Assessing Digital Health Literacy Among Outpatients to Improve the Coverage of COVID- 19 Vaccine Boosters: A Case of Bwaila Hospital Lilongwe, Malawi

Introduction: Availability and utilization of digital health interventions (DHIs) may help increase COVID-19 vaccination uptake and health literacy. COVID-19 vaccine hesitancy remains a challenge in Malawi. Among all 29 health districts, only 4.7% of the population has been vaccinated. Digital Health Literacy (DHL) is important in addressing misinformation and improving vaccination rates. This study assessed the impact of health information-seeking behaviour on DHL related to the COVID-19 vaccine booster at Bwaila District Hospital in Malawi. Methods: This study employed a qualitative phenomenological method to explore how outpatients at the Bwaila Clinic use and process health information to improve their access to COVID-19 vaccine boosters. We conducted 10 In-Depth Interviews (IDIs) and 1 Focus Group Discussion (FGD) with outpatients at Bwaila Hospital, and 8 IDIs with key informants at the Ministry of Health from December 2023 to February 2024. All interviews were audio-recorded, transcribed, and translated. Data was analyzed using an iterative thematic analysis approach. Results: We elicited 5 themes of the digital health literacy framework. The development, interaction, and utilization of digital tools have influenced the COVID-19 vaccine uptake. Outpatients accessed, shared, and discussed vaccine information through the Ministry of Health (MOH) digital platforms. Vaccine reluctance was influenced by mismatched information and disinformation. Conclusion: The effective utilization of digital health communication platforms by outpatients and training is essential. Addressing both structural and behavioral barriers to digital engagement, health systems can better equip individuals to make informed decisions about COVID-19 vaccine uptake and health promotion.