Afroogh, S., Akbari, A., Malone, E., Kargar, M. & Alambeigi, H. Trust in AI: progress, challenges, and future directions. Humanit. Soc. Sci. Commun. 11, 1568 (2024).
Feng, J., Lazar, J. & Preece, J. Empathy and online interpersonal trust: a fragile relationship. Behav. Inf. Technol. 23, 97–106 (2004).
Gille, F., Jobin, A. & Ienca, M. What we talk about when we talk about trust: theory of trust for AI in healthcare. Intell. Based Med 1–2, 100001 (2020).
Ivic, R. K. Who shapes the future of health communication? Networks, silos, and new imperatives in the digital age. J. Health Commun. 30, 522–527 https://doi.org/10.1080/10810730.2025.2574675 (2025).
Reddy, S. Generative AI in healthcare: an implementation science informed translational path on application, integration and governance. Implement. Sci. 19, 27 (2024).
Fahim, Y. A., Hasani, I. W., Kabba, S. & Ragab, W. M. Artificial intelligence in healthcare and medicine: clinical applications, therapeutic advances, and future perspectives. Eur. J. Med. Res. 30, 848 (2025).
Demir, F. & Yavuz, U. Evaluating the performance of generative artificial intelligence models in multidimensional data analysis tasks: a comparative study with large language models. Discov. Comput. 29, 20 (2026).
Desai, A. N. Artificial intelligence: promise, pitfalls, and perspective. JAMA 323, 2448–2449 (2020).
Knight, D. R. T. et al. Artificial intelligence for patient scheduling in the real-world health care setting: a metanarrative review. Health Policy Technol. 12, 100824 (2023).
Mohsin Khan, M. et al. Towards secure and trusted AI in healthcare: a systematic review of emerging innovations and ethical challenges. Int. J. Med. Inf. 195, 105780 (2025).
Holzinger, A., Langs, G., Denk, H., Zatloukal, K. & Müller, H. Causability and explainability of artificial intelligence in medicine. WIREs Data Min. Knowl. Discov. 9, e1312 (2019).
Ji, J. et al. AI alignment: a comprehensive survey. Preprint at https://doi.org/10.48550/ARXIV.2310.19852 (2023).
Shin, D. The effects of explainability and causability on perception, trust, and acceptance: implications for explainable AI. Int. J. Hum. Comput. Stud 146, 102551 (2021).
Ratzan, S. C. Health literacy: communication for the public good. Health Promot. Int. 16, 207–214 (2001).
Ackerson, L. K. & Viswanath, K. The social context of interpersonal communication and health. J. Health Commun. 14, 5–17 (2009).
Aydın, G. Ö, Kaya, N. & Turan, N. The role of health literacy in access to online health information. World Conf. Technol. Innov. Entrep. 195, 1683–1687 (2015).
Nutbeam, D. Health literacy as a public health goal: a challenge for contemporary health education and communication strategies into the 21st century. Health Promot. Int. 15, 259–267 (2000).
Committee on Health Literacy, Board on Neuroscience and Behavioral Health & Institute of Medicine. Health Literacy: A Prescription to End Confusion https://doi.org/10.17226/10883 (National Academies Press, 2004).
Peerson, A. & Saunders, M. Health literacy revisited: what do we mean and why does it matter? Health Promot. Int. 24, 285–296 (2009).
Nutbeam, D. The evolving concept of health literacy. Soc. Sci. Med. 67, 2072–2078 (2008).
Parker, R. & Ratzan, S. C. Health literacy: a second decade of distinction for Americans. J. Health Commun. 15, 20–33 (2010).
Ratzan, S. C. & Parker, R. M. Health literacy—identification and response. J. Health Commun. 11, 713–715 (2006).
Paasche-Orlow, M. K., Parker, R. M., Gazmararian, J. A., Nielsen-Bohlman, L. T. & Rudd, R. R. The prevalence of limited health literacy. J. Gen. Intern. Med. 20, 175–184 (2005).
