DIGITAL GAPS AT HOME: PARENTAL LITERACY AND HEALTH DISPARITIES AMONG SCHOOL CHILDREN
DOI:
https://doi.org/10.71000/5yqnmq95Keywords:
Child Health, Digital Literacy, Health Behavior, Hygiene, Internet Access, Parental Influence, Socioeconomic FactorsAbstract
Background: The digital divide continues to be a critical global health challenge, particularly in low- and middle-income countries such as Pakistan. Barriers including poor internet access, limited availability of digital devices, and inadequate digital literacy impede equitable access to healthcare and education. For children in their primary school years, this gap adversely influences physical, cognitive, and behavioral development. Parental digital health literacy has recently gained recognition as a pivotal factor shaping child health outcomes, yet its influence in disadvantaged populations remains underexplored.
Objective: This study aimed to examine the impact of parental digital health literacy and health-related communication on hygiene practices and physical activity engagement among primary school-aged children in Lahore, Pakistan.
Methods: A cross-sectional study was conducted in 2024 among 384 parents of children aged 6–12 years enrolled in grades 1–5 across public and private schools in Lahore. Stratified random sampling ensured inclusion of urban and peri-urban populations across different socioeconomic strata. Data were collected using structured questionnaires incorporating validated tools, including items from the HLS19 and CPAQ. Analyses were conducted using IBM SPSS v27. Descriptive statistics summarized participant characteristics, while inferential tests included one-way ANOVA, independent samples t-test, and chi-square test, with statistical significance defined as p<0.05.
Results: Significant differences were observed across parental digital engagement categories. Children whose parents frequently shared health information online achieved the highest hygiene scores (M=3.719, SD=0.229) compared with those whose parents rarely (M=2.904, SD=0.490) or never (M=2.902, SD=0.404) communicated such information (F(4, 38)=109.185, p<0.001). Parents who used digital platforms reported higher hygiene outcomes for their children (M=3.59, SD=0.305) compared with those not using platforms (M=3.02, SD=0.497; t(239.04)=12.8, p<0.001). Chi-square analysis further revealed a strong association between frequency of parental health discussions and child engagement in physical activity (χ²=80.60, p<0.001).
Conclusion: Parental digital literacy and active health communication substantially improve hygiene practices and physical activity participation among primary school-aged children. Interventions that bridge the digital literacy gap among caregivers may play a transformative role in reducing child health inequities in underserved settings.
References
Aboye, G. T., Simegn, G. L., & Aerts, J. M. (2024). Assessment of the Barriers and Enablers of the Use of mHealth Systems in Sub-Saharan Africa According to the Perceptions of Patients, Physicians, and Health Care Executives in Ethiopia: Qualitative Study. Journal of Medical Internet Research, 26(1), 1–22.
Adil, A., Usman, A., Khan, N. M., & Mirza, F. I. (2021). Adolescent health literacy: factors effecting usage and expertise of digital health literacy among universities students in Pakistan. BMC Public Health, 21(1), 1–6.
Ahmad, A. H. (2024). Dr. Yunas Khan Fazli Rahman Arbab Haris Ahmad. 02(04), 1221–1235.
Ahmer, H., Farooqui, K., Jivani, K., Adamjee, R., & Hoodbhoy, Z. (2024). Applying the principles for digital development to improve maternal and child health in the Peri-urban areas of Karachi, Pakistan. PLOS Digital Health, 3(1), 1–15.
Arshanapally, S., Green, K., Slaughter, K., Muller, R., & Wheaton, D. (2022). Use of a Paid Digital Marketing Campaign to Promote a Mobile Health App to Encourage Parent- Engaged Developmental Monitoring: Implementation Study. JMIR Pediatrics and Parenting, 5(2), 1–13.
Benítez-Andrades, J. A., Arias, N., García-Ordás, M. T., Martínez-Martínez, M., & García- Rodríguez, I. (2020). Feasibility of social-network-based ehealth intervention on the improvement of healthy habits among children. Sensors (Switzerland), 20(5).
Causio, F. A., Gandolfi, S., Kaur, J., Sert, B., Fakhfakh, M., Angelis, L. De, Pumpo, M. Di, Diedenhofen, G., Berionni, A., Cascini, F., Morita, P., & Mackey, T. (2025). Impact of Digital Health Interventions on Health Literacy: A Systematic Review with Quality Appraisal.
Chidambaram, S., Jain, B., Jain, U., Mwavu, R., Baru, R., Thomas, B., Greaves, F., Jayakumar, S., Jain, P., Rojo, M., Battaglino, M. R., Meara, J. G., Sounderajah, V., Celi, L. A., & Darzi, (2024). An introduction to digital determinants of health. PLOS Digital Health, 3(1 January), 1–14.
Choukou, M. A., Sanchez-Ramirez, D. C., Pol, M., Uddin, M., Monnin, C., & Syed-Abdul, S. (2022a). COVID-19 infodemic and digital health literacy in vulnerable populations: A scoping review. Digital Health, 8(172).
