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Improving digital health literacy in Europe

Periodic Reporting for period 2 - IC-Health (Improving digital health literacy in Europe)

Reporting period: 2017-11-01 to 2018-10-31

Citizens' digital health literacy is an essential element for successful eHealth deployment. However, citizens often do not have the necessary skills to find, understand and appraise online health information and apply their knowledge to make health decisions. Digitally health literate citizens are empowered to play a more active role in their health self-management, resulting in improved prevention, adherence to a healthier lifestyle and better health outcomes.

IC-Health provides supported for the improvement of digital health literacy in Europe. The project aimed at testing a new model of digital health literacy intervention development and application based on the co-creation of Massive Open Online Courses (MOOCs) to enhance EU citizens’ skills on how to search, understand and appraise online health information.

In particular, IC-Health designed 35 open access online courses (MOOCs), in eight different national languages, for five different population cohorts including children, adolescents, pregnant and lactating women, elderly and people affected or susceptible to be affected by type 1 and type 2 diabetes.

The identified population cohorts, along with health professionals, academics, educators and other practitioners, were organised in Communities of Practice (CoPs) and they were involved directly in the co-creation of the MOOCs' content and structure. Once the courses were designed, they were also tested by the members of the CoPs themselves and by other users reached through dissemination activities. MOOCs use and impact were also monitored and assessed in order to ensure their uptake and sustainability beyond the duration of the project.
The starting point of the project to prepare the ground for shaping and facilitating the co-creation of the 35 MOOCs were the activities implemented under WP1 – Analysis of population cohorts and current scenarios of digital health literacy (DHL). A review of key factors, drivers, barriers and trends on digital health literacy was conducted with the purpose of carrying out an analysis of the elements that affect digital health literacy and of identifying evidence-based digital health promoting factors. Secondly, for each project country (Belgium, Denmark, Germany, Italy, Netherlands, Spain, Sweden, United Kingdom) the profile of each target group’s levels of digital literacy (DL), health literacy (HL) and digital health literacy (DHL) was compiled (survey, focus groups, analysis of literature and secondary sources).

After the analysis of trends and scenarios on DHL and of IC-Health population cohorts, to pave the way for an effective co-creation process for MOOC development, the activities of WP2 – Co-creation methodology and tools were implemented. The aim was to lead to the establishment of 35 Communities of Practice (one per target group per project country) and to the effective implementation of face-to-face and online co-creation activities.

The activities for WP2 began with the drafting of a co-creation methodology aimed at guiding the co-creation process of the MOOCs with target groups, experts and other relevant stakeholders in project countries. Based on this, national coordinators were provided with theoretical and practical training on the co-creation methodology and the steps to be followed to implement it efficiently. Once the national coordinators were trained, representatives of IC-Health target groups were recruited in eight EU countries (Spain, Belgium, Italy, United Kingdom, Denmark, Germany, Netherlands, Sweden) and organised in Communities of Practice along with health professionals, educators, academics and other practitioners and involved in the co-creation and use of the MOOCs. Their involvement took place both offline and online through a community web-based platform (URL: This platform is accessible upon registration, and individuals recruited for the Communities of Practice have been invited to register as part of the activities they consent to participate, together with other individuals interested in taking part in project online co-creation.

The tasks implemented under WP1 and WP2 were pivotal for the start of WP3 – Co-creation and MOOC development, which in fact relates with co-creation activities, development, use and fine-tuning of the MOOCs and their evaluation and impact assessment. Partners responsible for co-creation at national level drafted their strategy for carrying out offline and online co-creation, they set their calendar for face-to-face co-creation sessions and then launched offline and online co-creation starting from October 2017 until April 2018. The output of the co-creation process was the development of 35 MOOCs on Moodle Platform (URL: The following phase related with extending the testing of the courses by additional users for further fine-tuning of the MOOCs, whose final version was released at the end of the project (October 2018).

In parallel to WP3 activities, measures for exploitation and sustainability of project results and MOOCs were put in place under WP4. Business models and a tailored methodology for stakeholders' engagement were developed and their outcomes fed a dedicated sustainability strategy for MOOCs further dissemination and exploitation.
The overall aim of the project was the improvement of digital health literacy of citizens in Europe by increasing awareness of the opportunities of eHealth tools and by empowering them with enhanced skills on how to use ICT for health related purposes.

Within the framework of IC-Health, a survey was launched across the 8 project countries, collecting a total of 1704 surveys, among those 924 from adult cohorts and 780 from minor cohorts. Besides this, the major impact has been obtained by co-creating and delivering 35 MOOCs in 8 different languages for 5 different population cohorts, which are free and easily accessible on Moodle and which will be maintained for 24 months more after the end of the project. The partnership involved 731 people - representatives of project target groups and experts - in the co-creation of 35 MOOCs. The developed MOOCs were tested in their integrity by 763 people, including both CoP members and other users reached through dissemination activities and partners’ efforts.

In terms of usability of the MOOC system and generating a feeling of empowerment and improving the health self-management of the course learners, the feedback from the users highlight a good level of satisfaction. In terms of the co-creation experience the results show that this was also generally a positive experience for the majority of participants. Also, national coordinators generally expressed a feeling of vibrancy among participants during the co-creation meetings and activities. The effectiveness of the MOOCs in building digital health literacy related capacities (find, understand, apply and appraise) in the learner is reflected in both the assessment of the co-creation process and of the use of the MOOCs. In conclusion, the experience of the co-creation process, MOOC development and data collection and analysis across 8 countries has been largely positive. This has not been without challenge, and one of the most significant challenges (but at the same time added value) has been the management of this process across a diverse range of multi-disciplinary and multi-lingual cohorts.
10th IUHPE European Conference and International Forum for health Promotion Research
Face-to-face co-creation activities with CoP members in Belgium
National Coordinations simulating co-creation sessions during the co-creation training seminar
Face-to-face co-creation activities with CoP members in Sweden
IC-Health presented at EHMA 2017 Annual Conference
Face-to-face co-creation activities with CoP members in Germany
Face-to-face co-creation activities with CoP members in Spain and UK
Face-to-face co-creation activities with CoP members in Denmark
Face-to-face co-creation activities with CoP members in in Netherlands
IC-Health presented at eHealth Forum 2017 in Athens
IC-Health presented at eHealth Tallinn 2017 and ScanBalt Forum 2017
10th European Public Health Conference
IC-Health presented at ISPAD 2017
Face-to-face co-creation activities with CoP members in Italy