A multidimensional tool based on the eHealth Literacy Framework: development and initial validity testing of the eHealth Literacy Questionnaire (eHLQ)

Kayser, Lars, Karnoe, Astrid, Furstrand, Dorthe, Batterham, Roy, Christensen, Karl Bang, Elsworth, Gerald and Osborne, Richard H 2018, A multidimensional tool based on the eHealth Literacy Framework: development and initial validity testing of the eHealth Literacy Questionnaire (eHLQ), Journal of medical internet research, vol. 20, no. 2, pp. 1-10, doi: 10.2196/jmir.8371.

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Title A multidimensional tool based on the eHealth Literacy Framework: development and initial validity testing of the eHealth Literacy Questionnaire (eHLQ)
Author(s) Kayser, Lars
Karnoe, Astrid
Furstrand, Dorthe
Batterham, RoyORCID iD for Batterham, Roy orcid.org/0000-0002-5273-1011
Christensen, Karl Bang
Elsworth, GeraldORCID iD for Elsworth, Gerald orcid.org/0000-0001-6306-7593
Osborne, Richard HORCID iD for Osborne, Richard H orcid.org/0000-0002-9081-2699
Journal name Journal of medical internet research
Volume number 20
Issue number 2
Article ID e36
Start page 1
End page 10
Total pages 10
Publisher JMIR Publications
Place of publication Toronto, Ont.
Publication date 2018-02
ISSN 1438-8871
Keyword(s) computer literacy
eHealth
health literacy
questionnaire design
science & technology
life sciences & biomedicine
health care sciences & services
medical informatics
Summary 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.
Language eng
DOI 10.2196/jmir.8371
Field of Research 111711 Health Information Systems (incl Surveillance)
111712 Health Promotion
111709 Health Care Administration
08 Information And Computing Sciences
Socio Economic Objective 920408 Health Status (e.g. Indicators of Well-Being)
HERDC Research category C1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2018, Lars Kayser, Astrid Karnoe, Dorthe Furstrand, Roy Batterham, Karl Bang Christensen, Gerald Elsworth, Richard H Osborne
Persistent URL http://hdl.handle.net/10536/DRO/DU:30109032

Document type: Journal Article
Collection: Population Health
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