EHealth Literacy and the eHealth Literacy Scale (eHEALS / eHEALS-R) was developed by Cameron Norman and Harvey Skinner with colleagues and originally published in 2006, with updates in 2025 and forthcoming (2027).
Read below to learn more about the concept of eHealth literacy, stay informed about the latest developments, and learn about how the concept is evolving and what it means for health.
To obtain the instrument or inquire, please contact Cameron Norman using this link.
Understanding eHealth Literacy
What is eHealth literacy?
Every day, people go online to look up symptoms, research a diagnosis, compare treatment options, message a care provider, or manage a chronic condition through an app. Doing this well takes a specific set of skills — not just knowing how to use a computer, but knowing how to find trustworthy health information online, understand it, judge whether it’s credible, and actually use it to make a health decision.
This skill set is called eHealth literacy. It was originally defined as the ability to seek, find, understand, and appraise health information from electronic sources, and to apply what’s learned to solving a health problem (Norman & Skinner, 2006a). In plain terms: it’s health literacy for the digital age.
Where the concept came from
The idea was introduced in 2006 by Cameron Norman and Harvey Skinner, based on their work with youth health promotion programs in the late 1990s and early 2000s (Norman, 2011). They noticed that succeeding with digital health tools required more than internet know-how — it also drew on traditional health literacy, reading and writing skills, media savvy, computer skills, and basic science literacy, all working together.
To capture this, they proposed the Lily Model, which pictures eHealth literacy growing out of six underlying literacies: traditional literacy, health literacy, information literacy, scientific literacy, media literacy, and computer literacy (Norman & Skinner, 2006a). No single skill is enough on its own — it’s the combination that lets someone navigate the online health environment effectively.
Measuring it: the eHEALS
Alongside the concept, Norman and Skinner developed a short, practical questionnaire called the eHealth Literacy Scale (eHEALS) — an 8-item, self-report tool that asks people to rate their own confidence and skill in finding, evaluating, and using online health information (Norman & Skinner, 2006b). It has since become one of the most widely used and translated instruments in the field, used in research and practice around the world.
Why it keeps evolving
The internet of 2006 — before smartphones, social media, and today’s wearables and health apps — looked very different from the internet now. In 2011, Norman revisited the concept to ask how social media and mobile technology were changing what “eHealth literacy” needed to include (Norman, 2011).
More recently, a 2025 update — eHealth Literacy 3.0 — proposed a further-expanded model and definition, describing eHealth literacy as the ability to engage with digital technologies in effective, safe, and helpful ways to achieve health goals (Milanti et al., 2025). This shift reflects today’s online environment: not just finding information, but doing so safely, filtering out misinformation, and engaging with a much wider range of digital tools than existed in 2006.
Why this matters
The stakes of eHealth literacy are practical and immediate:
- Access and equity. People with lower eHealth literacy are less able to benefit from digital health tools — a “digital divide” that can widen existing health inequities.
- Misinformation. The same skills that help someone find good information also help them recognize and avoid poor-quality or misleading content online.
- Patient engagement. As more care moves online — telehealth visits, patient portals, health apps — eHealth literacy increasingly shapes whether people can participate fully in their own care.
- Design and communication. Understanding eHealth literacy helps organizations build digital health tools and communications that meet people where their skills actually are, rather than assuming a level of digital fluency that not everyone has.
As healthcare continues to move online, understanding — and measuring — eHealth literacy remains essential to making sure digital health tools genuinely work for the people who use them.
References
Milanti, A., Norman, C., Chan, D. N. S., So, W. K. W., & Skinner, H. (2025). eHealth literacy 3.0: Updating the Norman and Skinner 2006 model. Journal of Medical Internet Research, 27, e70112. https://doi.org/10.2196/70112
Norman, C. D. (2011). eHealth literacy 2.0: Problems and opportunities with an evolving concept. Journal of Medical Internet Research, 13(4), e125. https://doi.org/10.2196/jmir.2035
Norman, C. D., & Skinner, H. A. (2006a). eHealth literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research, 8(2), e9. https://doi.org/10.2196/jmir.8.2.e9
Norman, C. D., & Skinner, H. A. (2006b). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4), e27. https://doi.org/10.2196/jmir.8.4.e27
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