Digital exclusion, functional health literacy, and COVID-19 vaccination in later life: Evidence from 30,801 older adults across Europe

OBJECTIVES: Functional health literacy (HL), the ability to read and act on health information, is crucial for making informed decisions. Yet, few studies have specifically examined how it relates to COVID-19 vaccination behavior among older adults, particularly in conjunction with digital access. This study investigates the association between functional HL and COVID-19 vaccination uptake among older adults across Europe and explores whether this association is moderated by internet use. STUDY DESIGN: Observational prospective study. METHODS: Data from 30,801 respondents aged 50 and older were drawn from Wave 8 (2019/2020) and the second COVID-19 questionnaire (2021) of SHARE, covering 27 countries. Functional HL was assessed using the Single-Item Literacy Screener. COVID-19 vaccination status and internet use were self-reported. Probit regression models, adjusted for individual- and country-level factors, tested the association and included HL × internet use interaction terms to assess moderation. RESULTS: Overall, 27 % of respondents reported at least sometimes needing help reading health information, 54 % reported using the internet, and 80 % were vaccinated against COVID-19. Lower HL was significantly associated with a lower likelihood of being vaccinated (AME = -0.02, p < 0.001). A significant interaction between HL and internet use (p < 0.001) indicated that the association between HL and vaccination was stronger among non-users of the internet. CONCLUSIONS: Lower functional HL is associated with decreased COVID-19 vaccination uptake among older adults, particularly among those who do not use the internet. Public health interventions should address both HL and digital access to reduce inequalities in vaccination uptake among older populations.