Psychometric properties of the Hungarian version of the eHealth Literacy Scale

Healthcare information management and operational cost performance: empirical evidence

Healthcare knowledge management systems can mitigate hospitals' operational inefficiency. As a healthcare information technology, the electronic health record (EHR) receives much attention from medical institutions due to its considerable impact on operational cost performance. This paper focuses on EHR systems to address operational inefficiency by which patients pay more for health care services, and many U.S. hospitals are filing for bankruptcy. From the theoretical perspective of the practice-based view, this paper introduces a path to implement EHR systems for improving cost performance. The empirical investigation is archival data of 200 hospitals collected from the U.S. healthcare agencies. Findings contribute to prior work by hypothesizing moderating and mediating roles in EHR systems implementation. This paper introduces absorptive capacity and monitoring mechanisms as enablers of implementing EHR systems. The results showed that hospital monitoring strengthens the relationship between absorptive capacity and electronic health record systems implementation, which results in better operational cost performance. Theoretically, this study supports the long-term potential benefits of EHR adoption, and its findings are consistent with optimizing efficiency through data standardization and interoperability. From a practical perspective, this study supports hospitals' investments in evolving healthcare information technology systems through the development of a knowledge-based system employing EHR, particularly when hospitals are merging or need a financial strategic plan to control expenses.

Measuring electronic health literacy in the context of diabetes care: psychometric evaluation of a Persian version of the condition-specific eHealth literacy scale for diabetes

BACKGROUND

The rise of the internet and social media has led to increased interest among diabetes patients in using technology for information gathering and disease management. However, adequate eHealth literacy is crucial for protecting patients from unreliable diabetes-related information online.

OBJECTIVE

To examine the psychometric characteristics and explore the preliminary validity of the Persian version of the Condition-specific eHealth Literacy Scale for Diabetes (Persian CeHLS-D) to assess eHealth literacy in the context of diabetes care.

METHODS

After adapting, translating, examining content validity, and pilot testing the questionnaire, it was administered to 300 patients with type 2 diabetes mellitus (T2DM). Construct validity was assessed through confirmatory factor analysis, convergent and known-groups validity. The internal consistency (Cronbach's alpha), composite reliability and maximum reliability, and test-retest correlation were assessed.

RESULTS

Factor analysis supported the hypothesized two-factor model with 10 items, and the standardized factor loadings ranged from 0.44 to 0.86 (P-values < 0.001). Cronbach's alpha and test-retest correlation were good for each factor. Convergent validity was confirmed by significant correlations of Persian CeHLS-D with diabetes health literacy, perceived usefulness and importance of using the internet for health information, internet anxiety, and perceived physical and mental health. Know-groups validity determined using groups with different internet-use frequencies, and different attitudes towards providing online healthcare services, were satisfied.

CONCLUSION

This study demonstrated the Persian CeHLS-D as a reliable and valid measure of eHealth literacy among patients with T2DM in Iran. Its satisfactory psychometric properties support its use in research and clinical settings to assess eHealth literacy and inform interventions.

Electronic Health Literacy Scale-Web3.0 for Older Adults with Noncommunicable Diseases: Validation Study

BACKGROUND

In the current digital era, eHealth literacy plays an indispensable role in health care and self-management among older adults with noncommunicable diseases (NCDs). Measuring eHealth literacy appropriately and accurately ensures the successful implementation and evaluation of pertinent research and interventions. However, existing eHealth literacy measures focus mainly on individuals' abilities of accessing and comprehending eHealth information (Web1.0), whereas the capabilities for web-based interaction (Web2.0) and using eHealth information (Web3.0) have not been adequately evaluated.

OBJECTIVE

This study aimed to examine the reliability, validity, and measurement invariance of the eHealth Literacy Scale-Web3.0 (eHLS-Web3.0) among older adults with NCDs.

METHODS

A total of 642 Chinese older adults with NCDs (mean age 65.78, SD 3.91 years; 55.8% female) were recruited in the baseline assessment, of whom 134 (mean age 65.63, SD 3.99 years; 58.2% female) completed the 1-month follow-up assessment. Baseline measures included the Chinese version of the 24-item 3D eHLS-Web3.0, the Chinese version of the 8-item unidimensional eHealth Literacy Scale (eHEALS), and demographic information. Follow-up measures included the 24-item eHLS-Web3.0 and accelerometer-measured physical activity and sedentary behavior. A series of statistical analyses, for example, Cronbach α, composite reliability coefficient (CR), confirmatory factor analysis (CFA), and multigroup CFA, were performed to examine the internal consistency and test-retest reliabilities, as well as the construct, concurrent, convergent, discriminant, and predictive validities, and the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence.

RESULTS

Cronbach α and CR were within acceptable ranges of 0.89-0.94 and 0.90-0.97, respectively, indicating adequate internal consistency of the eHLS-Web3.0 and its subscales. The eHLS-Web3.0 also demonstrated cross-time stability, with baseline and follow-up measures showing a significant intraclass correlation of 0.81-0.91. The construct validity of the 3D structure model of the eHLS-Web3.0 was supported by confirmatory factor analyses. The eHLS-Web3.0 exhibited convergent validity with an average variance extracted value of 0.58 and a CR value of 0.97. Discriminant validity was supported by CFA results for a proposed 4-factor model integrating the 3 eHLS-Web3.0 subscales and eHEALS. The predictive validity of the eHLS-Web3.0 for health behaviors was supported by significant associations of the eHLS-Web3.0 with light physical activity (β=.36, P=.004), moderate to vigorous physical activity (β=.49, P<.001), and sedentary behavior (β=-.26, P=.002). Finally, the measurement invariance of the eHLS-Web3.0 across gender, education level, and residence was supported by the establishment of configural, metric, strong, and strict invariances.

CONCLUSIONS

The present study provides timely empirical evidence on the reliability, validity, and measurement invariance of the eHLS-Web3.0, suggesting that the 24-item 3D eHLS-Web3.0 is an appropriate and valid tool for measuring eHealth literacy among older adults with NCDs within the Web3.0 sphere.

Robot-assisted surgery and artificial intelligence-based tumour diagnostics: social preferences with a representative cross-sectional survey

BACKGROUND

The aim of this study was to assess social preferences for two different advanced digital health technologies and investigate the contextual dependency of the preferences.

