The health sector is characterized by an exponential use of digital health technology that serves both for care and for coordination among professionals and facilities and for health care system users (eg, health information, appointments scheduling, and communication with caregivers). Digital health technologies are intended to enhance the autonomy of users, including patients and individuals who use these technologies to support the health of their relatives. This implies that users, whether for themselves or for their loved ones, should have access to health information that enables them to better manage health-related concerns.

Although digital health is promising in terms of technology, its increasing use can lead to unintended negative consequences [1-3]. Indeed, digital health technology can mitigate some geographic location–related barriers, but access to, and the use of, these technologies can be influenced by various factors, including socioeconomic position. Geographic location and socioeconomic position remain important factors influencing the use of digital health technologies.

Individuals’ socioeconomic characteristics and their overall health status can affect how different social groups adopt digital health technologies [4]. Consequently, the growing digital divide may worsen existing social health inequalities. The COVID-19 pandemic has accelerated and amplified the digital divide [5]. The lockdown showed that many people were at a loss when faced with the necessity of carrying out web-based procedures. This health, social, and economic crisis has amplified the risks of digital exclusion. Existing digital tools, such as telemedicine and health websites, have been useful in enabling remote medical consultations or keeping up to date with the spread of the virus. By contrast, countless websites are designed according to technical criteria, rather than on the basis of the experience of users in all their diversity [5]. Therefore, it is important to carefully examine the unexpected, undesirable, and negative consequences of digital health to understand its real impact on people and ensure that public health policies address these issues [1-3].

Studies highlight a social gradient in the access, use, and appraisal of digital health technologies in other countries [6,7], but data are lacking in France, where individuals belonging to the working classes have less access to computers and are less likely to search for health information on the internet [8].

More recently, using data from the Baromètre Santé study conducted between 2010 and 2017, French researchers showed that the profile of health information seekers versus nonseekers has remained consistent over time [9]. Seekers were more likely to be younger, more educated female individuals, with higher household incomes and holding executive positions. In 2017, as in 2014, general health websites remained the top source of information (38.6%), followed by social media and commercial websites, whereas institutional websites ranked as the third source (8.1%) [9]. These authors recommended that health authorities should improve citizens’ digital health literacy and provide reliable and accessible sources of web-based health information.

In response to this issue, some health authorities in different countries have progressively developed mechanisms to provide relevant, accurate, and useful information to health care system users, often through health information websites [10,11]. However, the use of these new sociotechnical tools has been poorly assessed, particularly in terms of differences and inequalities in use among social groups.

The literature includes several studies that have evaluated the quality of health information websites. Some studies have primarily focused on specific information related to particular diseases [12-23] or prevention measures [24-28], whereas other studies have analyzed general health information websites [29-35].

Studies evaluating the quality of health information websites often use automated tools and manual evaluations by professionals. These assessments focus on various criteria, such as readability, the ease of use, reliability, and the quality of information. Tools such as Flesch-Kincaid [14,18,21,22,30,36-41], Flesch Reading Ease [12,18,21,28,30,36-38,41], Simple Measure of Gobbledygook [14,18,21,22,24,30,40], Gunning Fog Index [14,21,22], Coleman-Liau Index [14,21,22], and Automated Readability Index [14,21] measure reading comfort. The Health on the Net Foundation Code of Conduct assesses reliability [17,30,36,42], and the DISCERN tool evaluates health information quality [19,20,28,38,42,43]. The Lida instrument assesses design and content [12,19,37,40], whereas the Clear Communication Index, a tool developed by the Centers for Disease Control and Preventions, evaluates written health materials [32,44]. Some studies also include user perspectives to evaluate website usability and information quality [45,46].

Access to clear and understandable health information is important for informed decision-making, but many health websites are difficult to navigate and read, especially for those with low literacy levels [12,32,37,47]. This can lead to health inequalities [39] and delay the adoption of appropriate health behaviors. Although government websites are usually easier to read [14], improvements are still necessary. Website design and content can also present barriers to use [48]. Few studies focus on the evaluation of a single website, and evaluations often overlook users’ sociodemographic characteristics, health status, and health literacy levels. Therefore, it is important to conduct evaluations that take into account these factors to identify any population groups facing barriers to accessing and understanding health information on these websites.

