Patient Educ Couns. 2026 Jan;142:109397. doi: 10.1016/j.pec.2025.109397. Epub 2025 Oct 20.
ABSTRACT
BACKGROUND: Health literacy plays a crucial role in traditional healthcare access, engagement, and outcomes, yet its impact within newer digital mental health (dMH) services remains unknown. This is a significant knowledge gap given that the digitalisation of mental health care is predicated on the idea of improving access and outcomes for traditionally underserved groups. This study aimed to investigate the prevalence and correlates of limited health literacy among routine care dMH service users.
METHODS: A prospective cohort study was conducted using data from 4578 adults who completed an initial assessment for a large national dMH service between January and June 2024. Limited health literacy was assessed using the Single Item Literacy Screener (SILS) (i.e., scored ≥ 3 out of 5). Analyses examined associations between limited health literacy and user characteristics, treatment enrolment and initiation.
RESULTS: At initial assessment, 11.4 % of participants reported limited health literacy, with these individuals more likely to be younger, have lower educational attainment, less proficiency in English, not be in employment nor married, and identify as Aboriginal and/or Torres Strait Islander (all ps<.001). They also reported more severe symptoms of depression and anxiety, and higher suicide risk (all ps<.001). Limited health literacy was not significantly associated with treatment enrolment nor initiation (ps = 0.322 – 0.985).
DISCUSSION: Findings indicate that a meaningful proportion of routine care dMH service users have limited health literacy, and this does not appear to impede access to the treatments provided by these services. Thus, dMH services may go some of the way to providing mental health treatment for groups who face heightened barriers to accessing healthcare. Further research is needed to ascertain whether limited health literacy impacts on users’ ongoing treatment engagement and outcomes, as well as which aspects of dMH service design and delivery may benefit users with diverse health literacy levels.
PMID:41390986 | DOI:10.1016/j.pec.2025.109397
