title: Low health literacy and evaluation of online health information: a systematic review of the literature.
abstract: BACKGROUND
  Recent years have witnessed a dramatic increase in consumer online health information seeking. The quality of online health information, however, remains questionable. The issue of information evaluation has become a hot topic, leading to the development of guidelines and checklists to design high-quality online health information. However, little attention has been devoted to how consumers, in particular people with low health literacy, evaluate online health information.
  
  
  OBJECTIVE
  The main aim of this study was to review existing evidence on the association between low health literacy and (1) people's ability to evaluate online health information, (2) perceived quality of online health information, (3) trust in online health information, and (4) use of evaluation criteria for online health information.
  
  
  METHODS
  Five academic databases (MEDLINE, PsycINFO, Web of Science, CINAHL, and Communication and Mass-media Complete) were systematically searched. We included peer-reviewed publications investigating differences in the evaluation of online information between people with different health literacy levels.
  
  
  RESULTS
  After abstract and full-text screening, 38 articles were included in the review. Only four studies investigated the specific role of low health literacy in the evaluation of online health information. The other studies examined the association between educational level or other skills-based proxies for health literacy, such as general literacy, and outcomes. Results indicate that low health literacy (and related skills) are negatively related to the ability to evaluate online health information and trust in online health information. Evidence on the association with perceived quality of online health information and use of evaluation criteria is inconclusive.
  
  
  CONCLUSIONS
  The findings indicate that low health literacy (and related skills) play a role in the evaluation of online health information. This topic is therefore worth more scholarly attention. Based on the results of this review, future research in this field should (1) specifically focus on health literacy, (2) devote more attention to the identification of the different criteria people use to evaluate online health information, (3) develop shared definitions and measures for the most commonly used outcomes in the field of evaluation of online health information, and (4) assess the relationship between the different evaluative dimensions and the role played by health literacy in shaping their interplay.
authors.affiliation: Amsterdam School of Communication Research / ASCoR, Department of Communication Science, University of Amsterdam, Amsterdam, Netherlands. N.Diviani@uva.nl.
authors.forename: Nicola
authors.identifier: http://orcid.org/0000-0002-1386-9915
authors.initials: N
authors.lastname: Diviani
authors.forename: Bas
authors.identifier: http://orcid.org/0000-0002-3635-6880
authors.initials: B
authors.lastname: van den Putte
authors.forename: Stefano
authors.identifier: http://orcid.org/0000-0001-5983-2790
authors.initials: S
authors.lastname: Giani
authors.forename: Julia Cm
authors.identifier: http://orcid.org/0000-0002-2259-5864
authors.initials: JC
authors.lastname: van Weert
mesh_terms: D054626:Consumer Health Information; D057220:Health Literacy; D006801:Humans; D057226:Information Seeking Behavior; D020407:Internet; D035502:Trust
keywords: health information seeking; health literacy; information quality; online health information