Domain-Specific Digital Health Literacy and Functional Engagement with E-Health Services in Primary Care: A Study from Surabaya, Indonesia

Titin Wahyuni; Eka Wilda Faida; Alfina Aisatus Saadah; Krisnita Dwi Jayanti

doi:10.56741/IISTR.jphs.002320

Authors

Titin Wahyuni
titin@stikes-yrsds.ac.id
STIKES Yayasan RS Dr Soetomo https://orcid.org/0000-0002-4459-8484
Eka Wilda Faida STIKES Yayasan RS Dr. Soetomo https://orcid.org/0000-0002-6460-1740
Alfina Aisatus Saadah STIKES Yayasan RS Dr. Soetomo https://orcid.org/0000-0001-7461-5559
Krisnita Dwi Jayanti IIK Bhakti Wiyata https://orcid.org/0009-0009-7082-2804

Keywords:

Digital Health Literacy, Health System Design, Low-and Middle-Income Countries, Patient Engagement, Primary Car

Abstract

Digital health systems have been increasingly integrated into primary care globally. In Indonesia, Surabaya’s municipal e-health programme has operated since 2013. Despite prolonged availability, face-to-face care remains dominant at community health centres (Puskesmas), suggesting that service availability alone may not ensure functional user engagement. This study described overall and domain-specific digital health literacy among primary care users and explored its associations with sociodemographic factors. A cross-sectional study was conducted among 100 adult users with prior e-health experience at an urban Puskesmas in Surabaya, using the eHealth Literacy Questionnaire (eHLQ). Descriptive statistics and Kendall’s tau-b correlation were used to examine overall and domain-level literacy and associations with age, educational attainment, and income. Overall digital health literacy was generally moderate to high, with 39% high, 36% moderate, and 25% low. Domain-specific analysis showed that the ability to actively engage with digital services had the highest proportion of low literacy (41%), followed by the ability to use technology to process health information (37%). Understanding of health concepts and language had the highest mean score, with most respondents falling into the moderate or high categories. Age showed a weak negative association, education a weak positive association, and income was not statistically significant. The findings suggest that functional engagement with e-health services is domain-specific and shaped by factors beyond access alone, underscoring the need for usability-focused design, integrated user support, and inclusive primary care strategies.

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Author Biographies

Titin Wahyuni, STIKES Yayasan RS Dr Soetomo

is a lecturer at the Diploma Programme in Medical Records and Health Information, STIKES Yayasan RS Dr. Soetomo, Surabaya, Indonesia. She holds the academic rank of Lektor and serves as Head of the Program of Study of Medical Records and Information Management. Her academic and research interests include medical records, health information management, digital health literacy, and primary healthcare information systems. (email: titin@stikes-yrsds.ac.id).

Eka Wilda Faida, STIKES Yayasan RS Dr. Soetomo

is a lecturer at the Diploma Programme in Medical Records and Health Information, STIKES Yayasan RS Dr. Soetomo, Surabaya, Indonesia. She holds the academic rank of Lektor Kepala and serves as Vice Chair for Academic Affairs of STIKES Yayasan RS Dr. Soetomo. Her areas of expertise include health management, medical records, health information management, and organisational management. (email: ekawildafaida@gmail.com).

Alfina Aisatus Saadah, STIKES Yayasan RS Dr. Soetomo

is a lecturer at the Diploma Programme in Medical Records and Health Information, STIKES Yayasan RS Dr. Soetomo, Surabaya, Indonesia. She holds the academic rank of Lektor. Her academic interests include health information management, medical records, maternal and public health, and healthcare service improvement. (email: aisatusalfina@gmail.com).

Krisnita Dwi Jayanti, IIK Bhakti Wiyata

is a lecturer in the Bachelor of Public Health Program at IIK Bhakti Wiyata Kediri. She holds the academic rank of Lektor. She is listed as a lecturer in the Epidemiology specialisation within the Public Health Study Program. (email: krisnita.jayanti@iik.ac.id).

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