Public health

Vol.:(0123456789)

Sexuality Research and Social Policy https://doi.org/10.1007/s13178-025-01110-x

From Digital Health Literacy to a Digital and Data Capabilities Approach to Sexual Health

Kath Albury1  · Samantha Mannix1

Accepted: 6 March 2025 © The Author(s) 2025

Abstract Introduction This article presents a narrative review of scholarly literature addressing the intersection of digital technolo- gies and sexual health, to better understand how digital literacy is currently defined and assessed in this context. It critically reflects on cross-disciplinary literature from across sexual health, digital literacy, and data literacy, to better understand the implications of emergent Australian policy agendas for sexual health workforces. Methods A narrative review of research addressing digital literacy within sexual health literature was conducted in 2022, adopting a sociotechnical approach. A search of 7 databases resulted in 30 full-text articles included for review after dupli- cates and unrelated results were removed. Results Current definitions of digital literacy are contradictory and at times unclear. Additionally, a consideration of data literacy for sexual health is yet to emerge. Further, literature addressing “digital literacy for sexual health,” has tended to frame literacy as a need (or deficit) for individual sexual health consumers, excluding the digital literacy of health workforces from consideration. Conclusions Drawing on recent research into data capabilities, we note that where the concept of “literacy” has historically been associated with attempts to measure and remediate individual deficits, a “capabilities” approach offers an opportunity to rethink the collective and systemic dimensions of digital and data practices for sexual health workforces and consumers alike. Policy implications Our analysis highlights the potential risk of disenfranchising and stigmatising sexual health workforces and consumers via initiatives promoting digital literacy. We endorse a holistic “capabilities approach” to digital transforma- tion policy and infrastructure.

Keywords Digital literacy · Data literacy · Health literacy · Sexual health · Health sociology

Introduction

Public health campaigns and interventions increasingly seek to simultaneously promote both digital literacy and health literacy—for example in the World Health Organisation’s (WHO) multiple global responses to what has been termed the “infodemic” of COVID misinformation (WHO,  n.d.). Increasingly, too, sexual health workforces are required to adopt digital technologies and practices (sometimes referred to as eHealth or mHealth) to undertake core activities such

as clinical service provision, health promotion, education and outreach, reporting, and quality assurance. However, Australian sexual health workforces have received little for- mal training or guidance to support the digital transforma- tion of sexual health service provision.

Given the sensitivities and stigma associated with sexual health—and increasing calls to support health consumers’ sexual health needs through digital provision of digital health content and services (Iyamu et al., 2023; Kickbusch et al., 2021; Smith et al., 2023), this article explores cross- disciplinary literature addressing the intersection of sexual health, digital literacy, and data literacy, to inform emergent public health research and policy agendas.

We contextualise this literature in relation to the con- temporary Australian policy environment, including still- nascent digital capabilities frameworks for health workforces (broadly defined). Our analysis references existing debates

* Kath Albury [email protected]

1 Department of Media and Communication/ARC Centre of Excellence for Automated Decision-Making and Society, Swinburne University of Technology, John Street, Hawthorn, VIC 3122, Australia

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around health literacy (Malloy-Weir et al., 2016; Sorensen et al., 2012); and the social, political, and moral implications of professional and popular demands to define and meas- ure literacies (Vee, 2017). We identify current limitations in literature addressing “digital literacy for sexual health”, which tends to frame literacy in terms of individual deficit, and exclude health workforces from consideration. Instead, we propose alternative (and less morally loaded) frameworks of digital and data capability for sexual health, drawing on recent participatory research with members of the not-for- profit workforce (McCosker et al, 2022a).

Our review was conducted as part of the first stage of a program of research involving collaboration between researchers, sexual health consumers, and members of the sexual health workforce to identify new digital literacy frameworks for sexual health policy-makers and practi- tioners (Albury & Mannix, 2023). We observed signifi- cant moves within Australian health and education policy development to incorporate digital and data literacies within undergraduate and postgraduate training for health profes- sionals (for example Scott et al., 2023), reflecting similar policy initiatives occurring across the globe (Iyamu et al., 2025; Lawrence & Levine, 2024).

However, it became increasingly clear that “literacy” may not be the appropriate framework to capture the dynamic and diverse requirements to understand, work with and partici- pate in digital sexual health platforms and emerging tech- nologies. We note instead, the potential for a capabilities framework to better attend to these complexities for digital health, whilst also foregrounding social justice and the social and political factors that are critical to sexual health and wellbeing (see: Alexander, 2008; Nussbaum, 2003, 2011; Sen, 2004).

As we outline below, this insight emerged alongside a broader Australian policy shift towards digital capabili- ties as opposed to digital literacies, particularly for health workforces, one evidenced by the current development of the Australian Digital Health Capability Framework (ADHCF) (see also Brunner et al., 2018). The ADHCF builds on the Australian Department of Employment and Workplace Rela- tions’ (DEWR, 2022) Australian Digital Capability Frame- work, which is in turn modelled on the European Commis- sion’s Digital Competence Framework for Citizens (also known as DigComp 2.1) (Carretero Gomez et al., 2017).

