Advances in digital technology have led to the development of various digital health tools, from online health magazines to real‑time remote patient monitoring via mobile apps and telemedicine. These innovations support health promotion, disease prevention and management, and patient empowerment. Moreover, recent breakthroughs in artificial intelligence (AI) across multiple healthcare domains promise even better outcomes. Thus, digital interventions have emerged as powerful means to improve health and broaden access to care [1,2].

Gender inequities in health reflect systematic differences in outcomes and access based on gender. Although medical technologies and healthcare services have grown substantially over the past century, significant disparities persist. Women generally live longer than men but spend fewer years in good health and experience higher rates of physical and mental illness and disability [3]. Furthermore, intersecting vulnerabilities, such as socioeconomic status, race, and geographic location, compound power imbalances, resource gaps, and social norms that exacerbate these inequities [4]. Digital health interventions leveraging various tools thus hold promise for addressing gender‑based health disparities [2].

Digital health technologies offer a wide range of solutions to address women’s unique health needs, including menstrual health, fertility, pregnancy, childbirth, postpartum care, and sex-specific diseases such as breast cancer and cervical cancer [5]. These tools help women manage their health, access care, and stay informed, especially in areas where traditional healthcare is hard to reach. In a recent report, the World Health Organization recognized the potential of digital health technologies to improve women’s health [2], noting that digital literacy can empower women to overcome traditional barriers and narrow gender‑based health gaps [2]. However, many women, particularly those from marginalized groups, are excluded from digital health technologies due to multiple intersecting factors including limited access to technology and lower digital health literacy (DHL). These barriers may hinder the effectiveness of digital health technologies in closing the gender health gap [2]. Therefore, well-designed digital health interventions that improve women’s capacity to effectively use digital health technology can benefit women’s health, whereas poorly designed or reckless digital health interventions risk widening existing gender health disparities.

This paper treats DHL as a critical design element for equitable digital health interventions that advance gender equity in health. First, it outlines the current digital gender divides and the role of DHL in digital health initiatives. Then, it proposes strategies to enhance intervention effectiveness by integrating DHL considerations and promoting gender‑equitable outcomes.

Despite rapid technological advances, gender gaps in both access to and skills for using digital technology persist worldwide. In 2023, 70% of men globally had internet access compared with 65% of women—a disparity most pronounced in the least developed countries. In high‑income nations, usage rates are nearly equal (94% of men vs. 93% of women), but in low‑income countries, only 34% of men and 20% of women go online [6]. Although smartphone and mobile internet adoption in low‑ and middle‑income countries has improved, women still lag behind men in device ownership and mobile data use [7,8].

Importantly, disparities in digital technology usage exceed those in mere access. Having connectivity does not guarantee sufficient digital skills: women are less likely than men to possess adequate digital literacy [8,9]. This skills gap is widest in low‑income countries [9] and persists even in high‑income nations where access is comparable [10,11]. Moreover, proficiency declines with age: a German study found no literacy gap among children, yet one appeared in upper secondary education and endured into adulthood [12]. Nevertheless, younger cohorts also face divides, driven in part by cultural and structural barriers to education that contribute to broader health inequities [4,9].

Digital literacy has become an essential capacity in our increasingly digital society. The United Nations Educational, Scientific and Cultural Organization defines digital literacy as “the confident and critical use of a full range of digital technologies for information, communication and basic problem-solving in all aspects of life” [13]. This concept encompasses both technical and cognitive skills, enabling individuals to effectively find, evaluate, create, and communicate information using digital platforms [14].

DHL, also known as electronic health (eHealth) literacy, is defined as “the ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem” [15]. Although “digital health” now encompasses eHealth, mobile health (mHealth), internet of things (IoT), big data, AI, robotics, and more [1,16], the terms “eHealth literacy” and “DHL” denote the same core competencies for engaging with electronic health technologies [17]. They are therefore used interchangeably.

Several frameworks have been developed to conceptualize DHL. Norman and Skinner [15] describe it as comprising analytic literacies (traditional, media, and information) and context‑specific literacies (computer, health, and scientific)—six literacies essential for digital health engagement. Norgaard et al. [18] proposed seven core competencies of DHL at the individual level (ability to process information and engage in one’s own health), system level (access to systems that work and digital services that suit individual needs), and interaction between the two levels (ability to engage actively with digital services, feeling safe and in control, and motivation to engage with digital services). The transactional model of eHealth Literacy operationalizes these competencies through four literacies: functional, communicative, critical, and translational [19]. Ban et al. [17], based on a systematic review of 32 studies, defined DHL as “the ability to convert knowledge into practical actions by processing, communicating and utilizing health information from digital platforms, while continually regulating the knowledge translation process aligned with one’s health goals.” They identified functional literacy, experience with one’s health, and access to technology as antecedents of DHL [17]. Although each framework blends digital and health literacies, DHL extends beyond their sum: it requires proficiency in navigating digital interfaces, assessing online content credibility, and employing digital health tools [15,17,18]. Notably, the additional skills demanded by DHL may not be present even among individuals with high health literacy [20,21].

Digital health interventions require participants to use digital technologies to find information or manage their health. In other words, digital health interventions assume participants have a certain level of DHL—unless the intervention specifically aims to improve it. Yet participants’ DHL can vary widely, and not everyone meets the required threshold. Interventions that require extensive interaction—such as searching for or interpreting health information via digital tools—demand higher DHL. In contrast, those focusing on simple behavior tracking via digital devices require less interaction and may suit individuals with lower DHL. However, even these interventions still require participants to understand and apply digital health data (for example, sensor readings) to their health management. Consequently, intervention effectiveness can differ based on participants’ DHL, and neglecting DHL in design and implementation may lead to negative consequences.

Because low DHL often overlaps with poor health status—and women are disproportionately represented among those with low DHL—interventions that serve only digitally literate individuals risk perpetuating or widening gender health disparities. Thus, while expanding access to digital technologies is important, digital health interventions must also address DHL to ensure equitable benefits and harness digital health’s potential to reduce gender health disparities [2]. The following strategies can help integrate DHL effectively.

As digital tools become increasingly prevalent, digital skills, access to digital services, and DHL are recognized as “super social determinants of health” because they profoundly influence all other determinants [30]. While digital health interventions have the potential to narrow gender health gaps, they can also widen them if DHL is overlooked. Considering DHL in digital health interventions is thus a key strategy for maximizing benefits and minimizing risks.

Incorporating DHL into digital health interventions requires collaboration across government agencies, private institutions, and researchers. Government initiatives are vital to ensure that advancements in digital health technology do not exclude women, especially those with low DHL [1]. National digital health strategies should include measures to expand digital infrastructure and improve DHL at the population level. Integrating DHL education into public curricula and continuing education ensures lifelong benefits for both women and men. Public health professionals also need DHL training to enhance their competencies and understand the effects of variable DHL among patients. Moreover, governments, in collaboration with stakeholders, should develop guidelines for incorporating DHL into digital health interventions. Ongoing attention and effort are necessary to ensure that varying DHL levels do not become barriers to participation and engagement, thereby allowing all individuals to reap the health benefits of digital interventions.