{
  "abstract": "Background Although digital health literacy (DHL) is recognised as a determinant of access to digital sexually transmitted and blood-borne infection (STBBI) testing, empirical evidence about its contribution to access disparities remains limited. We applied multidimensional DHL measures to examine inequities in awareness and use of GetCheckedOnline, British Columbia’s (BC) publicly funded digital STBBI testing service.Methods We analysed data from GetCheckedOnline’s 2022 community survey of English-speaking BC residents aged ≥16 years who were sexually active in the past year. Outcomes were awareness and use of GetCheckedOnline (yes/no). DHL was measured using latent factors from the eHealth Literacy Scale: Information Navigation, Resource Appraisal and Confidence in Use. Structural equation modelling (SEM) was used to estimate associations and mediation pathways between DHL, sociodemographic characteristics and service outcomes. Model fit was assessed using standard SEM indices.Results Among 1657 respondents (mean age 33 years, SD 11.77), Information Navigation was positively associated with awareness (β=0.162, p<0.001) and use (β=0.063, p=0.020) of GetCheckedOnline. Confidence in Use was positively associated with awareness (β=0.206, p=0.014) and use (β=0.115, p=0.020). In contrast, Resource Appraisal was negatively associated with awareness (β=−0.263, p=0.006) and use (β=−0.150, p=0.010). DHL factors mediated the effects of age, income, education and digital access on both outcomes.Conclusions DHL operates as a multidimensional and socially patterned determinant of access to digital STBBI testing services. While information navigation and confidence in use facilitate access, higher resource appraisal may reduce use, potentially reflecting concerns about service fit, privacy or trust. Findings highlight the need for digital interventions that are not only accessible but also contextually relevant, trusted and responsive to the needs of diverse users.",
  "authors": [
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada",
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Ihoghosa Iyamu"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada",
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Pierce Gorun"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada",
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Sofia Bartlett"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada",
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Geoffrey McKee"
    },
    {
      "affiliations": [
        "College of Nursing, University of South Carolina, Columbia, South Carolina, USA"
      ],
      "name": "Lorie Donelle"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Hsiu-Ju Chang"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada",
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Rodrigo Sierra-Rosales"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Devon Haag"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada"
      ],
      "name": "Heather Nicole Pedersen"
    },
    {
      "affiliations": [
        "School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada"
      ],
      "name": "Nathan John Lachowsky"
    },
    {
      "affiliations": [
        "School of Public Health and Social Policy, University of Victoria, Victoria, British Columbia, Canada"
      ],
      "name": "Catherine Worthington"
    },
    {
      "affiliations": [
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada",
        "Department of Infectious diseases, BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Troy Grennan"
    },
    {
      "affiliations": [
        "Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"
      ],
      "name": "Daniel Grace"
    },
    {
      "affiliations": [
        "School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada",
        "BC Centre for Disease Control, Vancouver, British Columbia, Canada"
      ],
      "name": "Mark Gilbert"
    }
  ],
  "title": "Complex role of digital health literacy in awareness and use of digital sexually transmitted and blood-borne infections testing: a structural equation modelling analysis of the 2022 GetCheckedOnline survey",
  "uid": "f87fbafd-0580-559b-8315-9cb89732f6a1"
}