METHODS

A cross-sectional online survey was performed among the general population of Hungary aged 40 years and over. Participants were asked to imagine that they needed a total hip replacement surgery and to indicate whether they would prefer a traditional or a robot-assisted (RA) hip surgery. To better understand preferences for the chosen method, the willingness to pay (WTP) method was used. The same assessment was conducted for preferences between a radiologist's and AI-based image analysis in establishing the radiological diagnosis of a suspected tumour. Respondents' electronic health literacy was assessed with the eHEALS questionnaire. Descriptive methods were used to assess sample characteristics and differences between subgroups. Associations were investigated with correlation analysis and multiple linear regressions.

RESULTS

Altogether, 1400 individuals (53.7% female) with a mean age of 58.3 (SD = 11.1) years filled in the survey. RA hip surgery was chosen by 762 (54.4%) respondents, but only 470 (33.6%) chose AI-based medical image evaluation. Those who opted for the digital technology had significantly higher educational levels and electronic health literacy (eHEALS). The majority of respondents were willing to pay to secure their preferred surgical (surgeon 67.2%, robot-assisted: 68.8%) and image assessment (radiologist: 70.9%; AI: 77.4%) methods, reporting similar average amounts in the first (p = 0.677), and a significantly higher average amount for radiologist vs. AI in the second task (p = 0.001). The regression showed a significant association between WTP and income, and in the hip surgery task, it also revealed an association with the type of intervention chosen.

CONCLUSIONS

Individuals with higher education levels seem to accept the advanced digital medical technologies more. However, the greater openness for RA surgery than for AI image assessment highlights that social preferences may depend considerably on the medical situation and the type of advanced digital technology. WTP results suggest rather firm preferences in the great majority of the cases. Determinants of preferences and real-world choices of affected patients should be further investigated in future studies.

The Impact of Parental Electronic Health Literacy on Disease Management and Outcomes in Pediatric Type 1 Diabetes Mellitus: Cross-Sectional Clinical Study

BACKGROUND

Despite the growing uptake of smart technologies in pediatric type 1 diabetes mellitus (T1DM) care, little is known about caregiving parents' skills to deal with electronic health information sources.

OBJECTIVE

We aimed to assess the electronic health literacy of parents caring for children with T1DM and investigate its associations with disease management and children's outcomes.

METHODS

A cross-sectional survey was performed involving 150 parent-child (8-14 years old with T1DM) dyads in a university pediatric diabetology center. Parents' electronic health literacy (eHealth Literacy Scale [eHEALS]), general health literacy (Chew questionnaire and Newest Vital Sign [NVS]), and attitudes toward T1DM care (Parental Self-Efficacy Scale for Diabetes Management [PSESDM] and Hypoglycemia Fear Survey [HFS]) were investigated. Children's treatment, HbA1c level, and quality of life (Pediatric Quality of Life Inventory Diabetes Module [PedsQL Diab] and EQ-5D-Y-3L) were assessed. Multiple linear regression analysis was performed to investigate the determining factors of 6-month average HbA1c.

RESULTS

Of the 150 children, 38 (25.3%) used a pen, 55 (36.7%) used a pen plus a sensor, 6 (4.0%) used an insulin pump, and 51 (34.0%) used an insulin pump plus a sensor. Parents' average eHEALS score (mean 31.2, SD 4.9) differed significantly by educational level (P=.04) and the children's treatment (P=.005), being the highest in the pump + sensor subgroup. The eHEALS score showed significant Pearson correlations with the Chew score (r=-0.45; P<.001), NVS score (r=0.25; P=.002), and PSESDM score (r=0.35; P<.001) but not with the children's HbA1c (r=-0.143; P=.08), PedsQL Diab (r=-0.0002; P>.99), and EQ-5D-Y-3L outcomes (r=-0.13; P=.12). Regression analysis revealed significant associations of the child's HbA1c level with sex (β=0.58; P=.008), treatment modality (pen + sensor: β=-0.66; P=.03; pump + sensor: β=-0.93; P=.007), and parents' self-efficacy (PSESDM; β=-0.08; P=.001).

CONCLUSIONS

Significantly higher parental electronic health literacy was found in T1DM children using a glucose sensor. The electronic health literacy level was associated with parents' diabetes management attitude but not with the child's glycemic control. Studies further investigating the role of parental electronic health literacy in T1DM children managed at different levels of care and the local context are encouraged.

Health care needs, eHealth literacy, use of mobile phone functionalities, and intention to use it for self-management purposes by informal caregivers of children with burns: a survey study

BACKGROUND

This study aimed to assess health care needs, electronic health literacy, mobile phone usage, and intention to use it for self-management purposes by informal caregivers of children with burn injuries.

METHODS

This cross-sectional research was carried out in 2021 with 112 informal caregivers of children with burns in a burn center in the north of Iran. The data collection tools were questionnaires that included the participants' demographics, their E-Health Literacy, their current mobile phone usage, and their desires for mobile phone use for burn care services.

RESULTS

Most informal caregivers had smartphones (83.0%) and Internet access (81.3%). Most participants occasionally used phone calls (63.4%), the Internet (45.5%), and social media (42.9) to receive information about psychosocial disorders, infection control, wound care, pain, itch, physical exercise, and feeding. Most participants have never used some of the mobile phone functionalities to receive burn-related information, such as applications/Software (99.1%) and e-mail (99.1%). Nevertheless, most informal caregivers desire to use mobile applications for self-management purposes in the future (88.4%). The mean eHealth literacy score was 25.01 (SD = 9.61). Informal caregivers who had higher education levels, access to the Internet, and lived in urban areas had higher eHealth literacy (P < 001).

CONCLUSION

The current research delivers beneficial information about the healthcare needs of informal caregivers and their preference to use mobile functionality to receive burns-related healthcare and rehabilitation information post-discharge. This information can help design and implement mobile health (mHealth) interventions to enhance the self-care skills of informal caregivers.

Sociodemographic factors associated to knowledge and attitudes towards dengue prevention among the Peruvian population: findings from a national survey

OBJECTIVES

To evaluate the frequency of knowledge and attitudes towards dengue prevention among the Peruvian population, as well as the sociodemographic factors associated with reported knowledge and attitude outcomes.

