A global survey on trust, digital health literacy and health information quality
Do Nascimento, I. J. B. et al. Infodemics and health misinformation: a systematic review of reviews. Bull. World Health Organ. 100, 544 (2022).
Google Scholar
Schulz, P. J. & Nakamoto, K. The perils of misinformation: when health literacy goes awry. Nat. Rev. Nephrol. 18, 135–136 (2022).
Google Scholar
Tunç, T., Demirci, H. F. & Ermiş, A. The mediating role of health literacy in the relationship between trust in public health authorities and distrust in health systems. BMC Public Health 25, 1–13 (2025).
Google Scholar
Larson, H. J. Defining and measuring vaccine hesitancy. Nat. Hum. Behav. 6, 1609–1610 (2022).
Google Scholar
van Kessel, R., Wong, B. L. H., Clemens, T. & Brand, H. Digital health literacy as a super determinant of health: more than simply the sum of its parts. Internet Interv. 27, 100500 (2022).
Google Scholar
Ratzan, S. C. et al. The Quality Health Information for All Commission: reinventing health communication for the digital era. Nat. Med. 31, 22–23 (2025).
Google Scholar
Lazarus, J. V. et al. Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023. Nat. Med. https://doi.org/10.1038/s41591-024-02939-2 (2024).
White, T. M., Wyka, K., Rabin, K. & El-Mohandes, A. Trust in the science behind COVID-19 vaccines as a driver of vaccine acceptance in the United States, 2021–2023. Vaccine X 21, 100576 (2024).
Google Scholar
Coombs, N. M., Porter, J. E. & Barbagallo, M. An exploration of the influencing factors for effective public health messaging during disasters: a scoping review. Public Health 228, 73–81 (2024).
Google Scholar
Piasecki, A. M., Hall, D. M., Zajac, J., Miller, S. A. & Nilson, J. R. A programmatic update on COVID-19 vaccination in rural communities in the United States. Vaccine 42, 125897 (2024).
Google Scholar
Sorich, M. J., Menz, B. D. & Hopkins, A. M. Quality and safety of artificial intelligence generated health information. BMJ 384, q596 (2024).
Google Scholar
Piltch-Loeb, R. et al. U.S. trust in physicians as key public health messengers during the H5N1 avian influenza outbreak. Sci. Rep. 15, 1–14 (2025).
Google Scholar
Blandi, L. et al. Digital information approach through social media among Gen Z and millennials: the global scenario during the COVID-19 pandemic. Vaccines 10, 1822 (2022).
Google Scholar
Rosenfeld, B. & Wallace, J. Information politics and propaganda in authoritarian societies. Annu. Rev. Polit. Sci. 27, 263–281 (2024).
Google Scholar
Trends in digital personalized learning in low-and middle-income countries. Office of Global Insight and Policy and United Nations Children’s Fund https://www.unicef.org/innocenti/media/896/file/UNICEF-Global-Insight-Digital-PL-LMIC-executive-summary-2022.pdf (2022).
Feroz, A. S., Ali, N. A., Khoja, A., Asad, A. & Saleem, S. Using mobile phones to improve young people sexual and reproductive health in low and middle-income countries: a systematic review to identify barriers, facilitators, and range of mHealth solutions. Reprod. Health 18, 1–13 (2021).
Google Scholar
Poulsen, A., Hickie, I. B., Alam, M., Wilson, C. E. & LaMonica, H. M. Access to mobile health in lower middle-income countries: a review. Health Technol. 15, 333–343 (2025).
Google Scholar
Mobile phone ownership. International Telecommunications Union https://www.itu.int/itu-d/reports/statistics/2023/10/10/ff23-mobile-phone-ownership/ (2025).
White, T. M., Lazarus, J. V., Rabin, K. H., Ratzan, S. C. & El-Mohandes, A. Emerging global patterns of COVID-19 vaccine information fatigue in 23 countries in 2023. Vaccine 42, 126475 (2024).
Google Scholar
Yuen, E. et al. Digital health literacy and its association with sociodemographic characteristics, health resource use, and health outcomes: rapid review. Interact. J. Med. Res. 13, e46888 (2024).
Google Scholar
Moucheraud, C., Guo, H. & Macinko, J. Trust in governments and health workers low globally, influencing attitudes toward health information, vaccines. Health Aff. 40, 1215 (2021).
Google Scholar
Qiu, C. S. et al. Determinants of digital health literacy: international cross-sectional study. J. Med. Internet Res. 27, e66631 (2025).
Google Scholar
Akse, R. Towards a conceptual model of uncertainty management for socio-technical innovations: a systematic review. Technol. Forecast. Soc. Change 209, 123796 (2024).