It also draws on the World Health Organisation’s (WHO) (2021) Global strategy on digital health 2020–2025 which observes that 120 WHO member states have developed digital health strategies and policies, identifying a need to build a “digitally capable health workforce” (p. 22). More recently, the WHO’s (2024) technical brief on The role of artificial intelligence in sexual and reproductive health and rights suggests a need to build shared understandings of digital and data technologies among diverse stakeholders,

including health workers and policymakers (p.1). Thus, while our case study specifically addresses the evolution of Australian digital health policy, it may offer broader insights for international policy contexts.

To better understand the implications of such policies for sexual health workforces, we map the ways “digital literacy” and “data literacy” have been defined and discussed within the global field of sexual health. We contextualise these terms in relation to existing debates around “health literacy”. Finally, we reflect on broader historical conversations about the value of defining and assessing literacy, and conclude by speculating on the potential benefits offered to health consumers and workforces alike where “digital and data lit- eracies” are reframed in relation to a capabilities approach.

Policy Contexts

Digital Health

Our analysis is situated within the current Australian policy environment. Since the release of the first National Digi- tal Health Strategy in 2018, the Australian Digital Health Agency (ADHA) has released a range of strategic plans and guidelines that support digital transformation and aim to “deliver a sustainable, interoperable, and inclusive health system now and into the future” (ADHA, 2023, p. 17). These include the Digital Health Blueprint 2023–2033 (ADHA, 2023); the National Digital Health Capability Action Plan (CAP) (ADHA, 2021); the National Digital Health Work- force and Education Roadmap (ADHA, 2020), and the Australian Digital Health Capability Framework (ADHCF) (AIDH, 2023). These activities speak to the increased rec- ognition by governments and the health care sector of the dynamic and emerging role of digital technologies and prac- tices within health care settings. Across these documents, digital technologies are broadly defined to include a range of data-driven technologies (such as electronic health records, mobile health apps, telehealth, wearables) used for patient treatment and to collect and/or share patients health informa- tion (AIDH, 2023).

A “digitally ready and enabled health and wellbeing workforce” (ADHA, 2023) has been identified as core to this work, with these strategies and policies signalling a desire for a targeted and consistent approach to workforce development. For example, the CAP outlines priority actions required to build digital health capability across the health workforce (broadly defined) in order to respond to, compliment and prepare for digital transformations in health. Actions include the development of new frame- works and guidelines (including the ADHCF), an enhanced focus on workforce education and training, and identifying

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new and specific digital health career pathways (ADHA, 2021).

As Scott and colleagues (2023) note, most Australian medical practitioners (and other members of the current Australian health workforce) have received little to no foun- dational training that supports their understanding and use of digital technologies. Additionally, “where such educa- tion is provided, it lacks standardisation and is often too focussed on direct care applications to the exclusion of data analysis and knowledge creation or system and technology implementation” (Scott et al., 2023, p. 1043). Consequently, Scott and colleagues (2023) offer a series of new compe- tency frameworks to inform university-based medical cur- ricula, including a focus on “the nature of data, information and knowledge” (p. 1045). Their recommendations resonate with both DigComp 2.1 and the Australian Digital Capabil- ity Framework which specifically define “information and data literacy” as a sub-category of digital capability.

While the CAP does not provide a definition of capability when outlining workforce transformations, the Australian Digital Health Capability Framework does suggest that a capability approach “addresses professionalism in terms of an individual’s life-long learning, adaptability to change, and self-efficacy” (AIDH, 2023, p.36). Here, development is seen to be ongoing, rather than applied to a specific role or standard of practice. However, these frameworks and competency guidelines operate at a high level and do not specifically address the domain of sexual health. While there are certainly precedents for including digital literacy as a necessary aspect of healthcare workforce training (for exam- ple within nursing education), to date, such literacy has been defined in relation to the use of specific technologies and software platforms (for example see: Cieślak et al., 2023; Lokmic-Tomkins et al., 2022; Raghunathan et al., 2023).

Further, digital and data technologies (and the associa- tion of digital literacy with sexual health) have been framed quite differently across disciplinary domains. A considera- tion of these historical differences provides a useful context for reflecting on the overlapping domains of digital litera- cies, competencies, and capabilities. We therefore offer an overview of diverse disciplinary approaches before present- ing our methods, findings; and a more detailed discussion of the potential for new understandings of digital and data capabilities for sexual health.

Sexual Health

There is a significant body of literature across scholarly disciplines—ranging from public health and health sociol- ogy to human computer interaction and psychology—that seeks to understand the diverse ways digital platforms and technologies are used, understood, and developed in relation to sexual health and wellbeing (Cao et al., 2020;

Romero et al., 2021; Tucker et al., 2022). Both public health and education research have explored the potentials and/or risks associated with delivering and searching for sexual health education and information (and mis- or dis- information through digital platforms) (Lim et al., 2017; Graham et al., 2023; Patterson et al., 2019).

