Introduction

Health literacy is defined as ‘people’s knowledge, motivation and competencies to access, understand, appraise and apply health information to make judgements and take decisions in everyday life concerning healthcare, disease prevention and health promotion to maintain or improve quality of life during the life course’ [1]. According to Nutbeam’s hierarchical model, health literacy consists of three components: functional health literacy (basic literacy skills and health knowledge), interactive health literacy (ability to communicate one’s health needs and understand information) and critical health literacy (skills to critically evaluate health information and apply it to different contexts) [2]. Health literacy is considered a key determinant of health, a potential mediator for demographic factors and is associated with positive health behaviours in adolescents [3,4]. Low health literacy is associated with poor health outcomes, reduced interaction with preventative services and reduced quality of life [4]. Poor health literacy is highly prevalent in adults across Europe and the USA, however the health literacy of adolescents is less well understood [5,6].

With the widespread emergence of new technologies, a related concept of digital health literacy, sometimes referred to as e-health literacy, has emerged. It is defined as the ability to seek, find, understand and appraise health information from a digital source to apply it to maintain good health and overcome health challenges [7]. Digital technologies have infiltrated every aspect of modern life. In the U.S, 95% of adolescents report using the internet daily, similarly 88% of respondents in 2021/2022 HBSC survey report using social media at least daily [8,9]. Adolescents are exposed to a large amount of diverse health information of varying quality and trustworthiness from a range of digital sources such as social media and internet websites [10]. Evidence suggests they also frequently actively seek health information on topics such as nutrition, mental health and sexual health from digital sources [11,12]. The abundance of easily accessible information available can be a source of empowerment for adolescents to become active agents in their own health [11–13]. The largely unregulated nature of the social media and internet sources, however, necessitates the ability to appraise the quality and reliability of information accessed, as demonstrated by the Covid 19 infodemic [14]. Adolescents may not have the necessary skills to critically evaluate reliability of information, potentially impacting their decision making and overall health [15]. Thus, further understanding is needed on the digital health literacy of adolescents.

Adolescence is a key developmental period involving rapid physical, emotional, cognitive, and social development [16]. It is characterised as a period of increased autonomy and independence [17]. During adolescence the limbic subcortical systems, the area of the brain responsible for emotions and reward processing, matures earlier than the prefrontal cortex, which is responsible for decision-making and impulse control [18]. Adolescents are therefore susceptible to engaging in risky behaviours. Initiation of problematic behaviours such as smoking, alcohol consumption and substance use is highest in this period and evidence suggests these behaviours track into adulthood, contributing to the epidemic of non-communicable disease [17,19]. It is estimated that approximately 70% of premature deaths in adulthood can be attributed to behaviours established in adolescence, such as obesogenic diets, smoking, alcohol consumption and physical inactivity [16]. According to the Health Behaviour in School-Aged Children (HBSC) 2021/2022 survey, less than 25% of boys and less than 15% of girls reported achieving recommended levels of physical activity levels [20]. Less than 40% report eating fruit and vegetables daily and more than 20% were classified as overweight or obese, an increase in more than a third of locations since the 2018 survey [20]. Prevalence of e-cigarette use increased in all but two regions in the most recent survey and prevalence of reported rates of unprotected sex has increased by 9% among boys and 6% among girls in 2022 compared to 2014 [21,22]. Targeted health promotion initiatives for the demographic should therefore be a public health priority. Digital health literacy is considered a super determinant of health, associated with health behaviours in adults, although it is poorly understood among adolescents [23].

The objective of the proposed scoping review is to assess the extent, breadth and type of literature exploring the digital health literacy of adolescents, investigating how it is defined and measured. This is the first systematic effort to examine the digital health literacy specifically of this demographic. The scoping review methodology was chosen as this is an emerging field of research that is poorly understood. A preliminary search of PubMed, the Cochrane Database of Systematic Reviews, Prospero and JBI Evidence Synthesis was conducted and no current or underway systematic reviews or scoping reviews on the topic were identified.

This protocol comprehensively outlines the chosen methodology for conducting the proposed scoping review. The aim of publishing this protocol is to ensure transparency and limit bias in the reporting of the proposed scoping review. Deviations made from this protocol will be reported and justified in the scoping review.

Methods

The scoping review methodology is the most appropriate approach for this study because it seeks to address a broad research question and explore the breadth and depth of the available evidence in an emerging field of research. The proposed scoping review will systematically identify and map relevant studies to provide a comprehensive overview of the current literature. Unlike a systematic review it will not exclude studies based on quality, as the aim is to describe the extent and nature of the evidence rather than assess effectiveness. This protocol was developed in accordance with the guidance and template developed by Lely and Morris et al and is reported in line with the Preferred Reporting Items for Systematic review and Meta-Analysis extension for Protocols (PRISMA-P) guidance [26]. The PRISMA protocol checklist can be found in online supplemental S1 Fig. The scoping review will be conducted using the framework developed by Arksey and O’Malley, with further guidance provided by Levac et al and will align with the recommendations of the Joanna Briggs Institute for elaborating scoping reviews [27–29]. The scoping review will be reported in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) [30]. The PCC (Population, concept, context) framework, as recommended by the JBI Manual for Evidence Synthesis, guided the development of the inclusion and exclusion criteria for this protocol.

Discussion

This protocol outlines a proposed scoping review that aims to synthesise available evidence on the digital health literacy of adolescents. The review will map how digital health literacy has been defined and measured in the literature with the aim of improving the conceptual clarity within this emerging field. By providing a comprehensive and structured overview of the definitions, underlying conceptual frameworks and measurement tools used with adolescent populations the results will help to identify areas of conceptual fragmentation and inconsistencies in measurement approaches. Mapping the characteristics of included studies will allow identification of gaps in the literature, including underrepresented geographical regions, population subgroups and research contexts. This may inform future empirical research and scale development. It may serve a valuable resource supporting educators and public health practitioners when choosing appropriate measurement tools and designing targeted interventions to support and enhance digital health literacy specifically for this demographic.

Despite these anticipated contributions, several limitations are acknowledged. By only including records published in English, relevant articles published in other languages may be excluded, limiting the comprehensiveness of the review. Due to resource constraints, screening will mainly be conducted by a single reviewer. However, a blinded peer review of a subset of screening decisions will be conducted during the title and abstract screening and the full text screening stages by the two co-authors to minimise selection bias and enhance methodological rigour. A key strength of this review is the comprehensive search strategy that was developed with the assistance of a health science research librarian and informed by the PRESS guideline. The search was conducted across five academic databases and will be supplanted with citation searching to identify any additional records that were not uncovered in the original database search. The inclusion of a broad range of study designs and methods in the proposed scoping review will provide a comprehensive overview of this emerging research area.

The results of the proposed review will be disseminated through publication in a peer-reviewed journal and presentations at relevant academic and public health conferences. In addition, a summary of the findings will be prepared for dissemination through the Atlantic Technological University (ATU) Policy Brief Series to support knowledge translation for policymakers and practitioners. The results will also be shared with stakeholders in education and public health where appropriate, with the aim of informing future research, policy development, and intervention design. As the proposed review forms part of a doctoral research programme, the findings will guide subsequent empirical work in this area.

Supporting information

Acknowledgments

We would like to acknowledge the contribution of Olive Greaney, health science librarian at ATU for her assistance in developing the search strategy.