To make health information websites accessible and user-friendly, it is important to involve users in the evaluation process [32]. Understanding users’ needs and preferences can ensure that the information provided is clear, relevant, and actionable [39]. It is crucial to assess issues related to the accessibility of health information to ensure that all individuals can take advantage of the wealth of health information available on the internet, given the growing focus on patient empowerment in health [48].

In France, the Santé.fr website is a public service website that provides general health information selected for its quality and usefulness. This website is under the Ministry of Health’s responsibility, and its mission is to provide free information on health care as well as medical and social services to the public. The information is adapted and accessible to people with disabilities and aims to encourage citizen participation in health choices, improve patient management, and simplify the adoption of preventive behaviors.

As Santé.fr is an information and support tool for users, it is crucial to track and evaluate its use and identify any disparities among different population groups. Therefore, it is important to explore the experiences and evaluations of Santé.fr users to determine to what extent the information provided meets their needs and expectations. The objective is to ensure that Santé.fr proves to be a genuine advantage for users and does not exacerbate the existing social inequalities by promoting the use of a tool that is inaccessible or unsuitable for a portion of the population because disparities in the access, understanding, appraisal, and use of digital health technology can worsen social health inequalities, depending on individuals’ social position.

The main objective of this study was to evaluate the access, understanding, appraisal, and use of Santé.fr by users according to their socioeconomic position and health status. Our specific objectives were to (1) determine users’ profiles in terms of the access behavior, understanding, appraisal, and use of Santé.fr based on their socioeconomic position and health status; (2) examine the association between users’ socioeconomic position and health status and their access, understanding, appraisal, and use of Santé.fr; and (3) determine the reasons why users of Santé.fr use this service.

The Évaluation du service public d’information en santé (the Santé.fr website) selon le statut socio-économique de ses utilisateurs (evaluation of the public health information service [the Santé.fr website] according to the socioeconomic status of users) study is a cross-sectional observational study of the French population using Santé.fr. It will use mixed methods, that is, it will combine quantitative and qualitative research methods [49]. The study period will last 1 year so that there will be enough time to collect the necessary quantitative and qualitative data.

The study target population is the entire population to which Santé.fr is offered, that is, the general French population. The source population is made up of all health care system users, whether or not they use Santé.fr; the respondents to this study; and the study sample. All inhabitants of metropolitan France and the Départements et régions d’outre-mer et collectivités d’outre-mer (overseas departments and regions and overseas communities) will be concerned by this study. The quantitative and qualitative study inclusion criterion is as follows: any adult (aged ≥18 y) living in metropolitan France or Départements et régions d’outre-mer et collectivités d’outre-mer.

The quantitative study will include both users and nonusers of Santé.fr who visit the website and voluntarily complete the questionnaire. Before participation, all participants will receive comprehensive and adequate information through an information note. Santé.fr users are individuals who have previously consulted Santé.fr or are visiting it for the first time when completing the questionnaire. Nonusers of Santé.fr are individuals who, although aware of this public health information service, have never accessed it before coming across the questionnaire or were not previously familiar with it.

The questionnaire will be self-administered by Santé.fr users, using a computer-assisted web interviewing method (ie, completed on the web). An article on Santé.fr will be developed to present the research team and the study to participants and to share the external link to the questionnaire. A poster will be designed to encourage users to participate in the study. The article and the questionnaire will be displayed on Santé.fr at several navigation levels (eg, thumbnail on the home page, contextual message block, end of an article, and thematic folder) to increase access to the questionnaire. Users connecting to Santé.fr will be able to click directly on the poster and reach either the article or the questionnaire. Users will decide whether to participate in the study. A communication plan will be elaborated by the research team to disseminate the study as much as possible.

The qualitative study will include individuals, who may or may not be users of Santé.fr, with a variety of profiles, including different sexes, age groups, geographic origins, and socioeconomic positions. Specifically, socioeconomic position will be assessed based on criteria such as education level, occupational category, and income level.