DESIGN/SETTING

A cross-sectional study was conducted, based on information from the National Survey of Budget Programs of Peru, 2019.

PARTICIPANTS

We included 57 829 respondents with a mean age of 40.3±17.4 years, of whom 52.8% were women and 87.6% were from urban areas.

PRIMARY AND SECONDARY OUTCOMES

Knowledge about dengue infection (transmission, symptoms, importance of going to a health centre and not self-medicating) and preventive attitudes to avoid infection.

RESULTS

Of all the respondents, 36.2% (n=23 247) presented good knowledge about dengue and 11.6% (n=7890) had a higher number of preventive attitudes (≥3 attitudes). In the multivariate regression analysis, we found that being female (for knowledge: aPR (adjusted prevalence ratio): 1.03; 95% CI 1.02 to 1.03; and for attitude: aPR: 1.02; 95% CI 1.01 to 1.02), being married/cohabiting (for knowledge: aPR: 1.02; 95% CI 1.00 to 1.03; and for attitude: aPR: 1.01; 95% CI 1.00 to 1.02) and residing in the jungle (for knowledge: aPR: 1.14; 95% CI 1.12 to 1.16; and for attitude: aPR: 1.09; 95% CI 1.07 to 1.11) were associated with better knowledge and more preventive attitudes. In addition, we found that being an adolescent (for knowledge: aPR: 0.97; 95% CI 0.96 to 0.99; and for attitude: aPR: 0.99; 95% CI 0.97 to 0.99), and belonging to the Quechua ethnic group (for knowledge: aPR: 0.93; 95% CI 0.91 to 0.94; and for attitude: aPR: 0.98; 95% CI 0.97 to 0.99) were associated with a lower proportion of adequate knowledge and fewer preventive attitudes.

CONCLUSIONS

Our study found a high proportion of poor knowledge and few preventive attitudes towards dengue in the Peruvian population. That highlights the requirement to implement national strategies to educate people about dengue and promote preventive attitudes, considering the factors found.

Associations Among Online Health Information Seeking Behaviors, Electronic Health Literacy and Food Neophobia: A Cross-Sectional Study

Few studies have investigated whether improve electronic health (eHealth) literacy can alleviate food neophobia in university students. We explored the associations among online health information (OHI)-seeking behaviors, eHealth literacy and food neophobia. A questionnaire-based, cross-sectional study of 5151 university students in China was conducted from October to December 2022. The study used Chinese versions of the eHealth literacy scale (C-eHEALS), and the food neophobia scale (FNS-C), as well as the OHI-seeking behaviors scale. Data were collected through Wenjuanxing software. Analysis of variance, t-tests, the Pearson correlation coefficient and chi-square tests were performed for data analysis. The average (SD) scores of C-eHEALS and FNS-C were 26.81 (5.83) and 38.86 (6.93), respectively. University students in China had a low C-eHEALS and a high FNS-C level, and there were significant differences between the high and low groups of C-eHEALS (P < .001) and FNS-C (P < .001). There was also a significant correlation between eHealth literacy and food neophobia (P < .001), and a lower eHealth literacy level indicated a higher probability of food neophobia occurrence. University students with high FNS-C and low C-eHEALS show more OHI-seeking behaviors. When schools, communities, and parents want to alleviate students' food neophobia, OHI-seeking training to improve eHealth literacy may be a good intervention.

The association and intervention effect between eHealth literacy and lifestyle behaviors among Chinese university students

OBJECTIVE

Our aim was to evaluate the association between eHealth literacy and lifestyle behaviors to intervene among Chinese university students.

METHOD

The Chinese eHealth Literacy Scale (C-eHEALS) questionnaire was used to investigate the eHealth literacy level and association with lifestyle behaviors among Chinese university students. Independent sample t-test and Pearson's correlation coefficient were used by statistical software SPSS v20.

RESULTS

In the first round, 5,151 university students participated in the study, including 71.46% female and 28.54% male, aged 18-22 (93.13%).The average eHealth literacy score was 26.81 ± 5.83. Four lifestyle behaviors (e.g., exercise, smoking, drinking and sleeping) were all significantly correlated with eHealth literacy scores and demonstrated significant differences. In the second investigation (N = 2,939), the average eHealth literacy score was 31.64 ± 6.44, a notable improvement compared with the first investigation.

CONCLUSION

Those in the group with high eHealth literacy scores have a healthier lifestyle than those in the low-score group. Training in eHealth-related resources is a positive measure to improve university students' eHealth literacy.

Factors Influencing eHealth Literacy among Spanish Primary Healthcare Users: Cross-Sectional Study

BACKGROUND

Adequate eHealth literacy levels empower people to make informed decisions, enhancing their autonomy. The current study assessed a group using primary care services for their eHealth literacy and examined its relationship with sociodemographic characteristics.

METHODS

Adult patients in need of primary care nursing services participated in this cross-sectional study, which was carried out in a healthcare center in the Madrid region of Spain. Through systematic random sampling, 166 participants were chosen for the study. The eHealth Literacy Questionnaire was used to assess eHealth literacy (eHLQ).

RESULTS

The studied population showed higher eHealth literacy scores in dimensions 2 ("understanding of health concepts and language") and 4 ("feel safe and in control"); the lowest scores were recorded for dimensions 1 ("using technology to process health information"), 3 ("ability to actively engage with digital services"), and 7 ("digital services that suit individual needs"). People with completed secondary education and a better-perceived health status who were younger and employed showed a higher level of eHealth literacy.

CONCLUSIONS

The findings advance our knowledge of the variables affecting eHealth literacy. We may be able to understand patients' needs and provide them with greater support if we can pinpoint the areas where they demonstrate the lowest eHealth literacy.

Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above

BACKGROUND

Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population.

METHODS

A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines.

RESULTS

The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+.

CONCLUSION

PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.

Translation and Validation Study of the French Version of the eHealth Literacy Scale: Web-Based Survey on a Student Population

BACKGROUND

eHealth literacy is emerging as a crucial concept for promoting patient self-management in an overloaded hospital system. However, to the best of our knowledge, no tool currently exists to measure the level of eHealth literacy among French-speaking people. The eHealth Literacy Scale (eHEALS) is an easy-to-administer 8-item questionnaire (5-point Likert scale, ranging from strongly disagree to strongly agree) that has already been translated into many languages. Currently, it is the most cited questionnaire in the literature.

