Journal of Health Literacy

Journal of Health Literacy

Health media literacy among digitally engaged residents of semi-rural Gran Canaria, Spain: A cross-sectional study

Articles in Press

Document Type : Original Article

Authors
Nuria Déniz-Ramírez 1
Claudio-Alberto Rodríguez Suárez 1, 2
María-Naira Hernández-De Luis 3
Candelaria de la Merced Díaz-González 2
Milagros De la Rosa- Hormiga 2
Héctor González-de la Torre 2
1 Insular Maternal and Child University Hospital Complex, Canary Islands Health Service (SCS), 35016 Las Palmas de Gran Canaria, Spain.
2 Nursing Department, Faculty of Healthcare Science, University of Las Palmas de Gran Canaria (ULPGC), 35016 Las Palmas de Gran Canaria, Spain.
3 Las Remudas Primary Health Care Centre; Canary Islands Health Service Las Palmas de Gran Canaria, Spain.
10.22038/jhl.2026.92016.1881
Abstract
Background and Objective: Media environments play a key role in shaping how individuals access, interpret, and use health information. Health media literacy (HML) refers to the cognitive and critical skills required to evaluate the credibility, intent, and meaning of health messages across media platforms. To assess the level of HML among digitally engaged adults living in semi-rural areas of Gran Canaria, Spain.

Material and Methods: A community-based cross-sectional study was conducted between November 2024 and March 2025 among adults aged ≥16 years living in semi-rural municipalities of Gran Canaria, Spain. Participants were recruited through non-probabilistic convenience sampling using digital dissemination via a web link and QR code. HML was assessed using the validated Spanish version of the Media Health Literacy Scale (MeH-Lit-SV), a 21-item instrument (total score: 0-84; higher scores indicate greater HML). Sociodemographic characteristics and media-use behaviors were also collected. Descriptive and non-parametric analyses were performed, and associations were examined using Spearman’s rho.

Results: A total of 264 participants were included. The mean HML score was 52.73 (SD=15.8), indicating moderate literacy. Higher scores were observed among women (p≤0.038) and participants with higher educational levels (p<0.001). Individuals who sought health information through multiple media sources scored significantly higher (p<0.001). No significant association was found between time spent on social media and HML. Age showed weak positive correlations with goal appraisal (r=0.130; p=0.034) and implicit meaning appraisal (r=0.173; p=0.005).

Conclusion: Digitally engaged adults in semi-rural Gran Canaria show moderate HML levels, with differences related to gender, education, and information-seeking behaviour. These findings highlight the need for targeted community-based strategies to strengthen critical appraisal skills and promote equitable access to reliable health information. Results should be interpreted considering the digitally engaged nature of the sample.
Keywords
Health Communication
Health Literacy
Information Seeking Behavior
Rural Population
Social Media

Acknowledgments: The authors would like to thank all participants who generously contributed their time to this study.


Availability of Data and Materials: The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.


Conflict of Interest: The authors declare that they have no conflicts of interest.


Consent for Publication: Not applicable.


Ethical Approval and consent to participate: The study was conducted in compliance with fundamental ethical principles and was approved by the Research Ethics Committee (CEIm) of Hospital de Gran Canaria Dr. Negrín, Las Palmas Province, Canary Islands, Spain (code: 2024-508-1). Participants received clear, detailed information about the objectives and procedures, and provided informed consent before participating. The questionnaire was administered anonymously to ensure confidentiality. Participants’ rights regarding confidentiality, anonymity, and the exclusive use of data for research purposes were safeguarded. All procedures were conducted in accordance with the Declaration of Helsinki and relevant ethical guidelines. 


Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.


