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Digital Health Information Use, Trust, and Language-Related Disparities in Health Literacy in South Tyrol, Italy: Cross-Sectional Survey Study.

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Title: Digital Health Information Use, Trust, and Language-Related Disparities in Health Literacy in South Tyrol, Italy: Cross-Sectional Survey Study.
Authors: Ausserhofer D; Institute of General Practice and Public Health, Claudiana-College of Health Professions, Lorenz Böhler Street 13, Bolzano-Bozen, Bolzano, 39100, Italy, 39 0471 067 ext 392., Barbieri V; Institute of General Practice and Public Health, Claudiana-College of Health Professions, Lorenz Böhler Street 13, Bolzano-Bozen, Bolzano, 39100, Italy, 39 0471 067 ext 392., Lombardo S; Provincial Institute for Statistics of the Autonomous Province of Bolzano - South Tyrol, Bolzano-Bozen, Bolzano, Italy., Gärtner T; Provincial Institute for Statistics of the Autonomous Province of Bolzano - South Tyrol, Bolzano-Bozen, Bolzano, Italy., Eisendle K; Directorate, Claudiana-College of Health Professions, Bolzano-Bozen, Italy., Piccoliori G; Institute of General Practice and Public Health, Claudiana-College of Health Professions, Lorenz Böhler Street 13, Bolzano-Bozen, Bolzano, 39100, Italy, 39 0471 067 ext 392., Engl A; Institute of General Practice and Public Health, Claudiana-College of Health Professions, Lorenz Böhler Street 13, Bolzano-Bozen, Bolzano, 39100, Italy, 39 0471 067 ext 392., Wiedermann CJ; Institute of General Practice and Public Health, Claudiana-College of Health Professions, Lorenz Böhler Street 13, Bolzano-Bozen, Bolzano, 39100, Italy, 39 0471 067 ext 392.
Source: JMIR formative research [JMIR Form Res] 2026 Sep 24; Vol. 10, pp. e80934. Date of Electronic Publication: 2026 Sep 24.
Publication Type: Journal Article
Language: English
Journal Info: Publisher: JMIR Publications Country of Publication: Canada NLM ID: 101726394 Publication Model: Electronic Cited Medium: Internet ISSN: 2561-326X (Electronic) Linking ISSN: 2561326X NLM ISO Abbreviation: JMIR Form Res Subsets: MEDLINE
Imprint Name(s): Original Publication: Toronto, ON, Canada : JMIR Publications, [2017]-
MeSH Terms: Health Literacy*/statistics & numerical data , Health Literacy*/standards , Trust*/psychology , Language*, Humans ; Italy ; Female ; Cross-Sectional Studies ; Male ; Adult ; Middle Aged ; Digital Health ; Surveys and Questionnaires ; Aged ; Digital Media
Abstract: Background: 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.
Objective: 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.
Methods: 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.
Results: 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; P<.001) and reported more frequent digital health information use (P=.003) compared with German-speaking participants. Digital health information use was weakly positively correlated with HL in bivariate analyses (r=0.11). In the fully adjusted mediation model, the indirect effect of language group on HL through digital health information use was not significant (B=0.018, 95% bootstrap CI -0.035 to 0.074; partially standardized effect=0.005), whereas the direct effect of language group remained robust (B=0.96; P<.001). Trust in professional health information (B=0.39; P<.001) and trust in health information on the internet (B=0.61; P<.001) were both positively associated with HL.
Conclusions: 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.
(© Dietmar Ausserhofer, Verena Barbieri, Stefano Lombardo, Timon Gärtner, Klaus Eisendle, Giuliano Piccoliori, Adolf Engl, Christian Josef Wiedermann. Originally published in JMIR Formative Research (https://formative.jmir.org).)
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Eur J Public Health. 2016 Dec;26(6):906-911. (PMID: 27312257)
J Immigr Minor Health. 2011 Apr;13(2):253-9. (PMID: 20585985)
Health Promot Int. 2018 Oct 1;33(5):901-911. (PMID: 28369557)
J Med Internet Res. 2017 Jan 19;19(1):e9. (PMID: 28104579)
J Health Commun. 2018;23(8):724-734. (PMID: 30160641)
Int J Public Health. 2009;54(5):313-24. (PMID: 19644651)
J Am Med Inform Assoc. 2025 Mar 01;32(3):572-578. (PMID: 39688734)
J Immigr Minor Health. 2024 Aug;26(4):699-710. (PMID: 38589753)
J Med Internet Res. 2016 Oct 04;18(10):e264. (PMID: 27702738)
J Med Internet Res. 2017 Jun 19;19(6):e218. (PMID: 28630033)
Springerplus. 2015 Aug 19;4:432. (PMID: 26306294)
Res Involv Engagem. 2017 Dec 20;3:31. (PMID: 29276627)
J Med Internet Res. 2006 Jun 16;8(2):e9. (PMID: 16867972)
BMC Public Health. 2020 Jun 30;20(1):1040. (PMID: 32605608)
Patient Educ Couns. 2022 May;105(5):1268-1275. (PMID: 34474924)
Ann Intern Med. 2011 Jul 19;155(2):97-107. (PMID: 21768583)
Ann Ist Super Sanita. 2019 Jan-Mar;55(1):10-18. (PMID: 30968831)
BMC Public Health. 2015 Jul 21;15:678. (PMID: 26194350)
J Gen Intern Med. 2009 Nov;24(11):1211-6. (PMID: 19760299)
J Health Psychol. 2019 Oct;24(12):1668-1675. (PMID: 28810415)
Int J Public Health. 2020 Apr;65(3):325-333. (PMID: 32277246)
JBI Evid Synth. 2020 Jul;18(7):1389-1469. (PMID: 32813388)
Front Public Health. 2024 Feb 19;12:1332720. (PMID: 38439762)
Psychol Methods. 2007 Mar;12(1):23-44. (PMID: 17402810)
Int J Med Inform. 2023 Sep;177:105124. (PMID: 37329766)
Nurs Res. 2021 Set/Oct 01;70(5):344-353. (PMID: 33990120)
Health Promot Int. 2023 Oct 1;38(5):. (PMID: 37796105)
Front Public Health. 2024 Nov 01;12:1447747. (PMID: 39555039)
