DIane Levin-Zamir ^1* Stephan Van Den Broucke ^2* Éva Bíró ³ Henrik Bøggild ⁴ Lucy Bruton ⁵ Saskia Maria De Gani ⁶ Hanne Søberg Finbråten ⁷ Sarah Gibney ⁵ Robert Griebler ⁸ Lennert Griese ⁹ Øystein Guttersrud ¹⁰ Zuzana Klocháňová ¹¹ Zdenek Kucera ¹² Christopher Le ¹³ Thomas Link ¹⁴ Julien Mancini ¹⁵ Dominika Miksova ⁹ Doris Schaeffer ⁹ Carlota Ribeiro da Silva ¹⁶ Kristine Sorensen ¹⁷ Christa Straßmayr ⁸ Miguel Telo De Arriaga ¹⁶ Mitja Vrdelja ¹⁸ Jürgen Pelikan ⁸

• ¹ Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel
• ² Institut de recherche en sciences psychologiques, Faculté de psychologie et des sciences de l'éducation, Université Catholique de Louvain, Louvain-la-Neuve, Walloon Brabant, Belgium
• ³ Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
• ⁴ Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalberg, Denmark
• ⁵ Department of Health, Dublin, Dublin, Ireland
• ⁶ Careum Foundation, Careum Center for Health Literacy, Zurich, Switzerland
• ⁷ Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences,, Elverum, Norway
• ⁸ Competence Centre Health Promotion and Healthcare, Austrian National Public Health Institute, Vienna, Austria
• ⁹ School of Public Health, Bielefeld University, Bielefeld, Germany
• ¹⁰ Department of Nursing and Health Promotion, Faculty of Health Sciences, Oslo Metropolitan University, oslo, Norway
• ¹¹ Department of Public Health, Faculty of Health Care and Social Work, Trnava University, Trnava, Czechia
• ¹² Czech Health Literacy Institute, Prague, Czechia
• ¹³ Department of Health and Nursing Sciences, Faculty of Social and Health Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
• ¹⁴ Department of Quality Measurement and Patient Survey, Austrian National Public Health Institute, vienna, Austria
• ¹⁵ Aix Marseille University, APHM INSERM, IRD, ISSPAM, SESSTIM, Cancer, Biomedicine & Society Group, marseille, France
• ¹⁶ Direção-Geral da Saúde, Lisbon, Portugal
• ¹⁷ Global health literacy academy, Risskov, Denmark
• ¹⁸ Communication Unit, National Institute of Public Health, Trubarjeva, Slovenia

Digital health information sources are playing an increasingly prominent role in health promotion, public health and in healthcare systems. Consequently, digital health literacy skills are likewise becoming increasingly important. Using a concept validation approach, the present study aimed to validate a digital health literacy measure applied in the European Health Literacy Survey 2019-2021 (HLS19) of the WHO M-POHL Network. Analyzing data from 29,160 respondents from 13 European countries, the scale displayed high internal consistency. Confirmatory factor analysis (CFA) strengthened the hypothesized one-factor structure. In most countries, the data displayed acceptable fit to the unidimensional Rasch partial credit model (PCM). Pearson correlation with a measure of general health literacy showed sufficient discriminant validity, and a social gradient was found. Testing for predictive validity showed that the scale score predicts health-related outcomes. The study shows that considerable proportions of the general adult populations across 13 countries in Europe have limited DHL skills. The level of DHL has direct potential consequences for some forms of health service utilization, in some countries. Implications of the study include recommendations for improving digital health literacy, promoting organizational health literacy and quality assurance for digital health information and resources.