Digital health engagement and health literacy among cancer patients: a cross-sectional study of ICT usage patterns

The integration of digital health technologies into oncology care has accelerated dramatically, yet the relationship between technology access and health literacy remains insufficiently characterized. This study examined information and communication technology (ICT) usage patterns and health literacy levels among cancer patients receiving active treatment, investigating whether a gap exists between technology ownership and meaningful digital health engagement. We hypothesized that higher health literacy levels would be associated with increased ICT utilization for health information seeking. We conducted a cross-sectional study of 267 cancer patients at Marmara University Medical Oncology Clinic between January and September 2025. Participants completed a comprehensive 28-item questionnaire assessing sociodemographic characteristics, ICT usage patterns, and attitudes toward digital health applications. Health literacy was measured using the validated Turkish Health Literacy Scale-32 (TSOY-32). Statistical analyses included ANOVA for continuous variables and chi-square tests for categorical variables, with significance set at p < 0.05. The mean age of participants was 53.01 ± 13.60 years, with 64.8% female and 80.8% married. Despite high smartphone ownership (91.6%), limited health literacy was prevalent, with 68.6% of patients classified as having inadequate (31.5%) or problematic-limited (37.1%) health literacy. Healthcare professionals remained the primary information source (50% always consulted), followed by the internet (33.5% regular users). Significant associations emerged between health literacy levels and ICT usage patterns, including internet use for health information ( p < 0.001), mobile application use ( p = 0.002), and medication research frequency ( p = 0.031). Notably, 93.2% of patients expressed willingness to use health applications if recommended by their physician, yet only 51.4% currently had health-related applications installed, and merely 22% would definitely pay for such applications. This study reveals a critical digital health gap in cancer care: while technology access is nearly universal, limited health literacy creates substantial differences in digital health engagement patterns. The strong influence of physician recommendations on application adoption suggests that healthcare provider-endorsed, integrated digital health solutions may be more effective than consumer-market applications. Our findings underscore the important consideration for health literacy-informed design of digital health interventions and systematic integration of these tools into oncology practice. Future digital health strategies should consider not only technological access but also the capacity to critically evaluate and effectively utilize digital health information. Not applicable.