Within the public health literature, there is an emerg- ing focus on the potential for online sexual health ser- vices to facilitate prevention, testing, and/or treatment (Aicken et al., 2016; Baraitser & Lupton, 2022; Tucker et  al., 2022). Recent research has questioned whether greater adoption of digital testing services will increase equitable access, particularly for already marginalised populations (Iyamu et al., 2023; Ludwick et al., 2024). There is also growing attention on the role of artificial intelligence (AI) and automation (such as chatbots) in pro- viding sexual health education, advice, and information to health consumers (Marcus et al., 2020; Nadarzynski et al., 2020, 2021). Additionally, generative AI platforms such as ChatGPT are provoking significant inquiry related to their ethical implications for clinical health practice (Moodie, 2023; WHO, 2024).

A significant body of literature in social sciences and humanities (particularly media and communications, inter- net studies, science and technology studies, and digital sociology) addresses the relationship between digital litera- cies, data literacies, sexualities, gender, and health. Some research investigates the formation of individual attitudes and behaviours, with a focus on the role of digital literacies in “information-seeking” (Albury & Hendry, 2022; Lupton, 2021). Other studies are more sociotechnical in orientation, seeking to understand the ways digital platforms and tech- nologies (such as dating apps, “smart” sextoys and social media platforms) both shape and are shaped by lived expe- riences within sexual cultures (for example, Albury et al., 2023; Duguay, 2018; Race, 2015).

Research adopting a socio-cultural approach to digi- tal media and sexual health examines the more informal ways young people access digital sexual health information (Byron, 2020; Cormier & O’Sullivan, 2021; Power et al., 2022). This tends to consider sex and intimacy broadly, encompassing wellbeing. Other sociotechnical studies unpack concerns regarding ethics, privacy, and trust; and the risk of increasing stigmatisation of already marginalised communities via data-driven digital health practices (Davis et al., 2022; Guyan, 2022; Newman et al., 2020).

Researchers in the fields of science and technology studies, cultural studies and human–computer interaction have investigated the emergence of “data-driven intimacy” (Flore & Pienaar, 2020), exploring the ways data collec- tion and algorithms on different platforms (i.e., dating apps) shape, extend and/or regulate intimate relationships (Albury et al., 2019; de Ridder, 2021). This literature also includes

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examinations of the ways social inequalities related to gen- der, sexuality and race can be magnified in digital spaces (Carlson, 2019; Carlson & Frazer, 2021; Dobson, 2015; Duguay, 2016).

Health Literacy

While there are many and diverse definitions of health liter- acy (Bröder et al., 2017; Malloy-Weir et al., 2016), the work of Don Nutbeam (1998) has been particularly influential in the Australian context. Nutbeam defines health literacy as “the personal, cognitive and social skills which determine the motivation and ability of individuals to gain access to, understand, and use information to promote and maintain good health” (p. 357). Here health literacy is operational- ised through competency-based frameworks, with a focus on three distinct (yet overlapping) competencies: Functional (communication of information); Interactive (personal skills); and Critical (personal and community empower- ment) (Nutbeam, 2000).

Within the Australian policy context, there has been a concerted push over the past decade to ensure health lit- eracy is on the policy agenda. While a more comprehensive National Health Literacy Strategy is currently under devel- opment (see: Australian Department of Health and Ageing, 2022), the 2014 National Statement on Health Literacy identifies health literacy as a responsibility shared by both healthcare workers/organisations and individual consumers (Australian Commission on Safety and Quality in Health Care, 2014). Here, health literacy is seen as a “safety and quality issue” (ACSQHC, 2014), which Trezona and col- leagues (2019) argue has resulted in a focus on “clinical care and service delivery” to the detriment of health promotion activities.

There have been growing calls for health literacy to be incorporated into formal health professional training and development programs (Nutbeam & Lloyd, 2021; Trezona et al., 2019). This work is largely framed around the ways health professionals and organisations can better communi- cate with patients/consumers with diverse and low health literacy levels. Recent reviews have illuminated a content focus within existing (local and international) programmes on interpersonal communication skills, as well as instruction on the assessment of patient literacy levels and defining and addressing health literacy more generally (including preva- lence and impacts) (Connell et al., 2023; Saunders et al., 2019; Toronto et al., 2015). Saunders and colleagues (2019) note however, a lack of an agreed upon and consistent defini- tion of health literacy and associated frameworks for profes- sionals, currently makes this work difficult.

Bringing this interdisciplinary literature together, paints a complex and dynamic picture for sexual health practitioners

and organisations—one that requires individual skills and competencies in order to use digital technologies, but also an understanding of the social and cultural practices and politics embedded within and across digital platforms and digital technologies as they are used by consumers for sexual health and wellbeing.

Methods

The present work was conducted in the first stage of a pro- gram of research collaboration between researchers, sexual health consumers, and members of the sexual health work- force which examines the role of digital technologies for sexual health. Key outputs initially included “digital literacy resources for sexual health”.

Our literature review consequently sought to answer the overarching research question (RQ1) “how is digital literacy currently defined and assessed within the broad domain of sexual health”?

Sub-questions were as follows:

• RQ2: What populations are considered/addressed in research that connects sexual health and digital literacy?

• RQ3: What is the purpose and value of digital technolo- gies and digital literacy within the broad domain of sex- ual health?

• RQ4: What is the connection between digital literacy and sexual health outcomes?

Given the explicit discussion of data literacy in both Dig- Comp 2.1 and the Australian Digital Capability Framework, we also asked:

RQ5: How is data literacy currently defined and assessed within the broad domain of sexual health?

