A scoping review of tools to assess digital literacy among middle-aged and older adults for application to the practice of medical nutrition therapy

With the COVID-19 pandemic there was a swift and necessary adoption of telehealth for medical care, including medical nutrition therapy services. While the pandemic control measures have entered a new phase in Australia, the federal government has pledged to continue some Medical Nutrition Therapy (MNT) services as virtual consultations. It is important to ensure that service is equitable for all in the community and that the digital divide does not prevent access for disadvantaged groups. Older patients may be particularly at risk, and it is important to assess their ability to understand and accept virtual care. The aim of this scoping review was to identify available tools for assessing digital literacy in middle-aged and older adults and to determine their feasibility for patient use and their applicability to MNT services. The review followed the Joanna Briggs Institute guide for scoping reviews.⁽¹⁾ Five medical databases, reference lists of the identified studies and publications from main authors were searched to source peer-reviewed articles published in English from 2014 to February 2021. Studies for inclusion were those that used or tested a digital literacy tool in participants aged 45 years and above. Quantitative study designs conducted in clinical, community or population settings were considered. Studies not meeting these criteria were deemed ineligible. The results were synthesised in tabular form and with a narrative review. The generalisability of the included studies was assessed, and the applicability of the identified tools were evaluated using a four point-scale informed by the National Health Medical Research Council guide for developers of guidelines. Searches yielded 866 articles, of which 30 studies (31 reports) inclusive of 11,620 participants, were used in the final analysis. Seven tools for assessment of digital literacy were identified, and the electronic health Literacy Scale (eHEALS) and modifications of this tool were most frequently used. Other tools included the Computer Proficiency Questionnaire and variations for mobile and wireless networks. Most studies found low digital health literacy among older adults. The eHEALS was found to be the most applicable for practitioners to use for assessing suitability of virtual care for their patients. This tool is inclusive of eight questions self-administered using a Likert scale (5-point) and covering the domains of traditional literacy, health and scientific literacy, information literacy as well as media and computer literacy. The findings highlight the importance of locating an appropriate digital literacy tool for older adults to better inform telehealth-delivered MNT practice. Future studies should explore effective interventions and educational programs for disadvantaged and under-served populations to help connect them with healthcare services online.