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2011 - Internet skills performance tests: are people ready for eHealth?


Van Deursen, A.J.A.M. & Van Dijk, J.A.G.M. (2011). Internet skills performance tests: are people ready for eHealth? Journal of medical internet research, 13(2), e35.



Background: Despite the amount of online health information, there are several barriers that limit the Internet’s adoption as a
source of health information. One of these barriers is highlighted in conceptualizations of the digital divide which include the
differential possession of Internet skills, or “eHealth literacy”. Most measures of Internet skills among populations at large use
self-assessments. The research discussed here applies a multifaceted definition of Internet skills and uses actual performance
Objective: The purpose of this study was to assess how ready a sample of the general population is for eHealth. More specifically,
four types of Internet skills were measured in a performance test in which subjects had to complete health-related assignments
on the Internet.
Methods: From November 1, 2009, through February 28, 2010, 88 subjects participated in the study. Subjects were randomly
selected from a telephone directory. A selective quota sample was used divided over equal subsamples of gender, age, and
education. Each subject had to accomplish assignments on the Internet. The Internet skills accounted for were categorized as
operational (basic skills to use the Internet), formal (navigation and orientation), information (finding information), and strategic
(using the information for personal benefits). The tests took approximately 1.5 hours and were conducted in a University office,
making the setting equally new for all. Successful completion and time spent on the assignments—the two main outcomes—were
directly measured by the test leader.
Results: The subjects successfully completed an average of 73% (5.8/8) of the operational Internet skill tasks and an average
of 73% (2.9/4) of the formal Internet skill tasks. Of the information Internet skills tasks, an average of 50% (1.5/3) was completed
successfully and, of the strategic Internet skills tasks, 35% (0.7/2). Only 28% (25/88) of the subjects were able to successfully
complete all operational skills tasks, 39% (34/88) all formal skills tasks, 13% (11/88) all information skills tasks, and 20% (18/88)
both the strategic skill tasks. The time spent on the assignments varied substantially. Age and education were the most important
contributors to the operational and formal Internet skills. Regarding the formal Internet skills, years of Internet experience also
had some influence. Educational level of attainment was the most important contributor to the information and strategic Internet
Conclusions: Although the amount of online health-related information and services is consistently growing, it appears that the
general population lacks the skills to keep up. Most problematic appear to be the lack of information and strategic Internet skills,
which, in the context of health, are very important. The lack of these skills is also problematic for members of younger generations,
who are often considered skilled Internet users. This primarily seems to account for the operational and formal Internet skills.
The results of the study strongly call for policies to increase the level of Internet skills.