A social sciences narrative review methodology was deployed to develop both a summary of findings, and a deeper understanding of extant literature via interpretation and critique (Greenhalgh et al., 2018; Lupton, 2021).

An initial search was conducted through the following databases: Web of Science, Medline, PubMed, Cinahl, Embase, PsychInfo, and Communications and Mass Media. Search terms included: “digital literacy” “digital health literacy” “eHealth literacy” “data literacy” AND “sexual- ity” “sexualities” “sexual health” “intimate relationships” “sexual relationships” “sexually transmitted*” “HIV”. After duplicates and unrelated results were removed, this review included the examination of 30 articles. When searching for this combination of terms with “data literacy” only, there were no exact matches across the listed databases.

Following Lupton (2021), Google Scholar was also used to broaden the scope of the search to better include social

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science and humanities research, as well as books, grey lit- erature, and government reports. Interdisciplinary research was surveyed, with a particular focus on the intersection of public health and digital media studies, to map and syn- thesise current approaches to digital and data literacies in sexual health. Additional articles were found through read- ing relevant reference lists and reviews. In addition to this formal search strategy, a broader literature search was also implemented around the role of digital platforms and tech- nologies in sexual and/or intimate relationships. Due to the dynamic and evolving nature of digital technologies and health, articles older than 2010 were excluded. Exceptions to this were made if the article was a framework, model, or def- inition that was still in use in more contemporary literature.

Our analyses are interdisciplinary and sociotechnical, drawing on the social sciences and humanities traditions “in which the technical operation of a system is examined in tandem with the social relations that it creates or pre- serves” (Loukissas, 2019, p. xiii). Following Lupton (2021) we utilise a narrative review in order to synthesise what is currently known about digital and data literacies for sexual health, rather than seeking to “evaluate the validity of a method or a medical intervention” (p.2). Additionally, we do not seek to evaluate the suitability or efficacy of existing metrics for digital health literacy, or to measure the extent to which health policy and practice are positively or negatively “impacted” by digital and data-driven technologies. Instead, we consider the development of digital and data literacy (and capability) frameworks in health as socio-political processes (Bijker, 1995).

Finally, we note that while the present article focuses on the evidence and rationale underpinning the project’s conceptual shift from literacy from capabilities, subse- quent stages of research have since drawn on a range of qualitative methods to develop and pilot formative mod- els of applied digital and data capabilities with Australian sexual and reproductive health professionals (Albury & Mannix, 2025a, b).

Results

RQ1: How is digital literacy currently defined and assessed in relation to sexual health?

Much of the literature addressing digital technologies and platforms in relation to sexual health and digital literacies draws upon the conceptual work of Norman and Skinner (2006a), where digital literacy (also referred to as eHealth literacy or digital health literacy) is primarily defined as “the ability to seek, find, understand, and appraise health infor- mation from electronic sources and apply the knowledge gained to addressing or solving a health problem” (p. 1).

Used frequently by papers included in this review, this defi- nition builds upon broader understandings of health literacy (Nutbeam, 2000; Sorensen et al., 2012) and largely consid- ers literacy in relation to individual or personal attributes, including knowledge, skills, and behaviours (Table 1).

Only one paper, Diez et al., (2022), provides a specific definition of “sexual eHealth literacy”. This was defined as follows:

the ability to understand and evaluate sexual health relationships risks and the ability to express gender roles. Sexual eHealth literacy is supportive of gender equality, reducing inequalities, and negotiating rela- tionships and pleasure (p.338).

Other research does not offer a specific definition of digi- tal literacy but includes it as a sub-definition of health lit- eracy or sexual health literacy (Goodwin, 2021; Robinson & Graham, 2010). Within literature focused on quantifying and measuring individual digital literacy levels, drawing upon psychological theories of human behaviour and the use of standardised and validated scales, the definition of digi- tal literacy tends to be implicit or assumed (often drawing on Norman & Skinner, 2006b). This work is largely based within HIV research and focuses on consumer self-reported measures of individual knowledge and skills (Blackstock et al., 2016; Horvath & Bauermeister, 2017).

RQ2: What populations are considered/addressed in research that connects sexual health and digital literacy?

A large proportion of the literature examined for this review was from North America (21) and Europe (4). Thir- teen articles focused on PLWH, with most (10) focusing on adults, and a smaller number looking at sub-populations of PLWH such as young men who have sex with men (YMSM) (1), young adults (18–34) (1) and women (1). Young people of various ages were also considered (10), including a focus on US-college students and young gay men and other men who have sex with men. HIV health care provider (includ- ing clinicians, management, allied health) perspectives were canvassed in a small number of articles, however, these were largely focused on gaining greater insight into the digital literacy of patients, or patient experiences of treatment and/ or research interventions.

RQ3: What is the purpose and value of digital technolo- gies and digital literacy within the broad domain of sexual health?

