PhD Oral Exam - Comfort Titilope Akinfenwa, Health and Exercise Science

When studying for a doctoral degree (PhD), candidates submit a thesis that provides a critical review of the current state of knowledge of the thesis subject as well as the student’s own contributions to the subject. The distinguishing criterion of doctoral graduate research is a significant and original contribution to knowledge.

Once accepted, the candidate presents the thesis orally. This oral exam is open to the public.

Abstract

This thesis aimed to redefine eHealth literacy for contemporary digital health environments by examining the evolution of its conceptual foundations, evaluating existing measurement approaches, and establishing expert consensus on its core components. Three studies were conducted. Study 1: A scoping review was conducted to examine the evolution of eHealth literacy definitions from 2000 to 2025. Definitions were extracted, compared, and synthesised using thematic analysis, to identify key conceptual domains and changes over time. Study 2: Drawing on the same scoping review search, eHealth literacy measurement instruments were mapped against the domains identified in study 1 and their reported psychometric properties were charted using the COSMIN taxonomy. Study 3: A multi-round Delphi study was conducted with international experts in digital health, health literacy, health informatics, research, and other knowledge users, to achieve consensus on the essential domains and components required to define contemporary eHealth literacy. Participants rated the importance of proposed elements and provided iterative feedback until consensus was reached.

Study 1 identified 15 definitions sharing four recurring domains: knowledge, skill, context, and purpose. Definitions accumulated around a core of knowledge and skill; context appeared from 2014, but definitions remained divided on whether it is part of eHealth literacy or an influence on it. Study 2 identified 34 instruments. Measurement had broadened from the single-score eHEALS towards multidimensional instruments, but 82% relied solely on self-report, capturing perceived rather than demonstrated ability. Context was measured narrowly, and evidence on measurement error and responsiveness was absent. Study 3 produced a consensus definition based on a definitional framework comprising three domains and six subdomains: Knowledge (Health Knowledge; Knowledge of Digital Ecosystem), Skill (Critical Thinking, Technical, Cognitive, and Health Application Skills), and Context. The panel judged perceived competence and purpose to be influences on eHealth literacy rather than components of it.

This thesis provides a consensus-based definition of eHealth literacy suited to increasingly digital and algorithmic health environments. It elevates context to a core domain and identifies the gap between what eHealth literacy comprises and what existing instruments measure, setting a baseline for developing instruments that assess demonstrated ability and capture context.