Understanding Multi-Level Factors Impacting Digital Health Literacy in the Deep South of the United States.

As healthcare and health services become increasingly digitized, individuals with low digital health literacy (DHL) may experience inequitable care and outcomes. We explored factors impacting DHL and recommendations for improvement from community health coordinators and advisors (CHAs) in Alabama and Mississippi in United States. Semi-structured interviews were conducted with CHAs to gather insights on their perspectives on and experiences with DHL. Interviews were transcribed and analyzed using a grounded coding schema, with key barriers and recommendations mapped onto the Taplin Multi-Level Intervention model to help identify influences across various levels. Thirty-two CHAs participated, predominantly female (94%) and Black or African American (94%). At the individual level, factors involved demographic characteristics, increased patient workload, and attitudes towards technology. Social support was captured at the relationships level. At the provider level, provider-patient communication and injustices were involved, compounded by health system infrastructure and culture at the practice-setting level. Resource landscape and shared knowledge and beliefs were significant at the community level. The COVID-19 pandemic further highlighted these challenges at the societal level. CHAs provided targeted recommendations for addressing barriers at each level. CHAs identified multi-level factors contributing to DHL and emphasized levels based on comprehensive interventions.