OBJECTIVE

The aim of this study was to translate eHEALS to French and validate the French version of eHEALS (F-eHEALS).

METHODS

The validation of the F-eHEALS scale followed the 5 steps of the transcultural validation method: double reverse translation, validation by a committee of experts (n=4), pretest measurement to check the clarity of the items (n=22), administration of the scale in French via a web-based quantitative study combined with two other questionnaires (Health Literacy Survey-Europe-16 and Patient Activation Measure-13; N=328 students), and finally test-retest (n=78) to check the temporal stability of the measurements obtained from the scale.

RESULTS

The results obtained for the measurement of factor structure, internal consistency, and temporal stability (intraclass correlation coefficient=0.84; 95% CI 0.76-0.9; F77,77=6.416; P<.001) prove the validity and fidelity of the proposed scale. The internal consistency of F-eHEALS was estimated by Cronbach α of .89. The factor analysis with varimax rotation used to validate the construct showed a 2-factor scale. The effect of the construct was analyzed using 3 hypotheses related to the theory. The F-eHEALS score was correlated with the Health Literacy Survey-Europe-16 score (r=0.34; P<.001) and the Patient Activation Measure-13 score (r=0.31; P<.001).

CONCLUSIONS

F-eHEALS is consistent with the original version. It presents adequate levels of validity and fidelity. This 2D scale will need to be generalized to other populations in a French-speaking context. Finally, a version taking into account collaborative applications (ie, Health 2.0; eg, Digital Health Literacy Instrument scale) should be considered on the basis of this study.

Research progress on digital health literacy of older adults: A scoping review

With the rapid development of digital health today, the lack of digital health literacy in older adults is an urgent problem. It is crucial that older adults adapt to the digital reform in medical treatment, pension, health management, and other fields. Therefore, we reviewed the current development status of digital health literacy among older adults. A total of 47 articles were included in this scoping review. Our findings revealed that research on digital health literacy in older adults is still in its infancy. Further development is warranted especially in terms of assessment tools and intervention methods.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

Patient-centred care in Hungary: Contributions to foster a policy agenda

In Hungary, the National Health Insurance Fund provides health care coverage for nearly all residents, but healthcare spending is below the EU's average (6.4% versus 9.9% of the GDP in 2019, respectively). In 1997, patients' rights were established by laws of the healthcare system. The patients' voice, however, has remained weakly embedded in decision-making processes both on the system and individual patient levels. Policy progress achieved in the past years may foster patient-centeredness in health policy decision-making. However, people-reported data are not yet embedded in the Hungarian health information system and national population or household surveys, thus undermining the monitoring of the performance of the health system regarding patient-centred aspects. From the academic research side, several advances have occurred regarding the availability of validated instruments for the measurement of patient-centred aspects. These recent studies have placed Hungary in a uniquely advanced position compared with other countries in the Central and Eastern European (CEE) region. The use of those instruments in clinical guidelines and practices, to the education curricula of future health workers, is still in an early stage.

Cross-cultural adaptation and psychometric properties of the Sinhala version of electronic health literacy scale: A cross-sectional validation study

eHealth Literacy Scale (eHEALS) is the most widely used, valid and reliable tool to assess eHealth literacy skills, but no culturally appropriate tool exists to assess these skills among Sinhala-speaking Sri Lankans, including health professionals. This study aimed to cross-culturally adapt the original eHEALS from English to Sinhala and evaluate its psychometric properties. The study was conducted in two phases. The first phase involved translation and cross-cultural validation of the questionnaire. The second phase involved a cross-sectional survey conducted online among 268 health science students from a state university in Sri Lanka to confirm the psychometric properties of the questionnaire. An analysis of test-retest reliability was conducted with a subset of 72 students. The pre-final version of Sinhala eHEALS (Si-eHEALS) was developed following the cross-cultural adaptation process. The mean score of Si-eHEALS was 28.51±4.87. A satisfactory level of internal consistency was achieved (Cronbach’s alpha = 0.91). The test-retest reliability was acceptable (intraclass correlation coefficient -.776). Content validity index of Si-eHEALS was.97. The principal component analysis supported the unidimensionality of the scale, explaining 61.2 variance. There was a significant positive association between Si-eHEALS score with academic year (r_s = .146, p = .017), self-rated internet skills (r_s = .122, p = .046), usefulness of internet in health decision making (r_s = .212, p < .001) and importance of ability to access health resources on the internet (r_s = .230, p < .001), confirming concurrent validity. No significant difference based on gender (U = 5854, p = .550) and degree program (X²(2) = 2.965, p = .564) was found, confirming discriminant validity. In line with many previous validation studies, our study demonstrated good psychometric properties for Si-eHEALS. Si-eHEALS is a valid and reliable tool that assesses eHealth literacy in Sinhala speaking Sri Lankans, particularly health professionals.

Assessing eHealth literacy among internet users in Lebanon: A cross-sectional study

Objective

Assessing the level of eHealth literacy in a population is essential to designing appropriate public health interventions. This study aimed to assess eHealth literacy among adult internet users in Lebanon, recruited through social media and printed materials. The study examined the relationship between internet use, perceived eHealth literacy, and sociodemographic characteristics.

Methods

A cross-sectional study based on a web-based questionnaire was conducted between January and May 2020. The survey assessed internet use and eHealth literacy using the homonymous scale (eHEALS) in English and Arabic. Cronbach's alpha and factor analyses were used to evaluate eHEALS’ psychometric properties. A generalized linear model was used to identify factors predicting the eHEALS.

Results

A total of 2715 respondents were recruited mostly through Facebook (78%) and printed materials (17%). Most respondents completed the survey in English (82%), were aged 30 ± 11 years, female (60%), Lebanese (84%), unmarried (62%), employed (54%), and with a graduate-level education (53%). Those who completed the eHEALS questionnaire (n = 2336) had a moderate eHealth literacy (M = 28.7, SD = 5.5). eHEALS was significantly higher among older females with a high education level, recruited from Facebook, Instagram, or ResearchGate, and perceived the Internet as a useful and important source of information.

Conclusions

Future internet-delivered public health campaigns in Lebanon should account for moderate-to-low levels of eHealth literacy and find ways to engage older males with low education levels representing neglected segments (e.g. Syrians). To be more inclusive, campaigns should reach neglected population segments through non-digital, community-based outreach activities.