Parker, R. M., Baker, D. W., Williams, M. V. & Nurss, J. R. The test of functional health literacy in adults: a new instrument for measuring patients’ literacy skills. J. Gen. Intern. Med. 10, 537–541 (1995).
Parker, R. M., Ratzan, S. C. & Lurie, N. Health literacy: a policy challenge for advancing high-quality health care. Health Aff. (Millwood) 22, 147–153 (2003).
Hill, R. M., Oosterhoff, B., King, C. A. & Kaplow, J. B. Open trial of a brief, web-assisted behavioural intervention to reduce thwarted belongingness and suicidal ideation among adolescents: the Supporting Grieving Teens intervention. Couns. Psychother. Res. 23, 211–221 (2023).
Osborne, R. H., Batterham, R. W., Elsworth, G. R., Hawkins, M. & Buchbinder, R. The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ). BMC Public Health 13, 658 (2013).
Edwards, M., Wood, F., Davies, M. & Edwards, A. The development of health literacy in patients with a long-term health condition: the health literacy pathway model. BMC Public Health 12, 130 (2012).
Sørensen, K. et al. Measuring health literacy in populations: illuminating the design and development process of the European Health Literacy Survey Questionnaire (HLS-EU-Q). BMC Public Health 13, 948 (2013).
Guzys, D., Kenny, A., Dickson-Swift, V. & Threlkeld, G. A critical review of population health literacy assessment. BMC Public Health 15, 215 (2015).
Koh, H. K., Baur, C., Brach, C., Harris, L. M. & Rowden, J. N. Toward a systems approach to health literacy research. J. Health Commun. 18, 1–5 (2013).
Sørensen, K. et al. Health literacy and public health: a systematic review and integration of definitions and models. BMC Public Health 12, 80 (2012).
Yang, K., Hu, Y. & Qi, H. Digital health literacy: bibliometric analysis. J. Med. Internet Res. 24, e35816 (2022).
Moriishi, C. et al. Factor structure of self-reported health literacy scales: a large-scale cross-sectional study among Japanese-speaking adults. Health Promot. Int. 40, daaf135 (2025).
Park, S. & Ahmed, R. “I learned myself”: using structuration theory to uncover Korean immigrants’ health literacy development in the U.S. as an agentic behavior during the COVID-19 pandemic. Health Commun. 40, 154–164 (2025).
DeWalt, D. A., Berkman, N. D., Sheridan, S., Lohr, K. N. & Pignone, M. P. Literacy and health outcomes: a systematic review of the literature. J. Gen. Intern. Med. 19, 1228–1239 (2004).
Shahid, R. et al. Impact of low health literacy on patients’ health outcomes: a multicenter cohort study. BMC Health Serv. Res. 22, 1148 (2022).
Jensen, K. V. et al. Low caregiver health literacy is associated with non-urgent pediatric emergency department use. Can. J. Emerg. Med. 27, 17–26 (2025).
Poon, P. K. M. et al. Poor health literacy associated with stronger perceived barriers to breast cancer screening and overestimated breast cancer risk. Front. Oncol. 12, 1053698 (2023).
Gazmararian, J. A. Health literacy among Medicare enrollees in a managed care organization. JAMA 281, 545–551 (1999).
Altin, S. V., Finke, I., Kautz-Freimuth, S. & Stock, S. The evolution of health literacy assessment tools: a systematic review. BMC Public Health 14, 1207 (2014).
Chen, J. et al. Impact of multifaceted health education on influenza vaccination health literacy in primary school students: a cluster randomized controlled trial. BMC Med. 23, 333 (2025).
Chen, Y. The roles of prevention messages, risk perception, and benefit perception in predicting binge drinking among college students. Health Commun. 33, 877–886 (2018).
Berkman, N. D., Sheridan, S. L., Donahue, K. E., Halpern, D. J. & Crotty, K. Low health literacy and health outcomes: an updated systematic review. Ann. Intern. Med. 155, 97–107 (2011).