Participants will be recruited through the following channels:

For the quantitative study, a sample size calculation was performed. As we had no information on the proportion of Santé.fr users, we calculated the number of participants necessary according to the estimation formula in the case of an expected prevalence of 50% with a risk of error α of 5% and a precision of 5%. A sample of 385 people was deemed necessary. For the qualitative study, we estimate conducting 30 interviews, taking into account feasibility and the need for a wide range of respondent profiles.

The data collection and processing implemented in this research conforms to the Commission nationale de l’informatique et des libertés (National Commission of Informatics and Liberties) reference methodology MR-004 (research not involving human persons, studies, or evaluations in the health field).

An information note at the beginning of the questionnaire informs participants about the study, its objectives, its progress, the processing of personal data, and their rights. By completing the questionnaire, the participants implicitly agree to share their data for scientific purposes. For the interviews, the participants will give their oral consent.

Personal data will be processed to analyze the results of the research in relation to its objectives. The data collected will be recorded in a digital file that complies with several data security and confidentiality conditions. The data will be deidentified (ie, anonymized) using the following techniques: we have ensured that the nature of the response modalities is broad enough to prevent the recognition of the person who completed the questionnaire (such as age group and income group); we do not collect nominative data; and we assign a numerical identifier specific to the study to pinpoint the respondent that is known only to the research team.

No compensation will be offered to users for participating in the study.

The first difficulty concerning the quantitative part of the study could be linked to the recruitment of participants, given that participation in the study will be on a voluntary basis. Despite our efforts to aim at a wide dissemination at several navigation levels on Santé.fr (eg, thumbnail on the home page, contextual message block, end of an article, and thematic folder) to multiply access to the questionnaire, the response rate could prove to be too low to allow statistical analyses to be conducted. For the time being, owing to the different waves of the COVID-19 pandemic, the current pop-in dedicated to screening and vaccination against COVID-19 and appearing on any page after a few minutes of navigation could not be removed and replaced by a message presenting the study. It would therefore be advisable to provide maximum visibility for the study on Santé.fr; for example, a pop-in would make it possible to make the study visible to each user and thus increase the chances of response. Moreover, as Santé.fr users prefer to access the website on their mobile phones, if the study does not appear on the home page on mobile phones, the number of respondents could be insufficient can be used.

By contrast, people who feel uncomfortable using the internet could also have difficulties accessing the questionnaire. A lack of motivation or time to complete the questionnaire as well as a low interest in digital health topics and research could decrease the response rate to the study. Compensation for participating in the study could give users a reason to complete the questionnaire.

For the qualitative study too, the lack of sufficiently diverse respondents could be a challenge. In addition, the risk of social desirability bias in the interviewees’ responses to the interviewer could be an issue.

This study would be the first of its kind in France and, more widely, in Europe to focus on the evaluation of a digital health information website according to users’ socioeconomic position.

The study that we intend to set up is thus essential because it will make it possible to fill a gap in the existing literature. More precisely, it will allow us to discover the issues related to inequalities in access to, and the use of, digital technologies to obtain health information. This study will give an insight into the digital divide that accounts for the poor access to these digital health information services for people who do not have access to the necessary material conditions such as digital devices and an internet connection. This study will discover the social inequalities that affect the access, understanding, appraisal, and use of health information found on the internet, particularly among people with lower levels of education, income, and digital health literacy.

As access to health information on the internet is crucial for health decision-making and for people’s empowerment, if inequalities in access are discovered by this study, then they may also be related to inequalities in the health status of social groups. It would therefore be important to ensure that all social groups have equal access to Santé.fr, a quality digital health information service offering reliable health information.

With regard to our research subject, using mixed methods is a relevant choice because it will allow us to combine quantitative methods (questionnaire) and qualitative methods (interviews and focus groups). The quantitative methods will make it possible to obtain an overview of access to Santé.fr and to measure specific indicators (access, understanding, appraisal, and use) that constitute the digital health literacy determinants. The combination of these 2 methods will give a complete and more accurate view of this evaluation through quantitative results and user experiences that may be influenced by users’ socioeconomic position. Reasons for the use or lack of use can be obtained through the qualitative component of the study.

This study could serve as a feasibility study for collecting data on the French population’s habits regarding the use of the internet to access health information, which could be incorporated into general national health surveys for regular monitoring purposes as well as Santé.fr follow-up surveys.