Seniors’ eHealth literacy, health and education status and personal health knowledge

Background

The COVID-19 pandemic made eHealth literacy skills and online health activities essential for seniors.

Research aims

(a) To examine the differences in eHealth literacy dimensions (awareness of sources, recognizing quality and meaning, understanding information, perceived efficiency, validating information) as related to participants’ health status and education level. (b) To explore the effect of eHealth literacy dimensions on participants’ personal health knowledge.

Methods

We used a cross-sectional design with a convenience sample of 298 Israeli seniors aged 65 or over during the second lockdown. The questionnaire was composed of three sections: (a) background characteristics, (b) an eHealth Literacy scale, and (c) perceived personal health knowledge.

Results

Participants with an excellent health status reported higher levels of awareness of sources and perceived efficiency than participants with poor or good health statuses. Furthermore, participants with a graduate degree understand online information better than participants with a high school education. Moreover, it was found that participants with a high school education sense that they are being smart on the net more than participants with an undergraduate degree. Finally, we found that eHealth literacy dimensions influenced the participants’ personal health knowledge.

Conclusion

As the population ages, it becomes more at risk for disease, and as a result, its health status weakens. Therefore, it is important to provide seniors with appropriate intervention programs for improving their eHealth literacy, which may eliminate health inequality. In addition, caregivers need to develop patients’ eHealth literacy skills—finding, evaluation, and interpretation of online health knowledge relevant to them.

A Comprehensive Analysis of E-Health Literacy Research Focuses and Trends

Objective: To sort out the research focuses in the field of e-health literacy, analyze its research topics and development trends, and provide a reference for relevant research in this field in the future. Methods: The literature search yielded a total of 431 articles retrieved from the core dataset of Web of Science using the keywords “ehealth literacy”, “E-health literacy” and “electronic health literacy”. A bibliometric analysis was performed by using CiteSpace to explore the development history, hot themes, and trends of future research in the field of e-health literacy. Results: The thematic evolution path in e-health literacy was divided into three stages. The research focuses were inspected from four aspects: evaluation, correlation with health-promotion behaviors, influencing factors, and intervention measures for improvement. Conclusion: E-health literacy research faces challenges such as the development of the connotation of the term, the objectivity of evaluation methods, and the long-term impact of interventions. Future research themes in e-health literacy will include the standardization of evaluation instruments and the individualization of therapeutic strategies.

eHealth Literacy Instruments: Systematic Review of Measurement Properties

Background

The internet is now a major source of health information. With the growth of internet users, eHealth literacy has emerged as a new concept for digital health care. Therefore, health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies.

Objective

This study aimed to identify currently available eHealth literacy instruments and evaluate their measurement properties to provide robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument.

Methods

We conducted a systematic review and meta-analysis of self-reported eHealth literacy instruments by applying the updated COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) methodology.

Results

This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth literacy scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile web. That instrument was evaluated in 18 different languages and 26 countries, involving diverse populations. However, various other factor structures were exhibited: 7 types of two-factor structures, 3 types of three-factor structures, and 1 bifactor structure. The transactional eHealth literacy instrument (TeHLI) was developed to reflect the broader concept of eHealth literacy and was demonstrated to have a sufficient low-quality and very low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility) and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated.

Conclusions

The eHealth literacy scale was the most frequently investigated instrument. However, it is strongly recommended that the instrument's content be updated to reflect recent advancements in digital health technologies. In addition, the transactional eHealth literacy instrument needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence.

Recursive Path Model for Health Literacy: The Effect of Social Support and Geographical Residence

Background: The public health relevance of health literacy is highlighted by the fact that its higher levels can improve health outcomes and reduce health inequities. In order to design effective interventions for improving health literacy, the relationship between health literacy and other factors such as sociodemographic variables, subjective health and social support must be understood. Objective: Our aim was to test a socioecological model of the determinants of health literacy with a special focus on the effect of residence. Our study investigated geographical differences regarding the levels of health literacy and its determinants as this was not investigated before in European nationwide surveys. Methods: Data was collected by a polling company in a sample (n = 1,200) of the Hungarian adult population nationally representative by age, gender, and permanent residence in 2019 January. The questionnaire included items on sociodemographic data, subjective well-being, social support, and two health literacy scales. A recursive path model was used to outline the mediating effect of social support between sociodemographic variables and health literacy where both direct and indirect effects of the explanatory variables and multiple relationships among the variables were analyzed simultaneously. Multiple-group analysis was applied to the three pre-set categories of permanent residence (capital city, urban and rural). Results: There was no statistically significant difference by residence regarding levels of health literacy. Social support and educational attainment were the most important determinants of health literacy after adjusting for the effect of other sociodemographic variables. However, the magnitude of effect of social support and educational attainment is different between types of settlements, the strongest being in rural areas. Conclusion: Social support seems to mediate the effect of socioeconomic position on health literacy which could be taken into account when designing interventions to improve health literacy, especially in rural areas. Further studies would be needed especially in rural communities to see whether improvement of social support could be utilized in projects to increase the level of health literacy.

Evaluating the psychometric properties of the eHealth Literacy Scale in Brazilian adults

OBJECTIVE

To translate and adapt the eHealth Literacy Scale for the cultural reality of Brazil and to evaluate the psychometric properties of its Brazilian Portuguese version.

METHODS

The instrument was translated and adapted to Brazilian Portuguese and applied to a sample of 502 individuals from 18 to 80 years old who lived in the surrounding areas of six Family Health Units of a city in the countryside of the state of São Paulo, Brazil. The data was evaluated using exploratory and confirmatory factor analysis, item response theory, and instrument reliability measures (Cronbach's alpha and McDonald's omega).

RESULTS

The eHealth Literacy Scale - Brazilian version (eHEALS-Br) presented an excellent internal consistency (α = 0.95 e ω = 0.95), with only one dimension and an explained variation of 81.79%.

CONCLUSIONS

The Brazilian version of the instrument showed excellent psychometric properties to measure the levels of digital health literacy in adults from the country.

