Health literacy and digital health service use among community residents in Taiwan: implications from a pilot assessment using the HLS-SF12

Health literacy influences individuals’ ability to prevent illness, manage chronic conditions, and effectively use digital health tools. Validated measurement tools and evidence remain limited for aging Asian populations. This study assessed the psychometric properties of the 12-item Short-Form Health Literacy Scale (HLS-SF12) and examined sociodemographic and behavioral factors associated with health literacy among community residents in Taiwan. This cross-sectional study included 365 adults recruited from community health centers across Taiwan between September 25, 2024, and May 27, 2025. Participants completed the 12-item Short-Form Health Literacy Scale (HLS-SF12) and provided sociodemographic and behavioral information. Internal consistency and construct validity were assessed using Cronbach’s α, the Kaiser–Meyer–Olkin (KMO) index, and Bartlett’s test of sphericity. Group differences were analyzed with t-tests and χ² tests, and logistic regression was performed to examine factors independently associated with low health literacy in this cross-sectional sample. Ethical approval was obtained from the Institutional Review Board of Tainan Municipal Hospital (IRB No. 1140403). The HLS-SF12 demonstrated excellent internal consistency (Cronbach’s α = 0.920). KMO (0.928) and Bartlett’s test (p < 0.001) indicated that the data were suitable for exploratory factor analysis, which was exploratory and sample-specific. Hypertension was the most common chronic condition, and the prevalence of multimorbidity was significantly higher among participants living in southern regions (p = 0.014). Lower scores were observed in areas such as evaluating treatment options, understanding vaccination requirements, and accessing mental health information. Lack of regular medical visits was associated with higher odds of low health literacy in this cross-sectional analysis (adjusted OR = 4.5; 95% CI, 1.2–16.1), without implying causality. The HLS-SF12 appears to be a reliable and valid tool for assessing health literacy in community-based research. Findings highlight gaps in digital and mental health literacy among Taiwanese adults and underscore the need for region-specific, digitally inclusive interventions. These results may also inform research and interventions in other aging, technology-dependent health systems. Establishes health literacy as the foundation of preventive medicine, emphasizing its vital role in shaping individuals’ ability to make informed health decisions and participate in disease prevention activities. Confirms the 12-item Short-Form Health Literacy Scale (HLS-SF12) as a dependable and psychometrically sound tool for measuring health literacy among community-dwelling adults in Taiwan. Highlights regional differences in sociodemographics, chronic disease rates, and digital health usage, emphasizing the need for targeted, community-focused solutions. Identifies key areas of low performance—including evaluating treatment options, understanding vaccination requirements, and accessing mental health information—that require targeted educational strategies. Shows that missing regular medical visits significantly predict low health literacy, emphasizing the need to increase healthcare engagement in population prevention efforts.