The Impact of Digital Health Literacy on Patient Adherence, Self-Management, and Follow-up Care: An Integrative Review

BACKGROUND: Digital health technologies have become integral to health care delivery, yet significant disparities continue to undermine equitable access and effectiveness. Approximately 16% of adults in the United States lack basic digital health literacy (DHL) skills, with barriers disproportionately affecting older adults, low-income individuals, and minoritized communities. Understanding the relationship between DHL and patient engagement is essential for addressing these inequities. PURPOSE: This integrative review examined the relationship between DHL and patient adherence to follow-up care, self-management behaviors, and telehealth engagement to identify factors contributing to health care disparities in digital health utilization. METHODS: A systematic search was conducted on August 26, 2024, across PubMed, Embase, and CINAHL. Studies published in English from January 2014 to September 2024 were included if they measured DHL using validated instruments or examined telehealth utilization patterns related to patient adherence to follow-up care, self-management behaviors, or telehealth engagement. Fourteen studies met the inclusion criteria and were appraised using the Johns Hopkins Evidence-Based Practice model. RESULTS: Higher DHL was consistently associated with improved patient behaviors, enhanced self-management, including better medication adherence, and improved telehealth engagement. Patients with higher DHL reported greater confidence using digital tools and satisfaction with virtual care. However, disparities remain entrenched, with studies consistently showing that older adults, rural populations, and individuals with lower incomes face greater barriers to effective telehealth engagement. CONCLUSIONS: DHL is a key determinant of equitable telehealth participation and patient outcomes. Integrating DHL assessment and training into routine health care delivery is essential to reducing disparities and advancing health equity.