Digital technologies and platforms are largely repre- sented as sites or systems for information, where the com- munication of information is mainly framed as static or as one-directional. For example, Diez and colleagues (2022)

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Table 1 Overview of findings

How is digital literacy defined and assessed within the broad domain of sexual health?

eHealth literacy/digital health literacy/digital literacy

Norman and Skinner Defined Han et al. (2018); Von Rosen et al., 2017; Nunn et al. (2017); Horvath and Bauermeister, (2017); Blackstock et al. (2016); Nokes et al. (2018); Britt et al. (2017)

Norman and Skinner meas- ured/scale used

Sanders et al. (2021); Woods and Sullivan (2019); Fiscella et al. (2015); Horvath and Bauermeister (2017); Carroll et al. (2019); Nokes et al. (2018); Robinson and Graham (2010); Blackstock et al. (2016); Chenneville et al. (2021); Britt et al. (2017); Bonett et al. (2018); McRee et al. (2018)

Other Component of health literacy Robinson and Graham (2010); Woods et al., (2016)

Telehealth literacy Labisi et al. (2022); Comulada et al. (2020) Sexual health literacy Diez et al. (2022), Lee-Foon et al. (2020);

Goodwin (2021) Nil defined Lorimer et al. (2016); Smith and Badowski

(2021); Yelverton et al. (2021); Lau et al., (2022); Godongwana et al. (2021); Patterson et al. (2019); Wilson et al. (2017)

What is the purpose and value of digital technologies and digital literacy within the broad domain of sexual health?

Information (Consumers) searching for sexual health information online

Patterson et al. (2019); Comulada et al. (2020); von Rosen et al. (2017); Nokes et al. (2018); Robinson and Graham (2010); Carroll et al. (2019); Fiscella et al. (2015); Sanders et al. (2021); Lee-Foon et al. (2020); Wilson et al. (2017)

Online sexual health promo- tion and/or education

Horvath and Bauermeister (2017); Bonett et al. (2018); McRee et al. (2018); Nunn et al. (2017); Chenneville et al. (2021)

General health info Britt et al., (2017); Blackstock et al. (2016) Clinical tools STI testing, diagnostic ser-

vices, notifications Horvath and Bauermeister (2017); Godong-

wana et al. (2021) Telemedicine/telehealth Smith and Badowski (2021); Yelverton et al.

(2021); Labisi et al. (2022) Health kiosks Han et al. (2018) Online pharmacy Woods et al. (2016)

Sexual connection Social and sexual networking sites and apps

Lorimer et al., (2016); Blackstock et al. (2016)

Store health data Electronic health records; personal health records

Sanders et al. (2021); Fiscella et al. (2015); Carroll et al. (2019); Woods et al. (2016)

Social support Internet, social networking sites, chat rooms

Blackstock et al. (2016); Comulada et al. (2020)

What is the connection between digital literacy and sexual health outcomes?

Access, understand and criti- cally analyse sexual health information

Behaviour change Lorimer et al. (2016); von Rosen et al. (2017); Diez et al. (2022); Britt et al. (2017); Black- stock et al. (2016); Horvath and Bauermeister (2017)

Adherence to treatment (empowerment/activation)

Comulada; Lorimer et al. (2016); Fiscella et al. (2015); Carroll et al. (2019); Sanders et al. (2021); Robinson and Graham (2010); Chen- neville et al. (2021)

Prevention (accept health info/ promotion)

Lorimer et al. (2016); Nunn et al. (2017); McRee et al. (2018); Bonett et al. (2018)

Technological skills and access

Participate in digital treatment (prerequisite)

Smith and Badowski (2021); Yelverton et al. (2021); Lau et al. (2022); Labisi et al. (2022)

Equity (access, increase disadvantage, increase inequities)

Flowers et al. (2017); Simoni, Kutner, and Horvath; Godongwana et al. (2021)

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consider information in terms of risk (e.g. of mis- or disin- formation), while other work explores more formal delivery of sexual health information (Bonett et al., 2018; McRee et al., 2018; Nunn et al., 2017). Some of this work examines connections between digital literacy and an ability to assess credible, quality, and/or trustworthy information (Nokes et al., 2018) and to identify mis/disinformation (Diez et al., 2022). For example, Nunn and colleagues (2017) note the connection between digital literacy (specifically defined as the capacity to understand digital information) and consumer trust and loyalty to sexual health websites and information.

Other work considers the various ways that digital tech- nologies are used for the delivery of clinical services and communications, such as STI testing and diagnostic services (including notifications), telemedicine, and online pharma- cies (Horvath & Bauermeister, 2017; Smith & Badowski, 2021; Woods & Sullivan, 2019). Digital literacy here is largely concerned with technological skills. For example, Smith and Badwoski (2021) identify a patient’s inability to use zoom for telemedicine appointments as a lack of digital literacy (see also Yelverton et al., 2021). Similarly, partici- pants in qualitative work undertaken by Lau and colleagues (2022) identified their own limited digital literacy (i.e. an

ability to use computers) as a barrier to participation in an online exercise intervention for PLWH (People Living With HIV).

Where digital platforms (including social networking sites and apps) are considered in terms of access to sexual pleasure and connection, they are largely framed alongside notions of risk (Blackstock et al., 2016). Similarly, where the potential for social support in digital spaces is considered, it is secondary to considerations of information, interven- tions, and/or services. Notably, digital literacy is largely represented as a desirable attribute for individual consum- ers or patients within the examined literature. Where health professionals are considered, the emphasis is placed on their responsibility to consider the diverse digital literacy needs of their patients when developing messaging and/or clinical interventions (for example: Horvath & Bauermeister, 2017; Patterson et al., 2019).

