Exploring the role of health literacy in the evaluation of online health information: Insights from a mixed-methods study

• Health literacy level may impact on the evaluation of online health information.
• We explore in depth people’s evaluation of online health information.
• A general tendency not to question health information quality is observed.
• Low health literate respondents appear to overestimate their evaluation ability.
• People with low literacy rely more often on non-established evaluation criteria.

ObjectiveTo gain new insights into the relationship between health literacy and evaluation of online health information.MethodsUsing a mixed-methods approach, forty-four semi-structured interviews were conducted followed by a short questionnaire on health literacy and eHealth literacy. Qualitative and quantitative data were merged to explore differences and similarities among respondents with different health literacy levels.ResultsThematic analysis showed that most respondents did not question the quality of online health information and relied on evaluation criteria not recognized by existing web quality guidelines. Individuals with low health literacy, despite presenting higher eHealth literacy scores, appeared to use less established criteria and to rely more heavily on non-established ones compared to those with high health literacy.ConclusionDisparities in evaluation ability among people with different health literacy might be related to differences in awareness of the issue and to the use of different evaluation criteria. Future research should quantitatively investigate the interplay between health literacy, use of established and non-established criteria, and ability to evaluate online health information.Practice implicationsCommunication and patient education efforts should aim to raise awareness on online health information quality and to promote use of established evaluation criteria, especially among low health literate citizens.