated systematic review","volume":"155","author":"Berkman","journal-title":"Ann Intern Med"},{"issue":"8","key":"R4","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0073049","article-title":"Social determinants of health information seeking among Chinese adults in Hong Kong","volume":"8","author":"Wang","journal-title":"PLoS One"},{"issue":"1","key":"R5","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.5729","article-title":"Internet health information seeking and the patient-physician relationship: a systematic review","volume":"19","author":"Tan","journal-title":"J Med Internet Res"},{"issue":"2","key":"R6","doi-asserted-by":"publisher","DOI":"10.2196\/jmir.8.2.e9","article-title":"eHealth literacy: essential skills for consumer health in a networked world","volume":"8","author":"Norman","journal-title":"J Med Internet Res"},{"issue":"12","key":"R7","doi-asserted-by":"publisher","first-page":"1668","DOI":"10.1177\/1359105317695429","article-title":"The digital divide: examining socio-demographic factors associated with health literacy, access and use of internet to seek health information","volume":"24","author":"Estacio","journal-title":"J Health Psychol"},{"key":"R8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijmedinf.2023.105124","article-title":"Sociodemographic determinants of digital health literacy: a systematic review and meta-analysis","volume":"177","author":"Estrela","journal-title":"Int J Med Inform"},{"key":"R9","unstructured":"Pelikan JM R\u00f6thlin F Ganahl K . 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