Digital Health Information Use and Trust in Language-Related Health Literacy Disparities: Evidence from South Tyrol, Italy (Preprint)

BACKGROUND Health literacy (HL) is a crucial determinant of population health; however, disparities per-sist in multilingual settings. In South Tyrol, Italy, where German- and Italian-speaking populations coexist within a unified healthcare system, HL disparities may reflect differ-ences in language, culture, and digital engagement. OBJECTIVE This study investigated whether the utilization of digital health information mediates the relationship between language group and HL and examined informational trust and other sociodemographic factors as HL covariates. METHODS Data were obtained from a population-based survey conducted in South Tyrol, Italy. The analytical sample comprised 1,500 participants with adequate responses to the 16-item Eu-ropean Health Literacy Survey (HLS-EU-Q16) and identified the language group. Media-tion analysis was performed using PROCESS Model 4 (5,000 bootstrap samples), with digital health information use as the mediator, language group as the predictor, and HL as the outcome. Covariates included age, gender, education, self-rated health, mistrust in pro-fessional sources, and trust in health information on the Internet. RESULTS Italian-speaking participants exhibited significantly higher HL scores and more frequent use of digital health information than German-speaking participants. However, digital health information use did not significantly mediate the association between language groups and HL. Digital health information use was inversely correlated with HL in the bivariate anal-yses but was excluded from the multivariate model due to collinearity with online trust. In the multivariable analysis, trust in professional health information was positively associated with HL, whereas trust in Internet health information was negatively associated with HL. CONCLUSIONS Although digital engagement and online trust are related to HL, they do not explain the per-sistent language-based disparities in HL observed in South Tyrol. Public health strategies should prioritize strengthening critical appraisal skills and fostering trust in professional health information sources, alongside improving digital access, to effectively address HL inequalities in multilingual populations.