Generation Gaps in Digital Health Literacy and Their Impact on Health Information Seeking Behavior and Health Empowerment in Hungary

Background: Today the internet is a major source of health information, and younger generations have more confidence in their digital information seeking skills and awareness of online resources than older generations. Older generations, however, are more in demand of health services. The aim of our study was to explore these generational differences as related to self-perceived eHealth literacy and health care system utilization.

Methods: A cross-sectional survey study with 522 subjects was done in Hungary. Every subject belonged to one of four generations (Baby boomers, X, Y, and Z). The Web-based survey was designed and tested in English-speaking countries and translated into Hungarian for the present study. Variables include Internet health information seeking, eHealth literacy (measured by eHeals score), the self-perceived gain in empowerment by that information, and the number of health care appointments. One-way ANOVA was used for comparing the scores of the generations, and correlational and linear regression analysis was employed within the generations for further data analysis.

Results: We found significant differences among the generations in eHealth literacy as well as in the self-perceived gain in empowerment: while Boomers were the generation with the lowest eHeals scores, they showed the highest empowerment. Internet health information seeking behavior showed no differences. While subjects who use the Internet more frequently to search for health information have worse self-rated health status, the ones with higher eHeals scores report better subjective health status. We also identified the associations of the above variables within the older generations (Boomers and X) with the frequency of using health-care services: within the generation of Boomers the number of health care appointments was only associated with Internet health information seeking, while in Generation X with eHeals.

Conclusions: Baby boomers seek Internet health information as often as the younger generations, which provides a solid motivation for developing their eHealth literacy skills. We find it crucial to plan the Hungarian health promotion programmes utilizing this high frequency of Internet health information seeking, since the eHealth literacy skills of older generations have an effect on their subjective health status, and they are the most capable of applying information in making decisions.

Health literacy and behavioral health factors in adults

OBJECTIVES

This study was to examine the relationship between health literacy (HL) and health behaviors in the South Bohemia Region in the Czech Republic (CR) and compare them to HL and health behaviors in the Visegrád group countries (Czech Republic, Hungary, Poland, and Slovakia). The paper reports the results from the research in the CR.

STUDY DESIGN

A quantitative descriptive study.

METHODS

The sample was stratified by sex and age and included a representative sample of 303 adults. The data were collected using the combination of a country-specific questionnaire with the HLS-EU-16 standardized questionnaire.

RESULTS

Exercise was significantly associated with perceived health and HL; those with a lower level of HL did not exercise during the previous month. Based only on full answers (N = 251), inadequate HL was identified in 17.5% of the respondents (44), marginal HL in 31.5% (77), and adequate HL in 51% (128) of the respondents. Nearly 49% of the participants evaluated their health as 'good', 25.7% rated their health as 'very good' and 'satisfactory' by 25.7%. But 41.6% experienced one or more chronic diseases, 37.6% had some limitations to their health, and 20.5% smoked. For alcohol consumption, 26% drank weekly and 23% drank two to three times a month. Exercise varied from never (29.7%) to daily (7.9%).

CONCLUSION

Based on our results, we conclude that health behavior risk factors are still present in the South Bohemia region of the CR regardless of levels of HL reported on the HLS-EU-16.

Relationship Between Levels of Digital Health Literacy Based on the Taiwan Digital Health Literacy Assessment and Accurate Assessment of Online Health Information: Cross-Sectional Questionnaire Study

BACKGROUND

The increasing amount of health information available on the internet makes it more important than ever to ensure that people can judge the accuracy of this information to prevent them from harm. It may be possible for platforms to set up protective mechanisms depending on the level of digital health literacy and thereby to decrease the possibility of harm by the misuse of health information.

OBJECTIVE

This study aimed to create an instrument for digital health literacy assessment (DHLA) based on the eHealth Literacy Scale (eHEALS) to categorize participants by level of risk of misinterpreting health information into high-, medium-, and low-risk groups.

METHODS

This study developed a DHLA and constructed an online health information bank with correct and incorrect answers. Receiver operating characteristic curve analysis was used to detect the cutoff value of DHLA, using 5 items randomly selected from the online health information bank, to classify users as being at low, medium, or high risk of misjudging health information. This provided information about the relationship between risk group for digital health literacy and accurate judgement of online health information. The study participants were Taiwanese residents aged 20 years and older. Snowball sampling was used, and internet questionnaires were anonymously completed by the participants. The reliability and validity of DHLA were examined. Logistic regression was used to analyze factors associated with risk groups from the DHLA.

RESULTS

This study collected 1588 valid questionnaires. The online health information bank included 310 items of health information, which were classified as easy (147 items), moderate (122 items), or difficult (41 items) based on the difficulty of judging their accuracy. The internal consistency of DHLA was satisfactory (α=.87), and factor analysis of construct validity found three factors, accounting for 76.6% of the variance. The receiver operating characteristic curve analysis found 106 people at high risk, 1368 at medium risk, and 114 at low risk of misinterpreting health information. Of the original grouped cases, 89.6% were correctly classified after discriminate analysis. Logistic regression analysis showed that participants with a high risk of misjudging health information had a lower education level, lower income, and poorer health. They also rarely or never browsed the internet. These differences were statistically significant.

CONCLUSIONS

The DHLA score could distinguish those at low, medium, and high risk of misjudging health information on the internet. Health information platforms on the internet could consider incorporating DHLA to set up a mechanism to protect users from misusing health information and avoid harming their health.

Psychometric Validation and Cultural Adaptation of the Simplified Chinese eHealth Literacy Scale: Cross-Sectional Study

BACKGROUND

The rapid proliferation of web-based information on health and health care has profoundly changed individuals' health-seeking behaviors, with individuals choosing the internet as their first source of information on their health conditions before seeking professional advice. However, barriers to the evaluation of people's eHealth literacy present some difficulties for decision makers with respect to encouraging and empowering patients to use web-based resources.

OBJECTIVE

This study aims to examine the psychometric properties of a simplified Chinese version of the eHealth Literacy Scale (SC-eHEALS).

METHODS

Data used for analysis were obtained from a cross-sectional multicenter survey. Confirmatory factor analysis (CFA) was used to examine the structure of the SC-eHEALS. Correlations between the SC-eHEALS and ICEpop capability measure for adults (ICECAP-A) items and overall health status were estimated to assess the convergent validity. Internal consistency reliability was confirmed using Cronbach alpha (α), McDonald omega (ω), and split-half reliability (λ). A general partial credit model was used to perform the item response theory (IRT) analysis. Item difficulty, discrimination, and fit were reported. Item-category characteristic curves (ICCs) and item and test information curves were used to graphically assess the validity and reliability based on the IRT analysis. Differential item functioning (DIF) was used to check for possible item bias on gender and age.