Ayre, J. et al. Online plain language tool and health information quality: a randomized clinical trial. JAMA Netw. Open 7, e2437955 (2024).
Talevski, J., Wong Shee, A., Rasmussen, B., Kemp, G. & Beauchamp, A. Teach-back: a systematic review of implementation and impacts. PLoS ONE 15, e0231350 (2020).
Rosenfeld, L. E., McCullagh, K., King, C. J., Torres, M. & Litt, J. S. Organizational health literacy as a tool for health equity: application in a high-risk infant follow-up program. Children 10, 1658 (2023).
Qi, S., Hua, F., Xu, S., Zhou, Z. & Liu, F. Trends of global health literacy research (1995–2020): analysis of mapping knowledge domains based on citation data mining. PLoS ONE 16, e0254988 (2021).
Walters, R., Leslie, S. J., Polson, R., Cusack, T. & Gorely, T. Establishing the efficacy of interventions to improve health literacy and health behaviours: a systematic review. BMC Public Health 20, 1040 (2020).
Dunn, P. & Hazzard, E. Technology approaches to digital health literacy. Int. J. Cardiol. 293, 294–296 (2019).
Zachariah, D. et al. Addressing the health literacy needs and experiences of culturally and linguistically diverse populations in Australia during COVID-19: a research embedded participatory approach. J. Health Commun. 27, 439–449 (2022).
Malik, A., Kumar, S., Basu, S. & Bebenroth, R. Managing disruptive technologies for innovative healthcare solutions: the role of high-involvement work systems and technologically-mediated relational coordination. J. Bus. Res. 161, 113828 (2023).
Sittig, D. F., Belmont, E. & Singh, H. Improving the safety of health information technology requires shared responsibility: it is time we all step up. Healthcare 6, 7–12 (2018).
Nutbeam, D. Artificial intelligence and health literacy—proceed with caution. Health Lit. Commun. Open 1, 2263355 (2023).
Parker, S. M. et al. Preventing chronic disease in overweight and obese patients with low health literacy using eHealth and teamwork in primary healthcare (HeLP-GP): a cluster randomised controlled trial. BMJ Open 12, e060393 (2022).
Alhawas, A. K. A. et al. Enhancing public engagement with health information by digital health literacy: a detail review on role of stakeholders, emerging trends, challenges and future directions. J. Int. Crisis Risk Commun. Res. 7, 2252–2268 (2024).
Arias López, M. D. P. et al. Digital literacy as a new determinant of health: a scoping review. PLoS Digit. Health 2, e0000279 (2023).
Yu, Z. Beyond hype: separating large language model–driven health literacy from clinical decision support system diagnostic rigour. Aust. Crit. Care 38, 101265 (2025).
Azmuddin, R. A., Mohd Dom, T. N., Rani, H., Abdul Rahman, A. N. C. & Hamat, A. The use of digital annotation tools in improving online public health literacy among youths. GEMA Online J. Lang. Stud. 23, 132–151 (2023).
Abdollahpour, I., Yazdi, M., Kelishadi, R. & Paakkari, O. Health literacy as the most important covariate of self-rated health in adolescents. Sci. Rep. 15, 19109 (2025).
Merga, M. K. TikTok and digital health literacy: a systematic review. IFLA J. 51, 490–501 (2025).
Van Dijck, J., Poell, T. & De Waal, M. The Platform Society https://doi.org/10.1093/oso/9780190889760.001.0001 (Oxford Univ. Press, 2018).
Langford, A. T., Larkin, K., Resnicow, K., Zikmund-Fisher, B. J. & Fagerlin, A. Understanding the role of message frames on African-American willingness to participate in a hypothetical diabetes prevention study. J. Health Commun. 22, 647–656 (2017).
Bucher, T. If…Then: Algorithmic Power and Politics https://doi.org/10.1093/oso/9780190493028.001.0001 (Oxford Univ. Press, 2018).
Ueda, D. et al. Fairness of artificial intelligence in healthcare: review and recommendations. Jpn. J. Radiol. 42, 3–15 (2024).
