Digital Health Literacy and Immigrants’ Access to Digitalized Healthcare: A Comparative Study of Spain, and Sweden – Implications for Public Health Policy

Background: As healthcare systems undergo rapid digital transformation digital health literacy has become a critical determinant of equitable access to health services. Immigrants often additional challenges in navigating digital health resources due to language barriers, cultural differences and structural inequalities. This study aimed to compare the experiences of immigrants in Spain and Sweden in accessing and using digital health information, and to identify strategies to enhance digital health literacy within these populations. Methods: A comparative qualitative study was conducted in Sweden and Spain within the framework of the IDEAHL Project (Improving Digital Empowerment for Active Healthy Living). Participants were recruited through non-governmental organisations and community spaces supporting immigrant integration. Data were collected using semi-structured interviews, group discussions, and photovoice techniques. In Sweden, sessions were audio-recorded and transcribed verbatim, whereas in Spain, detailed field notes were taken and validated by facilitators. A comparative thematic analysis was conducted to identify commonalities and differences. Results: A total of 44 immigrants (20 in Sweden and 24 in Spain) participated in the study. Across both countries, participants frequently used digital platforms such as Google and YouTube to search for health-related information. However, they encountered persistent barriers related to language, digital skills, trust in online content and access. Swedish participants emphasised empowerment and the need for culturally adapted digital tools, while Spanish participants highlighted structural barriers such as legal status. limited access to e-Health services, and reliance on traditional healthcare providers. Both groups expressed a strong need for trustworthy, accessible, and easy-to-understand digital health content, as well as greater involvement of healthcare professionals in guiding digital health use. Conclusions: Improving digital health literacy among immigrant populations requires coordinated action from healthcare professionals, policymakers, and primary care providers. Strategies should include multilingual and interactive digital tools, training in critical evaluation skills, and co-design approaches that actively involve immigrants in the development of digital health solutions. The similarities observed between Spain and Sweden suggest that inclusive, person-centred strategies can be effectively adapted across diverse European contexts to promote digital equity and health system resilience.