RESULTS

A total of 574 respondents from 5 cities in China completed the SC-eHEALS. CFA confirmed that the one-factor model was acceptable. The internal consistency reliability was good, with α=0.96, ω=0.92, and λ=0.96. The item-total correlation coefficients ranged between 0.86 and 0.91. Items 8 and 4 showed the lowest and highest mean scores, respectively. The correlation coefficients between the SC-eHEALS and ICECAP-A items and overall health status were significant, but the strength was mild. The discrimination of SC-eHEALS items ranged between 2.63 and 5.42. ICCs indicated that the order of categories' thresholds for all items was as expected. In total, 70% of the information provided by SC-eHEALS was below the average level of the latent trait. DIF was found for item 6 on age.

CONCLUSIONS

The SC-eHEALS has been demonstrated to have good psychometric properties and can therefore be used to evaluate people's eHealth literacy in China.

Health Literacy, eHealth Literacy, Adherence to Infection Prevention and Control Procedures, Lifestyle Changes, and Suspected COVID-19 Symptoms Among Health Care Workers During Lockdown: Online Survey

Background

The COVID-19 pandemic has imposed a heavy burden on health care systems and governments. Health literacy (HL) and eHealth literacy (as measured by the eHealth Literacy Scale [eHEALS]) are recognized as strategic public health elements but they have been underestimated during the pandemic. HL, eHEALS score, practices, lifestyles, and the health status of health care workers (HCWs) play crucial roles in containing the COVID-19 pandemic.

Objective

The aim of this study is to evaluate the psychometric properties of the eHEALS and examine associations of HL and eHEALS scores with adherence to infection prevention and control (IPC) procedures, lifestyle changes, and suspected COVID-19 symptoms among HCWs during lockdown.

Methods

We conducted an online survey of 5209 HCWs from 15 hospitals and health centers across Vietnam from April 6 to April 19, 2020. Participants answered questions related to sociodemographics, HL, eHEALS, adherence to IPC procedures, behavior changes in eating, smoking, drinking, and physical activity, and suspected COVID-19 symptoms. Principal component analysis, correlation analysis, and bivariate and multivariate linear and logistic regression models were used to validate the eHEALS and examine associations.

Results

The eHEALS had a satisfactory construct validity with 8 items highly loaded on one component, with factor loadings ranked from 0.78 to 0.92 explaining 76.34% of variance; satisfactory criterion validity as correlated with HL (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.95). HL and eHEALS scores were significantly higher in men (unstandardized coefficient [B]=1.01, 95% CI 0.57-1.45, P<.001; B=0.72, 95% CI 0.43-1.00, P<.001), those with a better ability to pay for medication (B=1.65, 95% CI 1.25-2.05, P<.001; B=0.60, 95% CI 0.34-0.86, P<.001), doctors (B=1.29, 95% CI 0.73-1.84, P<.001; B 0.56, 95% CI 0.20-0.93, P=.003), and those with epidemic containment experience (B=1.96, 95% CI 1.56-2.37, P<.001; B=0.64, 95% CI 0.38-0.91, P<.001), as compared to their counterparts, respectively. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures (B=0.13, 95% CI 0.10-0.15, P<.001; B=0.22, 95% CI 0.19-0.26, P<.001), had a higher likelihood of healthy eating (odds ratio [OR] 1.04, 95% CI 1.01-1.06, P=.001; OR 1.04, 95% CI 1.02-1.07, P=.002), were more physically active (OR 1.03, 95% CI 1.02-1.03, P<.001; OR 1.04, 95% CI 1.03-1.05, P<.001), and had a lower likelihood of suspected COVID-19 symptoms (OR 0.97, 95% CI 0.96-0.98, P<.001; OR 0.96, 95% CI 0.95-0.98, P<.001), respectively.

Conclusions

The eHEALS is a valid and reliable survey tool. Gender, ability to pay for medication, profession, and epidemic containment experience were independent predictors of HL and eHEALS scores. HCWs with higher HL or eHEALS scores had better adherence to IPC procedures, healthier lifestyles, and a lower likelihood of suspected COVID-19 symptoms. Efforts to improve HCWs’ HL and eHEALS scores can help to contain the COVID-19 pandemic and minimize its consequences.

Exploring eHealth Literacy and Patient-Reported Experiences With Outpatient Care in the Hungarian General Adult Population: Cross-Sectional Study

BACKGROUND

Digital health, which encompasses the use of information and communications technology in support of health, is a key driving force behind the cultural transformation of medicine toward people-centeredness. Thus, eHealth literacy, assisted by innovative digital health solutions, may support better experiences of care.

OBJECTIVE

The purpose of this study is to explore the relationship between eHealth literacy and patient-reported experience measures (PREMs) among users of outpatient care in Hungary.

METHODS

In early 2019, we conducted a cross-sectional survey on a large representative online sample recruited from the Hungarian general population. eHealth literacy was measured with the eHealth Literacy Scale (eHEALS). PREMs with outpatient care were measured with a set of questions recommended by the Organisation for Economic Co-operation and Development (OECD) for respondents who attended outpatient visit within 12 months preceding the survey. Bivariate relationships were explored via polychoric correlation, the Kruskal-Wallis test, and chi-square test. To capture nonlinear associations, after controlling covariates, we analyzed the relationship between eHEALS quartiles and PREMs using multivariate probit, ordinary least squares, ordered logit, and logistic regression models.

RESULTS

From 1000 survey respondents, 666 individuals (364 females, 54.7%) were included in the study with mean age of 48.9 (SD 17.6) years and mean eHEALS score of 29.3 (SD 4.9). Respondents with higher eHEALS scores were more likely to understand the health care professionals' (HCPs') explanations (χ29=24.2, P=.002) and to be involved in decision making about care and treatment (χ29=18.2, P=.03). In multivariate regression, respondents with lowest (first quartile) and moderately high (third quartile) eHEALS scores differed significantly, where the latter were more likely to have an overall positive experience (P=.02) and experience fewer problems (P=.02). In addition, those respondents had better experiences in terms of how easy it was to understand the HCPs' explanations (P<.001) and being able to ask questions during their last consultation (P=.04). Patient-reported experiences of individuals with highest (fourth quartile) and lowest (first quartile) eHEALS levels did not differ significantly in any items of the PREM instrument, and neither did composite PREM scores generated from the PREM items (P>.05 in all models).