Ananny, M. & Crawford, K. Seeing without knowing: limitations of the transparency ideal and its application to algorithmic accountability. New Media Soc. 20, 973–989 (2018).
Laranjo, L. et al. Conversational agents in healthcare: a systematic review. J. Am. Med. Inf. Assoc. 25, 1248–1258 (2018).
Milne-Ives, M. et al. The effectiveness of artificial intelligence conversational agents in health care: systematic review. J. Med. Internet Res. 22, e20346 (2020).
Rodger, D. et al. Generative AI in healthcare education: how AI literacy gaps could compromise learning and patient safety. Nurse Educ. Pract. 87, 104461 (2025).
Alowais, S. A. et al. Revolutionizing healthcare: the role of artificial intelligence in clinical practice. BMC Med. Educ. 23, 689 (2023).
Ghassemi, M., Oakden-Rayner, L. & Beam, A. L. The false hope of current approaches to explainable artificial intelligence in health care. Lancet Digit. Health 3, e745–e750 (2021).
Khalid, H. et al. A comparative systematic literature review on knee bone reports from MRI, X-rays and CT scans using deep learning and machine learning methodologies. Diagnostics 10, 518 (2020).
Papagiannidis, E., Mikalef, P. & Conboy, K. Responsible artificial intelligence governance: a review and research framework. J. Strateg. Inf. Syst. 34, 101885 (2025).
Chatzichristos, C. et al. Bridging the AI-literacy gap in health care: qualitative analysis of the Flanders case study. J. Med. Internet Res. 27, e76709 (2025).
Dolezel, D. et al. Assessing artificial intelligence literacy: what do health information professionals know about AI? Adv. Health Inf. Sci. Pract. 1, KLVV3078 (2025).
Yoga Ratnam, K. K. Generative artificial intelligence in public health research and scientific communication: a narrative review of real applications and future directions. Digit. Health 11, 20552076251362070 (2025).
Zaidan, E. & Ibrahim, I. A. AI governance in a complex and rapidly changing regulatory landscape: a global perspective. Humanit. Soc. Sci. Commun. 11, 1121 (2024).
Ng, D. T. K., Leung, J. K. L., Chu, S. K. W. & Qiao, M. S. Conceptualizing AI literacy: an exploratory review. Comput. Educ. Artif. Intell. 2, 100041 (2021).
Zhang, P. & Kamel Boulos, M. N. Generative AI in medicine and healthcare: promises, opportunities and challenges. Future Internet 15, 286 (2023).
Abeo, A. N. A., Armstrong, S., Scriney, M. & Goss, H. Artificial intelligence techniques and health literacy: a systematic review. Mayo Clin. Proc. Digit. Health 3, 100269 (2025).
Chiu, T. K. F., Ahmad, Z., Ismailov, M. & Sanusi, I. T. What are artificial intelligence literacy and competency? A comprehensive framework to support them. Comput. Educ. Open 6, 100171 (2024).
Sabatini, J., Graesser, A. C., Hollander, J. & O’Reilly, T. A framework of literacy development and how AI can transform theory and practice. Br. J. Educ. Technol. 54, 1174–1203 (2023).
Chee, H., Ahn, S. & Lee, J. A competency framework for AI literacy: variations by different learner groups and an implied learning pathway. Br. J. Educ. Technol. 56, 2146–2182 (2025).
Brach, C. et al. Ten attributes of health literate health care organizations. NAM Perspectives https://doi.org/10.31478/201206a (National Academy of Medicine, 2012).
Karimov, A. & Saarela, M. AI literacy and governance as foundations for ethical AI: a cross-national review of government strategies. In 2025 IEEE Symposium on Trustworthy, Explainable and Responsible Computational Intelligence (CITREx) 1–7 https://doi.org/10.1109/CITREx64975.2025.10974932 (IEEE, 2025).
Chau, M., Rahman, M. G. & Debnath, T. From black box to clarity: strategies for effective AI informed consent in healthcare. Artif. Intell. Med. 167, 103169 (2025).
