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A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ).

ABSTRACT: BACKGROUND:For people to be able to access, understand, and benefit from the increasing digitalization of health services, it is critical that services are provided in a way that meets the user's needs, resources, and competence. OBJECTIVE:The objective of the study was to develop a questionnaire that captures the 7-dimensional eHealth Literacy Framework (eHLF). METHODS:Draft items were created in parallel in English and Danish. The items were generated from 450 statements collected during the conceptual development of eHLF. In all, 57 items (7 to 9 items per scale) were generated and adjusted after cognitive testing. Items were tested in 475 people recruited from settings in which the scale was intended to be used (community and health care settings) and including people with a range of chronic conditions. Measurement properties were assessed using approaches from item response theory (IRT) and classical test theory (CTT) such as confirmatory factor analysis (CFA) and reliability using composite scale reliability (CSR); potential bias due to age and sex was evaluated using differential item functioning (DIF). RESULTS:CFA confirmed the presence of the 7 a priori dimensions of eHLF. Following item analysis, a 35-item 7-scale questionnaire was constructed, covering (1) using technology to process health information (5 items, CSR=.84), (2) understanding of health concepts and language (5 items, CSR=.75), (3) ability to actively engage with digital services (5 items, CSR=.86), (4) feel safe and in control (5 items, CSR=.87), (5) motivated to engage with digital services (5 items, CSR=.84), (6) access to digital services that work (6 items, CSR=.77), and (7) digital services that suit individual needs (4 items, CSR=.85). A 7-factor CFA model, using small-variance priors for cross-loadings and residual correlations, had a satisfactory fit (posterior productive P value: .27, 95% CI for the difference between the observed and replicated chi-square values: -63.7 to 133.8). The CFA showed that all items loaded strongly on their respective factors. The IRT analysis showed that no items were found to have disordered thresholds. For most scales, discriminant validity was acceptable; however, 2 pairs of dimensions were highly correlated; dimensions 1 and 5 (r=.95), and dimensions 6 and 7 (r=.96). All dimensions were retained because of strong content differentiation and potential causal relationships between these dimensions. There is no evidence of DIF. CONCLUSIONS:The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool based on a well-defined a priori eHLF framework with robust properties. It has satisfactory evidence of construct validity and reliable measurement across a broad range of concepts (using both CTT and IRT traditions) in various groups. It is designed to be used to understand and evaluate people's interaction with digital health services.

SUBMITTER: Kayser L

PROVIDER: S-EPMC5826975 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:BACKGROUND:The Health Literacy Questionnaire (HLQ) is a multidimensional generic questionnaire developed to capture a wide range of health literacy needs. There is a need for validation evidence for the Norwegian version of the HLQ (N-HLQ). OBJECTIVE:The present study tested an initial version of the Norwegian HLQ by exploring its utility and construct validity among a group of nursing students. METHODS:A pre-test survey was performed in participants (N = 18) who were asked to consider every item in the N-HLQ (44 items across nine scales). The N-HLQ was then administered to 368 respondents. Scale consistency was identified and extracted in a series of factor analyses (principal component analysis [PCA] with oblimin rotation) demanding a nine-dimension solution performed on randomly drawn 50% of the samples obtained by bootstrapping. Correlations between the nine factors obtained in the 13-factor PCA and the scale scores computed by the scale scoring syntaxes provided by the authors of the original HLQ were estimated. KEY RESULTS:The pre-test survey did not result in the need to rephrase items. The internal consistency of the nine HLQ scales was high, ranging from 0.81 to 0.72. The best fit for reproduction of the scales from the original HLQ was found for these dimensions: "1. feeling understood and supported by health care providers," "2. having sufficient information to manage my health," and "3. actively managing my health." For the dimensions "7. navigating in the healthcare system" and "8. ability to find good health information," a rather high degree of overlap was found, as indicated by relatively low differences between mean highest correlations and mean next-highest correlations. CONCLUSIONS:Despite some possible overlap between dimensions 7 and 8, the N-HLQ appeared relatively robust. Thus, this study's results contribute to the evidence validation base for the N-HLQ in Norwegian populations. [HLRP: Health Literacy Research and Practice. 2020;4(4):e190-e199.] PLAIN LANGUAGE SUMMARY: This study tested the Norwegian version of the Health Literacy Questionnaire. The questionnaire (44 items across nine scales) was completed by 368 nursing students. Despite some overlap between scale 7 ("navigating in the health care system") and scale 8 ("ability to find good health information"), the questionnaire appears to serve as a good measurement for health literacy in the Norwegian population.

