Bridging the Digital Prevention Gap: A Systematic Literature Review of Digital Health Literacy and Preventive Health Behaviors in Low-Income Communities.

Digital health literacy is increasingly central to preventive healthcare, particularly in low-income and socioeconomically vulnerable communities where limited internet access, lower health literacy, and digital exclusion may restrict engagement with prevention services. Although digital health tools are expanding, evidence remains fragmented on how digital health literacy is associated with preventive behaviors in disadvantaged populations. This systematic literature review examined the association between digital health literacy and preventive health behaviors, including COVID-19 prevention, vaccination intention, online health information seeking, screening-related decision support, and chronic disease self-management. A structured search of electronic databases was conducted using terms related to digital health literacy, eHealth literacy, preventive health behavior, socioeconomic vulnerability, and the digital divide. Eligible primary studies assessed digital or eHealth literacy or online health information-related skills and reported prevention-related outcomes. One measurement-support study was retained only to contextualize the digital health literacy assessment and was not included in the preventive outcome synthesis. Findings were synthesized narratively because of heterogeneity in study design, populations, measures, and outcomes. Higher digital health literacy was generally associated with better prevention-related outcomes, especially COVID-19 preventive behaviors, vaccination intention, and online health information use. Education, income, internet access, computer literacy, employment, and general health literacy repeatedly influenced digital health literacy. The evidence also suggested that vulnerable users can benefit from digital prevention tools when interventions include accessible design, low-literacy content, privacy safeguards, and user support. The digital prevention gap is multidimensional, reflecting both individual skill differences and structural barriers. Strengthening digital health literacy should be treated as a core strategy for equitable prevention, not merely as a technology-access issue.