CONCLUSIONS

We demonstrated the association between eHealth literacy and PREMs. The potential patient-, physician-, and system-related factors explaining the negative experiences among people with highest levels of eHealth literacy warrant further investigation, which may contribute to the development of efficient eHealth literacy interventions. Further research is needed to establish causal relationship between eHealth literacy and patient-reported experiences.

Eliciting preferences for outpatient care experiences in Hungary: A discrete choice experiment with a national representative sample

Introduction

Patient-reported experience measures (PREMs) are central to inform on the responsiveness of health systems to citizens’ health care needs and expectations. At their current form, PREMs do not reflect the weights that patients assign to varying aspects of the care experience. We aimed to investigate patients’ preferences and willingness to pay (WTP) for attributes of the care experience in outpatient settings.

Methods

A discrete choice experiment was conducted among a representative sample of the general adult population of Hungary (n = 1000). Choice set attributes and levels were defined based on OECD’s standardized PREMs (e.g. a doctor spending enough time in consultation, providing easy to understand explanations, giving opportunity to ask questions, and involving in decision making) and a price attribute. Conditional and mixed logit analyses were conducted. WTP estimates were computed in preference and WTP space.

Results

The respondents most preferred attribute was that of a doctor spending enough time in consultation, followed by involvement in decision making. Moreover, waiting times had a less important effect on respondents’ choice preference compared with aspects of the doctor-patient relationship. Estimates in the WTP space varied from €4.38 (2.85–5.90) for waiting an hour less at a doctor’s office to €36.13 (32.07–40.18) for a consultation where a doctor spends enough time with a patient relative to a consultation where a doctor does not.

Conclusions

A preference-based PREMs approach provide insight on the value patients assign to different aspects of their care experience. This can inform the decisions of policy-makers and other stakeholders to coordinate efforts and resource allocation in a more targeted manner, by acting on attributes of the care experience that have a greater impact on the implementation of patient-centered care.

Psychometric Properties of the Norwegian Version of the Electronic Health Literacy Scale (eHEALS) Among Patients After Percutaneous Coronary Intervention: Cross-Sectional Validation Study

BACKGROUND

Web-based technology has recently become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients' perceived electronic health (eHealth) literacy skills is crucial for improving the delivery of patient-centered health information.

OBJECTIVE

The aim of this study was to translate and adapt the eHealth Literacy Scale (eHEALS) to conditions in Norway, and to determine its psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing, and cross-cultural validity) of the eHEALS in self-report format administered to patients after percutaneous coronary intervention.

METHODS

The original English version of the eHEALS was translated into Norwegian following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach α. The intraclass correlation coefficient (ICC) was used to assess the test-retest reliability. Confirmatory factor analysis (CFA) was performed for a priori-specified 1-, 2-, and 3-factor models. Demographic, health-related internet use, health literacy, and health status information was collected to examine correlations with eHEALS scores.

RESULTS

A total of 1695 patients after percutaneous coronary intervention were included in the validation analysis. The mean age was 66 years, and the majority of patients were men (1313, 77.46%). Cronbach α for the eHEALS was >.99. The corresponding Cronbach α for the 2-week retest was .94. The test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). The CFA showed a modest model fit for the 1- and 2-factor models (root mean square error of approximation>0.06). After modifications in the 3-factor model, all of the goodness-of-fit indices indicated a good fit. There was a weak correlation with age (r=-0.206). Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score, with a mean difference ranging from 2.24 (P=.002) to 4.61 (P<.001), and a higher eHEALS score was found for patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was also higher among patients who reported using the internet to find health information (95% CI -21.40 to -17.21, P<.001), and there was a moderate correlation with the patients' perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There were also moderate correlations identified between the eHEALS score and the health literacy domains appraisal of health information (r=0.380) and ability to find good health information (r=0.561). Weak correlations with the mental health composite score (r=0.116) and physical health composite score (r=0.116) were identified.

CONCLUSIONS

This study provides new information on the psychometric properties of the eHEALS for patients after percutaneous coronary intervention, suggesting a multidimensional rather than unidimensional construct. However, the study also indicated a redundancy of items, indicating the need for further validation studies.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03810612; https://clinicaltrials.gov/ct2/show/NCT03810612.

Association of eHealth Literacy With Lifestyle Behaviors in University Students: Questionnaire-Based Cross-Sectional Study

Background

Maintenance of good health and a healthy lifestyle have significant impacts on the lives of university students. However, university students are prone to engage in risky health behaviors, resulting in impaired health status. Electronic health (eHealth) literacy is an important factor in maintaining a healthy lifestyle. However, no studies have assessed the eHealth literacy levels and the associated lifestyle behaviors among university students in Japan.

Objective

The purposes of this study were to clarify the eHealth literacy level, the participant characteristics associated with eHealth literacy, and the association of eHealth literacy with lifestyle behaviors of students in a Japanese university.

Methods

A questionnaire-based cross-sectional study of 3183 students at a national university in Japan was conducted. eHealth literacy was quantified using the Japanese version of the eHealth Literacy Scale (eHEALS). The association between participant characteristics (gender, school year, department of study, and living status) and eHEALS score was assessed using t tests. Additionally, the associations of eHealth literacy with lifestyle behaviors (exercise, smoking, alcohol consumption, etc.) were evaluated using logistic regression analyses.

Results

The mean eHEALS score was 23.6/40 points. The mean eHEALS score for students in medical departments was 27.0/40 points, which was 2.9 points higher than that of nonmedical students (P<.001). Similarly, the graduate school participants had higher scores than the undergraduate students. The proportion of participants who exercised regularly was higher in the high eHEALS score group than in the low score group, with an adjusted odds ratio of 1.39 (P<.001).

Conclusions

The eHealth literacy level of university students in Japan was comparable to that of the general Japanese population. Graduate students, as well as those in medical departments, had higher eHealth literacy. Furthermore, students with higher eHealth literacy had better exercise routines.