Google Scholar
Bertolazzi, A., Quaglia, V. & Bongelli, R. Barriers and facilitators to health technology adoption by older adults with chronic diseases: an integrative systematic review. BMC Public Health 24, 1–17 (2024).
Google Scholar
Dong, Q., Liu, T., Liu, R., Yang, H. & Liu, C. Effectiveness of digital health literacy interventions in older adults: single-arm meta-analysis. J. Med. Internet Res. 25, e48166 (2023).
Google Scholar
Petty, R. E. & Cacioppo, J. T. The elaboration likelihood model of persuasion. Adv. Exp. Soc. Psychol https://doi.org/10.1016/S0065-2601(08)60214-2 (1986).
Chaiken, S. Heuristic versus systematic information processing and the use of source versus message cues in persuasion. J. Pers. Soc. Psychol. 39, 752–766 (1980).
Google Scholar
Kreuter, M. W. & Wray, R. J. Tailored and targeted health communication: strategies for enhancing information relevance. Am. J. Health Behav. 27, 227–232 (2003).
Google Scholar
Kemp, T., Butler-Henderson, K., Allen, P. & Ayton, J. The impact of health information management professionals on patient safety: a systematic review. Health Info. Libr. J. 38, 248–258 (2021).
Google Scholar
Fahy, E., Hardikar, R., Fox, A. & Mackay, S. Quality of patient health information on the Internet: reviewing a complex and evolving landscape. Australas. Med. J. 7, 24 (2014).
Google Scholar
Mayer, R. E. The Cambridge Handbook of Multimedia Learning (Cambridge Univ. Press, 1997).
Morgado, M. et al. Video-based approaches in health education: a systematic review and meta-analysis. Sci. Rep. 14, 1–14 (2024).
Google Scholar
Schubbe, D. et al. Using pictures to convey health information: a systematic review and meta-analysis of the effects on patient and consumer health behaviors and outcomes. Patient Educ. Couns. 103, 1935–1960 (2020).
Google Scholar
Sweller, J. Cognitive load during problem solving: effects on learning. Cogn. Sci. 12, 257–285 (1988).
Google Scholar
Crocco, A. G., Villasis-Keever, M. & Jadad, A. R. Analysis of cases of harm associated with use of health information on the internet. J. Am. Med. Assoc. 287, 2869–2871 (2002).
Google Scholar
van Dijk, J. The Deepening Divide: Inequality in the Information Society (SAGE Publications, Inc., 2005); https://doi.org/10.4135/9781452229812
McLuhan, M. Understanding Media: The Extensions of Man (New York, 1964).
Behre, J. Young adults’ online sexual health information seeking and evaluating skills: implications for everyday life information literacy instruction. Proc. Assoc. Inf. Sci. Technol. 59, 1–10 (2022).
Google Scholar
National Science Board. Science and Technology: Public Perceptions, Awareness, and Information Sources. Science and Engineering Indicators 2024 NSB-2024-4. National Science Foundation https://ncses.nsf.gov/pubs/nsb20244 (2024).
Taylor, H. R. A model for the communication process. Society for Technical Communication 9, 8–10 (1962).
Societal preparedness insights. Global Listening Project https://global-listening.org/societal-preparedness-insights (2024).
Norman, C. D. & Skinner, H. A. eHEALS: The eHealth Literacy Scale. J. Med. Internet Res. 8, e507 (2006).
Google Scholar
Baig, S. A. et al. UNC perceived message effectiveness: validation of a brief scale. Ann. Behav. Med. 53, 732–742 (2019).
Google Scholar
EIU’s 2024 Democracy Index. Economist Intelligence Unit https://www.eiu.com/n/democracy-index-2024/ (2024).
World Bank Country and Lending Groups. World Bank Group https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups (2020).
UHC service coverage index. World Health Organization https://data.who.int/indicators/i/9A706FD (2025).
Lazarus, J. V. et al. Influence of COVID-19 on trust in routine immunization, health information sources and pandemic preparedness in 23 countries in 2023. Nat. Med. 30, 1559–1563 (2024).
Google Scholar
Lazarus, J. V. et al. Revisiting COVID-19 vaccine hesitancy around the world using data from 23 countries in 2021. Nat. Commun. 13, 1–14 (2022).
Google Scholar
Lazarus, J. V. et al. A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nat. Med. https://doi.org/10.1038/s41591-022-02185-4 (2023).
Lazarus, J. V. et al. A global survey of potential acceptance of a COVID-19 vaccine. Nat. Med. 27, 225–228 (2020).
Google Scholar
Kyrychenko, Y. et al. Profiling misinformation susceptibility. Pers. Individ. Dif. 241, 113177 (2025).
Google Scholar
Piltch-Loeb, R. et al. Source data for ‘a global survey on trust and literacy in health information’. Zenodo https://doi.org/10.5281/zenodo.18781508 (2026).