RQ4: What is the connection between digital literacy and sexual health outcomes?

Connections between digital literacy and sexual health outcomes were implied, examined, or measured in a number

Table 1 (continued)

What populations are consid- ered/addressed in research that connects sexual health and digital literacy?

People living with HIV Adults living with HIV Smith & Badowski, 2021; Han et al. 2018; Sanders et al., 2021; Woods and Sullivan, 2019; Lau et al., 2022; Fiscella et al., 2015; Carroll et al., 2019; Nokes et al., 2018; Robinson & Graham, 2010; Woods et al. 2016

Women with HIV Blackstock et al. (2016) Young adults living with HIV Comulada et al. (2020) Young men (18–24) who have

sex with men Chenneville et al. (2021)

Gay, bisexual and other MSM Flowers et al. (2017); Goodwin (2021); Lee- Foon et al. (2020)

Sexual health website users Nunn et al., (2017) Young People Young men who have sex

with men Lorimer et al. (2016); Horvath and Bauer-

meister (2017); McRee et al. (2018); Bonett et al. (2018); Lee-Foon et al. (2020); Chen- neville et al. (2021)

Students von Rosen et al. (2017); Britt et al. (2017) Young people Patterson et al. (2019); Diez et al. (2022)

Professionals HIV clinicians Fiscella et al. (2015) Community organisations

(HIV); allied health; educa- tors

Lau et al. (2022)

Management personnel–HIV facilities

Yelverton et al. (2021)

Literature review Sexual health and HIV research

Godongwana et al. (2021); Han et al. (2018)

How is data literacy currently defined and assessed within sexual health?

Nil papers identified contain- ing term “data literacy”

Ability to use and understand personal health data

Carroll et al. (2019); Sanders et al. (2021); Woods and Sullivan (2019)

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of papers. Some examined the assumption that digital lit- eracy skills strengthen and enable consumers’ health service access and adherence to care and treatment, through enhanc- ing access to accurate sexual health information (Comulada et al., 2020). Carroll and colleagues (2019) frame this aspect of literacy as patient empowerment or a greater ability to self-manage HIV treatment and care. Some sexual health interventions have consequently focused on increasing the digital literacy of participants (for example: Chenneville et al., 2021).

Connections are also drawn in some literature between digital literacy and participation in high-risk sexual behav- iours (von Rosen et al., 2017). However, experimental and observational research in this space has demonstrated mixed results (Blackstock et al., 2016; Britt et al., 2017).

In some instances, individual possession of digital lit- eracy skills and knowledge is seen to facilitate access to treatment. Some of this work frames digital literacy as an equity and access issue, for example examining the inter- secting factors that may enhance or impede individuals and/ or population group’s ability to utilise and/or access digi- tal testing interventions and digital clinics (Flowers et al., 2017; Horvath & Bauermeister, 2017). Digital literacy is thus considered in relation to participation and inclusion, as an amplifier of existing health inequalities.

RQ5: How is data literacy currently defined and assessed within the broad domain of sexual health?

While there were no exact matches for the terms “data literacy” and the combination of search terms used, data was considered in some cases amongst broader considerations of digital and health literacies for sexual health interventions. This work largely considered the role of personal health records (for example: Carroll et al., 2019).

Discussion

A large proportion of papers included in this review focus on the skills, behaviours, and knowledge of indi- vidual patients/consumers. However, a gap remains in terms of the digital skills and needs of sexual health practitioners and organisations. A similar gap has previ- ously been identified in literature reflecting on the nature and purpose of health literacy, with scholars particularly challenging the ways health literacy has been defined and measured (Lloyd et al., 2018; Pleasant et al., 2015) An exhaustive review of these debates is beyond the scope of this paper. However, we suggest that scholarly discussions of health literacy offer valuable insights for reflecting on the utility of digital and data literacies for sexual health.

Digital Literacy vs. Health Literacy

Health literacy scholars have called for a “paradigm shift” within the field, in order to move away from an individualis- ing “deficit model of health literacy” (Pleasant et al., 2015, p. 1176; McCormack et al., 2016; Sørensen et al., 2012). Such a focus can perpetuate stigma towards already margin- alised (or health illiterate) health consumers and hinder the empowerment aims of health literacy interventions (Sykes et al., 2018). For Nutbeam (2023) and others (Jordan et al., 2010; McCormack et al., 2017; Sørensen et al., 2021) this “shift” requires recognition not only of the importance of accessible health information, but also a broader understand- ing of the more complex social, structural and environmental conditions that shape health literacy.

However, as found in the literature examined in this review, research exploring the implementation of health literacy programmes largely remains focused on individual skills and knowledge rather than a broader systems perspec- tive (Malloy-Weir et al., 2016; Broder et al., 2017). Here, health literacy remains framed in problem terms, or more specifically as “a patient problem that needs to be fixed or circumnavigated” (Dawkins-Moultin et al., 2016, p. 30).