Hibbard, J. H. & Peters, E. Supporting informed consumer health care decisions: data presentation approaches that facilitate the use of information in choice. Annu. Rev. Public Health 24, 413–433 (2003).
Woolf, S. H. et al. Promoting informed choice: transforming health care to dispense knowledge for decision making. Ann. Intern. Med. 143, 293–300 (2005).
You, Z., Wang, Y. & Xiao, Y. Analysing the suitability of artificial intelligence in healthcare and the role of AI governance. Health Care Anal. 33, 413–445 (2025).
Ciancio, A., Kämpfen, F., Kohler, H.-P. & Thornton, R. Surviving bad news: health information without treatment options. Am. Econ. Rev. Insights 7, 1–18 (2025).
Panteli, D. et al. Artificial intelligence in public health: promises, challenges, and an agenda for policy makers and public health institutions. Lancet Public Health 10, e428–e432 (2025).
Ratzan, S. C. et al. The Quality Health Information for All Commission: reinventing health communication for the digital era. Nat. Med. 31, 22–23 (2025).
Piltch-Loeb, R. et al. A global survey on trust, digital health literacy and health information quality. Nat. Health https://doi.org/10.1038/s44360-026-00102-4 (2026).
Sagona, M., Dai, T., Macis, M. & Darden, M. Trust in AI-assisted health systems and AI’s trust in humans. NPJ Health Syst. 2, 10 (2025).
Khosravi, M., Zare, Z., Mojtabaeian, S. M. & Izadi, R. Artificial intelligence and decision-making in healthcare: a thematic analysis of a systematic review of reviews. Health Serv. Res. Manage. Epidemiol. 11, 23333928241234863 (2024).
Hassan, M., Borycki, E. M. & Kushniruk, A. W. Artificial intelligence governance framework for healthcare. Healthc. Manage. Forum 38, 125–130 (2025).
Saenz, A. D. et al. Establishing responsible use of AI guidelines: a comprehensive case study for healthcare institutions. NPJ Digit. Med. 7, 348 (2024).
McKenna, V. B., Sixsmith, J. & Barry, M. M. The relevance of context in understanding health literacy skills: findings from a qualitative study. Health Expect. 20, 1049–1060 (2017).
Abou Hashish, E. A. & Alnajjar, H. Digital proficiency: assessing knowledge, attitudes, and skills in digital transformation, health literacy, and artificial intelligence among university nursing students. BMC Med. Educ. 24, 508 (2024).
Lenstra, N., DeGuzman, P. B., McConnaughy, R. & Weis, M. How do public library partnerships impact health? A scoping review. Health Promot. Pract. 27, 173–191 (2026).
McGinty, E. E. et al. The Lancet Psychiatry Commission: transforming mental health implementation research. Lancet Psychiatry 11, 368–396 (2024).
Reis, M., Reis, F. & Kunde, W. Influence of believed AI involvement on the perception of digital medical advice. Nat. Med. 30, 3098–3100 (2024).
Williams, M., Karim, W., Gelman, J. & Raza, M. Ethical data acquisition for LLMs and AI algorithms in healthcare. NPJ Digit. Med. 7, 377 (2024).
Abby Prestin, S. N. V. & Chou, W. S. Is online health activity alive and well or flatlining? Findings from 10 years of the Health Information National Trends Survey. J. Health Commun. 20, 790–798 (2015).
Acevedo Callejas, M. L. & Thompson, C. M. Stress, frequency of challenges, and coping for partners of individuals with mental health conditions. Health Commun. 32, 880–889 (2017).
Duggan, A. Understanding interpersonal communication processes across health contexts: advances in the last decade and challenges for the next decade. J. Health Commun. 11, 93–108 (2006).
Ratzan, S. C. The Journal of Health Communication: International Perspectives editor’s reflection—the first decade. J. Health Commun. 11, 5–6 (2006).
Editorial Board for Special Issue of Health Communication The extended parallel process model: two decades later. Health Commun. 28, 99 (2013).