Digital health interventions for people with low health literacy: An international trial of web-based materials to promote physical activity amongst people with type-2 diabetes

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The problem

Little is known about how people with lower levels of health literacy engage with web-based health behaviour change interventions and there are important unanswered questions about how best to meet the needs of this population. This international study aimed to address these by developing and testing a web-based intervention to promote motivational determinants of physical activity in people with Type 2 diabetes. Our objective was to determine whether audio-visual presentation and interactivity (quizzes, planners, tailoring) could overcome the ‘digital divide' by making digital interventions accessible and effective for people with all levels of health literacy.

The approach

Participants from UK, Ireland, Germany, Austria, and Taiwan were randomised to either an interactive or static version of the intervention. Measures were: intervention usage (objectively recorded); health literacy level; enablement; satisfaction; and attitudes, perceived ability to carry out physical activity and intentions towards physical activity (based on the Theory of Planned Behaviour).


To date, 791 people with Type 2 diabetes have taken part (trial ends March 2015). Initial analyses of the UK data (n = 312) suggests that primary care patients with low health literacy spend significantly longer on the intervention website, but there is no difference between participants with high and low levels of health literacy in terms of reported satisfaction or enablement. These preliminary findings will be tested in the international data.


Early data provides encouraging indications that it is possible to design a digital intervention that is valued by people with all levels of health literacy.


  • Ingrid Muller, University Coolege London, London, UK
  • Ali Rowsell, University Coolege London, London, UK
  • Elizabeth Murray, Ludwig Boltzmann Institute, Vienna, Austria
  • Paul Little, University Coolege London, London, UK
  • Kristin Ganahl, University of Dresden, Dresden, Germany
  • Gabriele Mueller, University College Dublin, Dublin, Ireland
  • Sarah Gibney, Taipei Medical University, Taipei, Taiwan
  • Peter Chang
  • Don Nutbeam, University Coolege London, London, UK
  • Lucy Yardley, University Coolege London, London, UK