Determinants and Health Outcomes of Digital Health Literacy in Patients With Cardiovascular Disease: Systematic Review and Meta-Analysis.

The overall pooled mean eHealth Literacy Scale score in adults with cardiovascular disease was 24.26.

• Twenty studies involving 8581 adults with CVD were included in the meta-analysis.
• The pooled mean eHEALS score was 24.26 (95% CI 21.19-27.32).
• There was substantial heterogeneity across studies (I2=98.4%; τ2=15.55; τ=3.94).
• The 95% prediction interval was wide, ranging from 14.66 to 33.85, indicating considerable variability in DHL across different settings.
• A random-effects meta-analysis model was used to synthesize pooled scores.

Lower digital health literacy was consistently associated with older age, lower educational attainment, female sex, limited social support, and less experience with digital technologies.

• These determinants were identified through systematic synthesis across the 20 included studies.
• The association with age and socioeconomic factors was described as revealing 'disparities associated with age and socioeconomic factors.'
• DHL was characterized as 'a context-dependent competency shaped by broader structural and social determinants.'
• Studies were published between 2006 and January 31, 2026, and searched across PubMed, Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, and Google Scholar.

Higher digital health literacy was associated with more favorable health-related outcomes in CVD patients.

• Favorable outcomes associated with higher DHL included better health behaviors, better quality of life, and greater use and acceptance of digital health technologies.
• These outcome associations were synthesized across the 20 included quantitative studies.
• The certainty of evidence for these associations was rated as low to very low using the GRADE approach.
• Substantial heterogeneity persisted across outcome analyses.

Subgroup analyses showed no statistically significant differences in digital health literacy by region, disease type, or age group.

• Subgroup analyses were conducted examining regional differences, CVD disease type, and age group.
• None of these subgroup factors produced statistically significant differences in DHL levels.
• Substantial heterogeneity persisted across all subgroup analyses.
• The certainty of evidence was rated as low to very low across analyses.

The certainty of evidence across included studies was rated as low to very low.

• Certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.
• Risk of bias was assessed using four tools: the Appraisal Tool for Cross-Sectional Studies, the Newcastle-Ottawa Scale, the Revised Cochrane Risk-of-Bias Tool for Randomized Trials, and the Risk of Bias in Nonrandomized Studies of Interventions.
• Substantial heterogeneity persisted across analyses, contributing to downgraded evidence certainty.
• Studies focusing exclusively on primary cerebrovascular disease and non-peer-reviewed articles were excluded from the review.

The authors recommend that digital health interventions be accompanied by structured digital inclusion strategies including routine assessment of DHL.

• The review identifies DHL as 'a foundational capability for digitally supported self-management in CVD care.'
• The authors call for 'routine assessment of DHL and care delivery to patients' digital capacities.'
• Further longitudinal and interventional studies were recommended to clarify causal pathways linking DHL to health outcomes.
• The authors also called for studies to 'incorporate provider- and system-level perspectives beyond individual-level assessments.'