From leadership research to district action: Digital health literacy among primary and secondary school teachers—a quantitative study

AI-assisted editorial implementation guide. Proposed district actions are separate from the original authors’ findings and recommendations. Independent peer review of this guide is not asserted.

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Evidence and transfer

Education-related source: verify which participants, institutions and outcomes were actually studied before district adoption. Source publication type: research-article. License and identity checks do not establish study quality or causality.

Original authors’ abstract, reproduced under the source license:

Introduction Digital health literacy (DHL) is a key competency for individuals’ daily decisions toward their health behavior and wellbeing. While there is much focus on health literacy (HL) among the general population, teachers have been rarely addressed. Given the shortages in the teaching workforce in Europe and the impact of demanding working conditions on their health, it is important to address DHL in teachers. This paper examines the DHL of primary and secondary teachers and its associations with sociodemographic and school-related factors. Methods An online cross-sectional study was conducted with 1,600 German primary and secondary school teachers between October and December 2022. To assess DHL, the Digital Health Literacy Instrument (DHLI) including seven subscales was used. Statistical analyses were conducted on item and subscale level and an overall DHL score was calculated. Next to descriptive analyses, bivariate and regression analyses were conducted to explore potential associations with sociodemographic and school-related factors. Results The frequency of difficulty in using digital health information varied across DHL dimensions and was greatest for protecting privacy (70.9%) and evaluating reliability (40.0%). In multivariate analysis, females more often reported a sufficient ability of adding content (OR = 1.61, CI = 1.05–2.48), while males more often reported a sufficient ability to protect their privacy (OR = 0.45, CI = 0.27–0.75). Teachers with leadership positions more often reported a sufficient ability in adding content (OR = 1.78, CI = 1.07–2.98). Regarding the ability to determine the relevance of online health-related information, no associations with a predictor variable were found. Discussion The results suggest that it is important to examine the individual dimensions of DHL and their distinct associations with sociodemographic and school-level factors, rather than just to rely on the overall level of DHL. The differential patterns identified in this study suggest a greater intervention need for teachers from higher age groups, primary and secondary general schools, and those without leadership roles. However, based on the limited predictive power of the variables included, further individual and school-level factors and their potential association with DHL should be investigated in the future. The promotion of DHL should be integrated into both teacher education and in-service training.

Study methods

To examine the DHL of primary and secondary teachers in Germany, an online cross-sectional survey in all 16 German federal states was conducted from October to December 2022. Following an ethical approval by the ethics committee of Fulda University of Applied Sciences (reference number 3.1.9.2), eligible study participants were recruited via a communication campaign run by a German agency for educational communication through print and digital communication channels. Participation was voluntary and anonymity was ensured, informed consent was given before participation. Postal invitations and reminders 3 weeks after the initial invitation were sent to 5,000 teachers. Those teachers were randomly selected, stratified according to school type and federal state and contacted by the agency. Furthermore, an advertisement in a printed teachers’ magazine with a circulation of 80,000 copies served to disseminate the survey. It was also disseminated through online media such as eight teacher-specific newsletters, five social media channels, five online commercials and content ads on educational websites for teachers, each with a reach of between 6,000 and 28,600 recipients approximately. To increase the motivation to participate, incentives were awarded as 25 vouchers worth 100 euros each, which could be redeemed at any time at more than 500 shops. To prevent the collection of individual contact data, the raffle was conducted via the external German agency for educational communication.

Limitations

Given our findings, a closer examination of age differences, with a particular focus on younger teachers as digital natives, may be of interest. Building on the relational nature of HL, the relevance of other individual and school-contextual factors could be examined both quantitatively and qualitatively. Examples of contextual factors and their association with a teacher’s DHL are the overall school culture, (innovation)climate, and support from school leadership, the availability and use of information and communication technologies (ICT) in the school, and the general attitude and level of integration of DHL within a school. Examples of socio-demographic factors that could be investigated are household composition, such as marital status and the number of children under care, or engagement in caregiving for others (49). It can be assumed that teachers who are in a relationship or have a care responsibility engage in surrogate health information seeking (74), its potential influence on a person’s DHL level could be further investigated. Another aspect that could be investigated are the associations between DHL and indicators of (mental) health, which have already been proven for general HL (4). If such associations are found, strong arguments could be made for the need for interventions to promote DHL, which in turn would have to be evaluated for their effectiveness on (mental) health outcomes.

A 90-day district inquiry

Days 1–15 · Appraise. Read the source methods, recruitment, comparator, outcomes and limitations. Record how the study setting differs from your district and which claim the design can support.
Days 16–30 · Design. Choose one school improvement question with teachers. Protect a short shared planning cycle, agree an instructional change and use a common rubric for examining student work. Agree participation, privacy protections, baseline and stopping rules before starting.
Days 31–60 · Observe. Collect the pre-agreed measures, keep a log of implementation changes and invite confidential voluntary feedback. Preserve existing support for staff and learners.
Days 61–90 · Decide. Review implementation fidelity, teacher time and independently scored student work against a recorded baseline. Examine access differences and competing explanations before attributing changes to leadership. Make a dated decision to stop, revise or extend the inquiry.

Board decision brief

Present the local problem, source setting, evidence limits, intervention, responsible owner, total cost, measured changes and uncertainty. Separate staff perceptions, implementation measures and student learning outcomes.

Attribution and reuse

Pia Rangnow; Lisa Fischer; Anja Hartmann; Denise Renninger; Lisa Stauch; Orkan Okan; Kevin Dadaczynski. Digital health literacy among primary and secondary school teachers—a quantitative study. Frontiers in Public Health (2024-06-07). https://doi.org/10.3389/fpubh.2024.1334263

Prepared 2026-11-07. Source authorship and DOI are preserved. The abstract and source passages are attributed extracts; this editorial guide is offered under the same CC BY 4.0 license.