Authors’ Contributions: Conceptualization: N.DR, CA.RS, H.GT; Data curation; N.DR, CA.RS; Formal analysis: CA.RS,  H.GT; Investigation: N.DR, CM.DG, MN.HL; Methodology: N.DR, CA.RS, H.GT, CM.DG, MN.HL; M.RH Software: N.DR, CA.RS, H.GT; Supervision: CA.RS; Validation: H.GT; M.RH; Visualization: N.DR, CM.DG, MN.HL, M.RH; Writing–original draft: N.DR, CA.RS, H.GT, CM.DG, MN.HL; Writing–review & editing; N.DR, CA.RS, H.GT, CM.DG, MN.HL; M.RH.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

1. Schiavo R. Health communication: From theory to practice. 2nd ed. San Francisco (CA): Jossey-Bass; 2014.
2. Wakefield MA, Loken B, Hornik RC. Use of mass media campaigns to change health behaviour. Lancet. 2010;376(9748):1261-1271 https://doi.org/10.1016/S0140-6736(10)60809-4 PMid:20933263 PMCid:PMC4248563
3. Carton L, Martín A, de los Reyes R, Sanz M, Muriel A, Mirón R, et al. Use of social networks as a source of information on health and digital health literacy in the Spanish general population. Rev Esp Salud Pública. 2024;98:e202405034. Available from: http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272024000100108](http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S1135-57272024000100108
4. Lee J, Lee EH, Chae D. eHealth literacy instruments: Systematic review of measurement properties. J Med Internet Res. 2021;23(11):e30644.  https://doi.org/10.2196/30644 PMid:34779781 PMCid:PMC8663713
5. Li W, Zhang Y, Liang J, Yu H. Psychometric evaluation of the Chinese version of the Media Health Literacy Questionnaire: A validation study. Digit Health. 2023;9:20552076231203801 https://doi.org/10.1177/20552076231203801 PMid:37766905 PMCid:PMC10521271
6. Tavousi M, Mohammadi S, Sadighi J, Zarei F, Kermani RM, Rostami R, Montazeri A. Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021. PLoS One. 2022;17(7):e0271524.  https://doi.org/10.1371/journal.pone.0271524 PMid:35839272 PMCid:PMC9286266
7. Norman CD, Skinner HA. eHealth literacy: Essential skills for consumer health in a networked world. J Med Internet Res. 2006;8(2):e9.  https://doi.org/10.2196/jmir.8.2.e9 PMid:16867972 PMCid:PMC1550701
8. Paramio Pérez G, Almagro BJ, Hernando Gómez Á, Aguaded Gómez JI. Validation of the eHealth Literacy Scale (eHEALS) in Spanish University Students. Rev Esp Salud Pública. 2015;89(3):329-338. https://doi.org/10.4321/S1135-57272015000300010
PMid:26388346
9. Nguyen TPT, Do AL, Do HN, Vu TMT, van Kessel R, Wong BLH, Boyer L, et al. Evidence of internal structure of the transactional eHealth literacy among Vietnamese youth: An instrument validation study. Front Public Health. 2023;11:1036877.  https://doi.org/10.3389/fpubh.2023.1036877 PMid:37033078 PMCid:PMC10079874
10. Nazarnia M, Zarei F, Rozbahani N. Development and psychometric properties of a tool to assess Media Health Literacy (MeHLit). BMC Public Health. 2022;22(1):14221.  https://doi.org/10.1186/s12889-022-14221-6 PMid:36180875 PMCid:PMC9525156
11. Navas-Echazarreta N, Juárez-Vela R, Martínez-Sabater A, Gea-Caballero V, Chover-Sierra E, Echaniz-Serrano E, et al. Psychometric properties of the Spanish version of the Media Health Literacy Questionnaire (MeHLit-SV). Front Public Health. 2024;12:1440386.  https://doi.org/10.3389/fpubh.2024.1440386 PMid:39381769 PMCid:PMC11458485
12. Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): Explanation and elaboration. Epidemiology. 2007;18(6):805-835.  https://doi.org/10.1097/EDE.0b013e3181577511 PMid:18049195 PMCid:PMC12161566
13. Li W, Zhang Y, Liang J, Yu H. Psychometric evaluation of the Chinese version of the Media Health Literacy Questionnaire: A validation study. Digit Health. 2023;9:20552076231203801.  https://doi.org/10.1177/20552076231203801 PMid:37766905 PMCid:PMC10521271