Project description:BACKGROUND:In this digital era, eHealth literacy is an essential skill set to leverage health information available online to promote health outcomes. South Korea has an advanced health information technology infrastructure, including widespread use of the internet and mobile phones. A few studies have explored eHealth literacy in South Korea using translated versions of the eHEALS; however, they were not fully validated. A unified reliable and valid assessment tool is critical to assess and enhance the eHealth literacy level across the population. OBJECTIVE:The aim was to develop a Korean version of eHealth Literacy Scale (K-eHEALS) and evaluate its reliability and validity employing healthy young adults in Korea. METHODS:The K-eHEALS was developed based on eHEALS, a widely used tool that measures eHealth literacy, and was validated using a sample of 500 young adults recruited from a pool of a Korean internet survey panel. Content validity was assessed using the content validity index (CVI) for individual items and for scale. Construct validity was examined using exploratory factor analysis and hypothesis testing. The Cronbach alpha coefficient was used to determine the internal consistency and the Pearson correlation coefficient was used to evaluable the stability of the measure (n=55). RESULTS:Both individual and scale CVIs were acceptable (individual CVIs>0.67; scale CVI=0.83). Single factors accounting for 50.3% of the variance in the scales were extracted revealing the unidimensional latent structure of K-eHEALS. Hypothesis testing showed significant association between eHealth literacy and hours of internet use per day, supporting the construct validity. Items of the K-eHEALS were internally consistent (Cronbach alpha=.88) and stable over a 1-month period (r=.754, P<.001). CONCLUSIONS:The findings of this study suggest that K-eHEALS is a valid and reliable measure of eHealth literacy in Korean young adults. Additional studies are needed with more diverse groups of adults in Korea.

Project description:BackgroundAs health resources and services are increasingly delivered through digital platforms, eHealth literacy is becoming a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark, but validity testing for varying purposes is an ongoing and cumulative process.ObjectiveThis study aims to examine validity evidence based on relations to other variables-using data collected with the known-groups approach-to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts. A priori hypotheses are set for the expected score differences among age, sex, education, and information and communication technology (ICT) use for each of the 7 eHealth literacy constructs represented by the 7 eHLQ scales.MethodsA Bayesian mediated multiple indicators multiple causes model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning across the groups, with ICT use as a mediator. A sample size of 500 participants was estimated. Data were collected at 3 diverse health sites in Australia.ResultsResponses from 525 participants were included for analysis. Being older was significantly related to lower scores in 4 eHLQ scales, with 3. Ability to actively engage with digital services having the strongest effect (total effect -0.37; P<.001), followed by 1. Using technology to process health information (total effect -0.32; P<.001), 5. Motivated to engage with digital services (total effect -0.21; P=.01), and 7. Digital services that suit individual needs (total effect -0.21; P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in 1. Using technology to process health information (total effect 0.22; P=.01) and 3. Ability to actively engage with digital services (total effect 0.25; P<.001), with the effects mostly mediated by ICT use. Higher ICT use was related to higher scores in all scales except 2. Understanding health concepts and language and 4. Feel safe and in control. Either no or ignorable cases of differential item functioning were found across the 4 groups.ConclusionsBy using a Bayesian mediated multiple indicators multiple causes model, this study provides supportive validity evidence for the eHLQ based on relations to other variables as well as established evidence regarding internal structure related to measurement invariance across the groups for the 7 scales in the Australian community health context. This study also demonstrates that the eHLQ can be used to gain valuable insights into people's eHealth literacy needs to help optimize access and use of digital health and promote health equity.

Project description:IntroductionHealth literacy research has focused predominantly on the adult population, and much less is understood about this concept from an adolescent perspective. The tools currently available to measure adolescent health literacy have been adapted from adult versions. This limits their applicability to young people because of the developmental characteristics that impact on adolescents' behaviour, including impulse control and judgement skills. This protocol describes the intended development and validity testing of a questionnaire to measure health literacy in adolescents.Methods and analysisThis protocol describes this mixed methods study that has three phases: the first phase will involve grounded research with adolescents using qualitative group interviews, co-design and concept mapping workshops to understand what health and healthy behaviours mean to adolescents and to explore their health literacy needs and the potential domains for the questionnaire. The draft health literacy domains identified will be presented to the youth advisory panel, and the questionnaire will be altered based on their feedback. Cognitive pretesting of the questionnaire items will also be conducted. Phase 2 will involve piloting the questionnaire to a two-stage random sample of young people in five urban and rural schools in Ireland. Test-retest reliability will be conducted using Pearson correlation coefficient. Confirmatory factor analysis will also be conducted to analyse the psychometric properties of the questionnaire. Phase 3 will involve the questionnaire being rolled out to a nationally representative sample of adolescents (n=6052) in Ireland to assess their levels of health literacy.Ethics and disseminationEthical approval to conduct this study has been granted from the University College Dublin Human Research Ethics Committee - Sciences (LS-20-08). Informed assent from adolescents and informed consent from parents/guardians will be sought. The findings of this research will be disseminated at national and international conferences, as well as through publication in peer-reviewed journals.

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A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ).

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