Building Digital Literacy in Health: About a Hen, an Egg, and Why Usage Is Not Understanding

Abstract

Digital transformation in healthcare is often equated with the widespread use of digital tools such as apps, wearables, electronic health records, and artificial intelligence–based systems. In this narrative, patients and citizens are frequently framed as users of technology rather than as competent actors whose understanding, confidence, and judgment ultimately determine whether digital health solutions are trusted and effective. However, usage alone does not constitute digital literacy. This short commentary argues that meaningful participation in digital health requires a broader understanding that integrates health literacy, data literacy, and digital literacy into a coherent framework, explicitly centered on patients and citizens and their ability to act competently in digital health contexts. Drawing on insights from a session at the DigiHealthDayS-2025, this paper explores why awareness, trust, and a shared language are currently the weakest links in digital health transformation. Using the metaphor of the “hen and the egg”, we describe how patient- and citizen-led initiatives can close the circle from understanding data to building digital competence and confidently using digital tools. Reflections from audience discussions highlight persistent gaps in awareness and trust, despite high levels of access and usage. The commentary concludes that digital literacy must be understood as a shared societal responsibility and a prerequisite for sustainable digital health innovation, rather than as an optional add-on or individual skill.