According to An Integrative Review on The Impact of Digital Health Literacy on Patient Adherence, Self-Management, and Follow-up Care, “digital health technologies have become integral to health care delivery, yet significant disparities continue to undermine equitable access and effectiveness.”
These disparities are structured by differences in access, skills, and confidence in using digital tools. Central to this challenge is digital health literacy (DHL). The review defines DHL as a factor shaping patient engagement and health outcomes.
It reports that “approximately 16% of adults in the United States lack basic digital health literacy (DHL) skills,” with barriers falling most heavily on “older adults, low-income individuals, and minoritized communities.” These gaps complicate efforts to use telehealth and digital communication as solutions to health inequities. Consequently, digital systems may unintentionally worsen health inequities unless literacy and access are addressed directly.
Digital health literacy includes the capacity to find, understand, and use health information delivered through electronic systems. Moreover, the integrative review found that “Higher DHL was consistently associated with improved patient behaviors, enhanced self-management, including better medication adherence, and improved telehealth engagement.” Patients who understood how to use portals, navigate applications, and interpret digital instructions were more likely to follow care plans and participate in virtual visits.
Additionally, “patients with higher DHL reported greater confidence using digital tools and satisfaction with virtual care.” In this sense, Confidence and satisfaction determine whether individuals continue using digital services or disengage after a single negative experience.
Ultimately, DHL acts as a mediator between technological availability and actual use.
“Disparities remain entrenched,” the authors note, with “older adults, rural populations, and individuals with lower incomes” facing the most barriers to effective telehealth participation.
These disparities are associated with a lack of devices, broadband internet, and educational opportunities. So, while telehealth may remove geographic barriers to care, it introduces new technical and cognitive demands. Without targeted support, these demands could disproportionately affect those already facing structural disadvantage. Telehealth usage data reinforce this, with uneven uptake by age, income, and race.
Digital tools can only improve outcomes if patients can use them effectively, influencing adherence and engagement. As evidenced by the integrative review, “DHL is a key determinant of equitable telehealth participation and patient outcomes.”
Patients often receive appointment reminders, test result notifications, and follow-up via email. However, when these emails contain protected health information (PHI), they must be secured during transmission and at rest to uphold HIPAA regulations.
More specifically, HIPAA compliant email solutions, like Paubox, are a regulated method for transmitting PHI and preserving patient privacy. It uses a patented encryption to safeguard these messages, while easily integrating with commonly used email platforms, like Gmail.
Paubox email maintains accessibility without users having to navigate inconvenient patient portals. It, therefore, reinforces care continuity through structured, readable follow-up messages that patients can revisit at their own pace. For patients with higher DHL, such communication may reinforce “improved patient behaviors” and “better medication adherence.”
For those with lower DHL, well-written email communication that’s free of medical or technical jargon can gradually increase familiarity with digital tools in lower-pressure contexts than live telehealth visits. HIPAA compliant emails can also be tailored with educational content.
For example, providers can send simplified instructions, links to tutorials, or reminders that are consistent with privacy regulations. In this way, HIPAA compliant email can operate as an intermediate step between traditional paper-based communication and full telehealth participation.
The review argues that “integrating DHL assessment and training into routine health care delivery [reduces] disparities and advancing health equity.” DHL assessments can take many forms, including:
Furthermore, community partnerships, such as collaborations with libraries or senior centers, may extend these efforts outside of clinical settings. The review also suggests that skills can improve over time with repeated exposure and structured guidance. Patients who initially struggle with telehealth may become confident users if supported appropriately.
Learn more: A guide to HIPAA compliant online forms
At the policy level, DHL intersects with infrastructure investment and regulatory frameworks. The World Health Organization’s Global Strategy on digital health 2020–2025 includes equitable access as a core objective. Yet access alone does not guarantee use. Literacy mediates the relationship between availability and benefit.
Its strategy states that “digital health should be an integral part of health priorities and benefit people in a way that is ethical, safe, secure, reliable, equitable and sustainable.” The strategy also aims “to improve health for everyone, everywhere by accelerating the development and adoption of appropriate, accessible, affordable, scalable and sustainable person-centric digital health solutions.”
Providers who use HIPAA compliant email for patient communication directly support these principles, including “transparency, accessibility, scalability, replicability, interoperability, privacy, security, and confidentiality.” These principles directly intersect with the concept of DHL, as systems that are not transparent or accessible are more difficult for patients with limited technical skills to use.
The WHO vision also encourages patient-centered care, where patients are active participants rather than passive recipients of digital health services. In this framework, digital health literacy becomes a prerequisite for realizing person-centric care, as patients must be able to understand and use the tools.
Ultimately, digital health services are only effective if it “enhances the efficiency and sustainability of health systems in delivering quality, affordable and equitable care.”
According to the WHO strategy, digital health services must respect “the privacy and security of patient health information.” It further states that “health data are to be classified as sensitive personal data, or personally identifiable information, that requires a high safety and security standard.”
HIPAA compliant email directly supports this principle, as part of ethical digital engagement. The secure system protects data and contributes to patient trust, encouraging patient participation in digital care.
The WHO also acknowledges that digital health can improve outcomes only if it is “supported by sufficient investment in governance, institutional and workforce capacity to enable the changes in digital systems and data use training, planning, and management.” As such, healthcare organizations must encourage DHL to be integrated into routine care delivery, training patients and providers as needed.
For example, healthcare organizations can send HIPAA compliant emails encouraging providers to use digital health tools for remote monitoring and communication, while also providing training sessions on how to effectively use these tools.
The strategy calls for “an interoperable digital health ecosystem” that allows “the seamless and secure exchange of health data by and between users, health care providers, health systems managers, and health data services.” It further states that data sharing should occur “with the patient’s consent, when undertaken in a manner that is built on trust, protects patient privacy, secures digital systems, and protects against malign or inappropriate use.”
HIPAA compliant emails can facilitate this data sharing while maintaining patient privacy and security. It maintains interoperability and data sharing in digital health systems, so healthcare providers can improve care coordination, patient outcomes, and overall efficiency in delivering healthcare services.
The WHO links digital health directly to long-term public health goals. The strategy aims to achieve “universal health coverage and the health-related Sustainable Development Goals.”
More specifically, providers can use HIPAA compliant emails to send targeted messages that support preventive care and chronic disease management. For example, clinics can send secure reminders for immunizations, cancer screenings, or follow-up laboratory tests, helping patients adhere to recommended care pathways that contribute to population-level health outcomes.
Such messages may include simplified explanations of test results or links to trusted educational resources, reinforcing the WHO’s goal of strengthening “health promotion, disease prevention, diagnosis, management, rehabilitation and palliative care.”
HIPAA compliance refers to adhering to regulations outlined in the Health Insurance Portability and Accountability Act to safeguard patients’ protected health information (PHI).
Providers can use HIPAA compliant emails to send sensitive health information, like patient education materials, appointment reminders, treatment plans, and other medical communications.
Yes, healthcare organizations can customize HIPAA compliant emails to support specific language needs by sending educational materials in multiple languages to cater to diverse patient populations.
Read more: Using HIPAA compliant emails for multi-language patient education