14. Levin-Zamir D, Bertschi I. Media health literacy, eHealth literacy, and the role of the social environment in context. Int J Environ Res Public Health. 2018;15(8):1643.  https://doi.org/10.3390/ijerph15081643 PMid:30081465 PMCid:PMC6121358
15. Kendir C, Breton E. Health literacy: From a property of individuals to one of communities. Int J Environ Res Public Health. 2020;17(5):1601.  https://doi.org/10.3390/ijerph17051601 PMid:32131441 PMCid:PMC7084319
16. Bonaccorsi G, Gallinoro V, Guida A, Morittu C, Ferro Allodola V, Lastrucci V, et al. Digital health literacy and information-seeking in the era of COVID-19: Gender differences emerged from a Florentine university experience. Int J Environ Res Public Health. 2023;20(3):2611https://doi.org/10.3390/ijerph20032611 PMid:36767976 PMCid:PMC9915269
17. Scheerder A, Van Deursen A, Van Dijk J. Determinants of Internet skills, uses and outcomes: A systematic review of the second- and third-level digital divide. Telemat Inform. 2017;34(8):1607-1624.  https://doi.org/10.1016/j.tele.2017.07.007
18. Jiao W, Chang A, Ho M, Lu Q, Liu MT, Schulz PJ. Predicting and empowering health for Generation Z by comparing health information seeking and digital health literacy: Cross-sectional questionnaire study. J Med Internet Res. 2023;25:e47595.  https://doi.org/10.2196/47595 PMid:37902832 PMCid:PMC10644182
19. Fry JM, Antoniades J, Temple JB, Osborne RH, Cheng C, Hwang K, Brijnath B. Health literacy and older adults: Findings from a national population-based survey. Health Promot J Austr. 2024;35(2):487-503.  https://doi.org/10.1002/hpja.779 PMid:37452578
20. Li W, Zheng X, Li R, Lin HC. Differentiating the associations of passive and active social media use with e-cigarette use among U.S. youth. Addict Behav. 2024;158:108121.  https://doi.org/10.1016/j.addbeh.2024.108121 PMid:39096628
21. Squires L, Peters A, Rohr L. Exploring critical media health literacy (CMHL) in the online classroom. J Media Lit Educ. 2023;15(1):58-71. https://doi.org/10.23860/JMLE-2023-15-1-5
22. Ishikawa H, Kiuchi T. Digital health literacy and trust in health information sources: A cross-sectional study. Patient Educ Couns. 2025;118:107997. https://doi.org/10.1016/j.pec.2024.107997
23. Stauch L, Baumann E, De Bock F, et al. Digital health literacy of children and adolescents and its association with health behaviors. J Med Internet Res. 2025;27:e69170.  https://doi.org/10.2196/69170 PMid:40324766 PMCid:PMC12089873
24. Ishikawa H, Miyawaki R, Kato M, Muilenburg JL, Tomar YA, Kawamura Y. Digital health literacy and trust in health information sources: A comparative study of university students in Japan, the United States, and India. SSM Popul Health. 2025;31:101844.  https://doi.org/10.1016/j.ssmph.2025.101844 PMid:40746760 PMCid:PMC12311546
25. Van Deursen AJ, Helsper EJ. Collateral benefits of Internet use: Explaining the diverse outcomes of engaging with the Internet. New Media Soc. 2018;20(7):2333-2351. https://doi.org/10.1177/1461444817715282 PMid:30581362 PMCid:PMC6256722
26. Hargittai E, Piper AM, Morris MR. From internet access to internet skills: Digital inequality among older adults. Univ Access Inf Soc. 2019;18:881-890. https://doi.org/10.1007/s10209-018-0617-5
27. Wamala Andersson S, Pisano Gonzalez M. Digital health literacy-a key factor in realizing the value of digital transformation in healthcare. Front Digit Health. 2025;7:1461342. https://doi.org/10.3389/fdgth.2025.1461342 PMid:40538571 PMCid:PMC121767
Journal of Health Literacy

Articles in Press, Accepted Manuscript
Available Online from 02 September 2026