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Validity Evidence Based on Relations to Other Variables of the eHealth Literacy Questionnaire (eHLQ): Bayesian Approach to Test for Known-Groups Validity.

ABSTRACT:

Background

As 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.

Objective

This 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.

Methods

A 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.

Results

Responses 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.

Conclusions

By 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.

SUBMITTER: Cheng C

PROVIDER: S-EPMC8554672 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description: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.

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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:BackgroundeHealth literacy is significantly associated with patients' online information behavior, physician-patient relationship, patient adherence, and health outcomes. As an important product of the internet, online health communities (OHCs) can help redistribute idle medical resources, increase medical resource utilization, and improve patient adherence. However, studies on eHealth literacy in OHCs are limited. Therefore, this study examined patients' eHealth literacy regarding health information-seeking behavior and physician-patient communication in OHCs.ObjectiveThis study aimed to investigate the association between eHealth literacy in OHCs and patient adherence by employing social cognitive theory.MethodsThis was an empirical study, in which a research model consisting of 1 independent variable (patients' eHealth literacy), 3 mediators (physician-patient communication in OHCs, patient health information-seeking behavior in OHCs, and patients' perceived quality of health information in OHCs), 1 dependent variable (patient adherence), and 4 control variables (age, gender, living area, and education level) was established to examine the associations. Multi-item scales were used to measure variables. An anonymous online survey involving 560 participants was conducted through Chinese OHCs in July 2018 to collect data. Partial least squares and structural equation modeling were adopted to analyze data and test hypotheses.ResultsThe survey response rate was 79.6% (446/560). The reliability, convergent validity, and discriminant validity were acceptable. Age, gender, living area, and education level were positively associated with patient adherence, and gender was positively associated with physician-patient communication and patients' perceived quality of internet health information in OHCs. Patients' eHealth literacy was positively associated with patient adherence through the mediations of physician-patient communication, internet health information-seeking behavior, and perceived quality of internet health information in OHCs.ConclusionsResults indicate that physician-patient communication, internet health information-seeking behavior, and the perceived quality of internet health information are significantly associated with improving patient adherence via a guiding of eHealth literacy in OHCs. These findings suggest that physicians can understand and guide their patients' eHealth literacy to improve treatment efficiency; OHCs' operators should this strengthen the management of information quality, develop user-friendly features, and minimize the gap between the actual and perceived information quality.