Choukou, M. A., Sanchez-Ramirez, D. C., Pol, M., Uddin, M., Monnin, C., & Syed-Abdul, S. (2022b). COVID-19 infodemic and digital health literacy in vulnerable populations: A scoping review. Digital Health, 8(172).
De Buhr, E., & Tannen, A. (2020). Parental health literacy and health knowledge, behaviours and outcomes in children: A cross-sectional survey. BMC Public Health, 20(1), 1–9.
Dolcini, M. M., Canchola, J. A., Catania, J. A., Mayeda, M. M. S., Dietz, E. L., Cotto-Negrón, C., & Narayanan, V. (2021). National-level disparities in internet access among low-income and black and hispanic youth: Current population survey. Journal of Medical Internet Research, 23(10).
Farooqi, A., Khalid, U., & Khan, A. M. (2022). Understanding the Digital Divide in the Contemporary Digital World. Global Political Review, VII(IV), 7–14.
Girmay, M. (2024). Child Health and AIDS Digital Health Divide: Opportunities for Reducing Health Disparities and Promoting Equitable Care for Maternal and Child Health Populations. 13, 1–5.
Gong, E., Wang, H., Zhu, W., Galea, G., Xu, J., Yan, L. L., & Shao, R. (2024). Bridging the digital divide to promote prevention and control of non-communicable diseases for all in China and beyond. BMJ (Clinical Research Ed.), 387, e076768.
GSMA. (2022). The Mobile Economy 2022. GSMA Assosciation, 1–56.
Gulzar, S., Saeed, S., Kirmani, S. T., & Karmaliani, R. (2022). Enhancing the knowledge of parents on child health using eLearning in a government school in the semi-rural community of Karachi, Pakistan. PLOS Global Public Health, 2(6), 1–10.
Hentschel, E., Tomlinson, H., Hasan, A., Yousafzai, A., Ansari, A., Tahir-Chowdhry, M., & Zamand, M. (2024). Risks to Child Development and School Readiness Among Children Under Six in Pakistan: Findings from a Nationally Representative Phone Survey. In International Journal of Early Childhood (Vol. 56, Issue 1). Springer Netherlands.
Hernandez, A. M., Khoong, E. C., Kanwar, N., Lopez-Solano, N., Rodriguez, J. A., De Marchis, E., Nguyen, O. K., & Casillas, A. (2024). Lessons learned from a multi-site collaborative working toward a digital health use screening tool. Frontiers in Public Health, 12(July), 1–6.
Hui, C. Y., Abdulla, A., Ahmed, Z., Goel, H., Habib, G. M. M., Hock, T. T., Khandakr, P., Mahmood, H., Nautiyal, A., Nurmansyah, M., Panwar, S., Patil, R., Rinawan, F. R., Salim, H., Satav, A., Shah, J. N., Shukla, A., Tanim, C. Z. H., Balharry, D., & Pinnock, H. (2022). Mapping national information and communication technology (ICT) infrastructure to the requirements of potential digital health interventions in low and middle-income countries. Journal of Global Health, 12.
Irfan, B., & Yaqoob, A. (2024). The Digital Lifeline: Telemedicine and Artificial Intelligence Synergy as a Catalyst for Healthcare Equity in Pakistan. Cureus, 16(2), 16–18.
Sarkar, T., Sharmin, S., Das, S., Roy, T., Harun, M. G. D., Chughtai, A. A., Homaira, N., & Seale, H. (2021). COVID-19 vaccine rumors and conspiracy theories: The need for cognitive inoculation against misinformation to improve vaccine adherence. PLoS ONE, 16(5 May 2021), 1–17.
Jafree, S. R., Bukhari, N., Muzamill, A., Tasneem, F., & Fischer, F. (2021a). Digital health literacy intervention to support maternal, child and family health in primary healthcare settings of Pakistan during the age of coronavirus: Study protocol for a randomised controlled trial. BMJ Open, 11(3), 1–9.
Jafree, S. R., Bukhari, N., Muzamill, A., Tasneem, F., & Fischer, F. (2021b). Digital health literacy intervention to support maternal, child and family health in primary healthcare settings of Pakistan during the age of coronavirus: Study protocol for a randomised controlled trial. BMJ Open, 11(3), 1–9.
Jamil, S., & Muschert, G. (2024). The COVID-19 Pandemic and E-Learning: The Digital Divide and Educational Crises in Pakistan’s Universities. American Behavioral Scientist, 68(9), 1161–1179.
Kan, K., Foster, C., Orionzi, B., Schinasi, D., & Heard-Garris, N. (2024). More than One Divide: A Multilevel View of the Digital Determinants of Health. Journal of Pediatrics, 266, 2023– 2026.
Khadka, S., Pathirana, N. L., Sethi, V., Andreev-Jitaru, D., Nair, A., & Backholer, K. (2025).
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Mahnoor Asif, Rubeena Zakar (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.