Front Public Health. 2022 Sep 23;10:988782. (PMID: 36211672)
Am J Health Behav. 2007 Sep-Oct;31 Suppl 1:S19-26. (PMID: 17931132)
J Gen Intern Med. 2005 Feb;20(2):175-84. (PMID: 15836552)
PLoS One. 2013 Aug 23;8(8):e73049. (PMID: 24009729)
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BMC Public Health. 2012 Jan 25;12:80. (PMID: 22276600)
Int J Environ Res Public Health. 2025 Apr 05;22(4):. (PMID: 40283795)
Contributed Indexing: Keywords: 16-item Health Literacy Survey European Union Questionnaire; HLS-EU-Q16; bilingual; digital engagement; digital health; disparities; health information; health literacy; language; mediation; multilingual
Entry Date(s): Date Created: 20260924 Date Completed: 20260924 Latest Revision: 20261003
Update Code: 20261004
PubMed Central ID: PMC13607262
DOI: 10.2196/80934
PMID: 42784772
Database: MEDLINE
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  Data: Digital Health Information Use, Trust, and Language-Related Disparities in Health Literacy in South Tyrol, Italy: Cross-Sectional Survey Study.
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  Data: Background: 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.&lt;br /&gt;Objective: 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.&lt;br /&gt;Methods: 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.&lt;br /&gt;Results: 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; P&amp;lt;.001) and reported more frequent digital health information use (P=.003) compared with German-speaking participants. Digital health information use was weakly positively correlated with HL in bivariate analyses (r=0.11). In the fully adjusted mediation model, the indirect effect of language group on HL through digital health information use was not significant (B=0.018, 95% bootstrap CI -0.035 to 0.074; partially standardized effect=0.005), whereas the direct effect of language group remained robust (B=0.96; P&amp;lt;.001). Trust in professional health information (B=0.39; P&amp;lt;.001) and trust in health information on the internet (B=0.61; P&amp;lt;.001) were both positively associated with HL.&lt;br /&gt;Conclusions: 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.&lt;br /&gt; (&#169; Dietmar Ausserhofer, Verena Barbieri, Stefano Lombardo, Timon G&#228;rtner, Klaus Eisendle, Giuliano Piccoliori, Adolf Engl, Christian Josef Wiedermann. Originally published in JMIR Formative Research (https://formative.jmir.org).)
– Name: Ref
  Label: References
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  Data: &lt;i&gt;Date Created: &lt;/i&gt;20260924 &lt;i&gt;Date Completed: &lt;/i&gt;20260924 &lt;i&gt;Latest Revision: &lt;/i&gt;20261003
– Name: DateUpdate
  Label: Update Code
  Group: Date
  Data: 20261004
– Name: PubmedCentralID
  Label: PubMed Central ID
  Group: ID
  Data: PMC13607262
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.2196/80934
– Name: AN
  Label: PMID
  Group: ID
  Data: 42784772
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=cmedm&AN=42784772
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.2196/80934
    Languages:
      – Code: eng
        Text: English
    PhysicalDescription:
      Pagination:
        StartPage: e80934
    Subjects:
      – SubjectFull: Humans
        Type: general
      – SubjectFull: Italy
        Type: general
      – SubjectFull: Female
        Type: general
      – SubjectFull: Cross-Sectional Studies
        Type: general
      – SubjectFull: Male
        Type: general
      – SubjectFull: Adult
        Type: general
      – SubjectFull: Middle Aged
        Type: general
      – SubjectFull: Digital Health
        Type: general
      – SubjectFull: Surveys and Questionnaires
        Type: general
      – SubjectFull: Aged
        Type: general
      – SubjectFull: Digital Media
        Type: general
      – SubjectFull: Health Literacy statistics & numerical data
        Type: general
      – SubjectFull: Health Literacy standards
        Type: general
      – SubjectFull: Trust psychology
        Type: general
      – SubjectFull: Language
        Type: general
    Titles:
      – TitleFull: Digital Health Information Use, Trust, and Language-Related Disparities in Health Literacy in South Tyrol, Italy: Cross-Sectional Survey Study.
        Type: main
  BibRelationships:
    HasContributorRelationships:
      – PersonEntity:
          Name:
            NameFull: Ausserhofer D
      – PersonEntity:
          Name:
            NameFull: Barbieri V
      – PersonEntity:
          Name:
            NameFull: Lombardo S
      – PersonEntity:
          Name:
            NameFull: Gärtner T
      – PersonEntity:
          Name:
            NameFull: Eisendle K
      – PersonEntity:
          Name:
            NameFull: Piccoliori G
      – PersonEntity:
          Name:
            NameFull: Engl A
      – PersonEntity:
          Name:
            NameFull: Wiedermann CJ
    IsPartOfRelationships:
      – BibEntity:
          Dates:
            – D: 24
              M: 09
              Text: 2026 Sep 24
              Type: published
              Y: 2026
          Identifiers:
            – Type: issn-electronic
              Value: 2561-326X
          Numbering:
            – Type: volume
              Value: 10
          Titles:
            – TitleFull: JMIR formative research
              Type: main
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