Some scholars argue this focus persists in large part due to the validated scales commonly used to measure health literacy (Batterham et al., 2016; Jordan et al., 2010). As also evident in this review, measures tend to focus on functional skills (such as the ability to act upon health information) rather than the social, emotional, or embodied components of health and wellbeing (Samerski, 2019).

Considering these debates within the public health litera- ture are ongoing (Lancet, 2022), it is perhaps unsurprising, remain that in practice, some organisational or health profes- sional approaches to digital literacy also focus on overcom- ing perceived deficits of patients/consumers. Rather than more specific considerations of organisational communica- tion policies, and associated strategies and procedures.

Lessons from History: Do We Need More Literacies?

The debates around health literacy and digital literacy reso- nate with the broader contested history of “literacy studies”. Within the fields broadly devoted to the study of language, linguistics, culture, and communication there has been sig- nificant debate regarding the ways that literacy is defined, and “literacy standards” are drafted and implemented. Simi- larly, humanities and social science research and practice have drawn attention to the ways that asymmetrical power relations are both naturalised and reinforced within popular and policy-driven conversations regarding the nature and purpose of literacy.

For example, Richard Hoggarts’ early (and still highly influential) study The Uses of Literacy (1957) explores the

Sexuality Research and Social Policy

ways standards of literacy dismissing mass-media in favour of “high culture” operate to enforce class boundaries in mid- twentieth century England (Hall, in Owen, 2008). More recently, the domain of “critical literacy” can be seen to intersect with “critical pedagogy” (Friere, 1968)—particu- larly with respect to media literacies. In these intersecting domains, the meaning and purpose of “digital health liter- acy” shifts to encompass not just a capacity to seek out, read, and understand information relevant to one’s health, but also to engage in collective cultures of advocacy, critical debate, and activism that supports collective or community health, safety, and wellbeing (Schey & Shelton, 2023).

However, as Annette Vee (2017) observes, even within the specialised field of “literature studies”, literacy has never simply been understood as a purely instrumental means of transmitting or receiving information. The social and political benefits of literacy are less an outcome of functional proficiency in “recognizing emblems or decod- ing letters to sound or words to meanings”, and more likely to be associated with the “ability to understand and use the intellectual resources provided by some three thou- sand years of diverse literate traditions” (p. 495). For this reason, it has become increasingly common for linguistic scholars to refer not to literacy, but to literacies (plural). In this context, literacies are understood as shaped by par- ticular settings and communities of practice, as opposed to being normatively defined via top-down checklists or frameworks (Barton et al., 2000).

In her critical examination of the drive to promote cod- ing (or computer programming) as a key element of “new literacy” in the USA, Vee (2017) notes that not all forms of workplace knowledge are widely understood through a common-sense lens of literacy—for example, it is not usual to describe a mechanic as “car literate”, or a barber as “hair literate” (p. 156). Given that reading, writing (and to a lesser extent, numeracy) are exceptional in this regard, Vee argues that the term “literacy” can therefore be seen to have both “functional and rhetorical components” (Vee, 2017, p. 87). That is, skills and knowledge are only understood as ele- ments of “literacy” when they not only have broad practical application, but are also associated with social, political or moral attributes.

Recognising the social value attributed to literacy (and stigma attached to illiteracy), it seems prudent to focus less intensely on assessing individual literacies, and more on determining the systemic enablers and barriers to literacies and expertise. As we have observed in our review, digital and data literacy is most often discussed in relation to health consumers. At the same time, sexual health workforces are increasingly expected to use and engage with data-driven technologies—from patient record management platforms, to chatbots, to organisational social media accounts. In sex- ual health, as elsewhere, the accumulation and deployment

of digital and data “expertise” is not limited to specialists or technologists but is increasingly an ordinary aspect of our everyday lives (Bassett, 2015; Burgess et al., 2022).

For this reason, contemporary professional and/or organ- isational understandings of digital and data literacies are dynamic—and workforces may experience considerable pressure as professional expectations of digital and data lit- eracy, expertise and capability evolve. In this context, “bag- gage” associated with literacy can be seen to impact not only health consumers, but health workforces, too—for example, in cases where highly experienced senior staff are deemed to be “digitally illiterate” in relation to emergent technolo- gies. As Vee (2017) puts it, “individuals may not necessarily lose their literacy, but [workplace] literacy moves on without them” (p. 151). We therefore see value in a shift from “lit- eracies” to “capabilities” for sexual health consumers and workforces alike.

From Literacies to Capabilities

If “literacies” is a loaded concept, then it could be argued that “competencies” (which the European Commission (2023) defines as “skills, knowledge and attitudes”) offer a more neutral definitional framework. However, an emphasis on individual competencies may lead to an instrumental or “box-ticking” approach to digital practices in workplace set- tings. Such an approach ignores the systemic factors (includ- ing policy and infrastructure) that can either enable or con- strain individuals’ ability to develop and extend skills and knowledge within specific organisational contexts. For this reason, we see the emergent policy focus on digital capabili- ties (as opposed to literacies or competencies) as a positive move.

Following McCosker et al., 2022a, p.2 “we position [digital and] data capability in organisational contexts, as a more holistic (rather than individual) set of infra- structures, practices, competencies and goals”. A focus on capabilities (as opposed to literacies) allows us to reframe conversations about the role of digital tech- nologies in health. Where “literacies” have historically been associated with attempts to measure and remediate individual deficits, “capabilities” offer an opportunity to consider collective and systemic approaches to digital and data practices. While this may include elements of individual skill development, a capabilities approach also urges organisations to incorporate strategies and action plans that build digital and data capability in relation to organisational goals and purpose (McCosker et al, 2022b). For example, prompting organisations to reflect upon how ethical principles and issues (including consent and embedding lived experience) are identified and addressed within organisational governance policy and infrastructure (McCosker et al, 2022b).

Sexuality Research and Social Policy

Such an approach invokes the ways that capabilities have been framed in relation to social justice, particularly drawing upon the work of economist Amartya Sen and phi- losopher Martha Nussbaum (Alexander, 2008; Nussbaum, 2003, 2011; Sen, 2004). As Nussbaum (2011) explains, a capabilities approach recognises that an individual’s capac- ity for wellbeing and efficacy is not simply an outcome of their own mental or physical ability and effort, but is con- tingent on the social and political circumstances they find themselves in. There is considerable precedent for adopting a capabilities approach in the domain of public health (for example Sacchetto 2018; Lorgelly et al., 2015), although capabilities—like literacies—are most often seen as relevant to health consumers, as opposed to health workforces. We suggest continued research and inquiry into the nature and utility of digital and data capabilities is necessary, in order to meet the needs of both sexual health workforces, and the communities they serve.

Conclusions and Policy Implications

While we began our research with a desire to develop new frameworks for digital literacy in sexual health, our review of relevant literature led us to adopt a capabilities approach. A consideration of capabilities encourages us to reflect on the complex relationships between individual skills and knowledge, and the systems in which such skills and knowl- edge are (or are not) deployed. We note, too, that recent work has called attention to the ways social media users engage in digital practices promoting sexual health and wellbeing that are less concerned with “information-seeking” and more focused on building community, culture or affinity (Albury & Hendry, 2022). Such practices, which Byron (2020) terms “digital cultures of care” are less easily captured in the con- ceptualisations of digital health literacy that emerged in our literature review. We suggest they are more likely to emerge in research and practice that attends to the social and cultural dimensions of sexual health professionals’ and health service users’ everyday digital and data practices (Albury & Man- nix, 2024; Burgess et al., 2022).

Our review found multiple formal definitions of digital literacy within sexual health literature. Some were precise (but narrowly defined). Others were vague, or contradictory. This suggests that policymakers and researchers will likely encounter significant barriers when attempting to produce a standard measure of digital literacy. Similarly, it is unlikely that a singular education and training framework for digital literacy or data literacy will suit all sexual health contexts, settings, and circumstances. This is unsurprising, given, as Vee (2017) puts it “there is little contemporary or historical consensus on what literacy is or what kinds of skills one needs to be literate. Thus, as a morally good but undefined

concept, literacy can serve as a cipher for the kind of knowl- edge a society values” (p. 21).

Finally, a consideration of digital and data capabilities for sexual health encourages us to ask if and how data-driven digi- tal technologies and platforms can promote social justice and equity for sexual health workforces and consumers alike. This question is especially pressing in a global political environment where access to digital platforms and technologies is increas- ingly restricted by platform governance policies—for example where content moderation guidelines on platforms like Meta and TikTok increasingly restrict the circulation of sexual and reproductive health content (Are, 2024; Williams, 2025).

Rather than suggesting a need for new, better definitions of digital or data literacy, we recommend sexual health policy- makers, researchers and practitioners adopt a “capabilities approach” to digital and data technology policy and practice. This aligns with the trajectories of existing Australian health workforce policy (ADHA, 2021) and education (Brunner, 2018), and broader international initiatives, such as WHO’s digital strategy—which is due for revision in 2025. We add a caveat, however, that a move away from digital and data lit- eracies and capabilities should not seek to reduce capabilities to a set of individualised measures or checklists.

In order to fully recognise the benefits of stepping away from the individualising (and potentially stigmatising) ten- dencies inherent in the concept of “literacy”, it is essential for policymakers and funders to acknowledge the role that ena- bling, rights-based approaches to policy and infrastructure can play in workforce digital transformation. Such an approach should not seek to simply measure individual strengths and deficits but must focus on supporting collective understand- ings of and access to digital technologies among both sexual health workforces and the communities they serve.

Acknowledgements We thank Professor Anthony McCosker for his critical guidance and support. Thanks to Dr Frances Shaw for her feed- back, and Dr Camille Nurka for editorial assistance.

Author Contribution Kath Albury conceived the study. Both authors reviewed relevant literature, wrote and edited the manuscript.

Funding Open Access funding enabled and organized by CAUL and its Member Institutions. This work was supported by Australian Research Council Grants FT210100085 and CE200100005.

Data Availability N/A This study draws on desk research.

Code Availability N/A

Declarations

Ethics Approval Not applicable.

Consent to Participate Not applicable.

Consent for Publication Not applicable.

Sexuality Research and Social Policy

Conflict of Interest The authors declare no competing interests.

Open Access This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

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