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      Evaluating computing students' digital skills and health literacy: A case from Bulgaria

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          Abstract

          The main purpose of this article is to describe the importance and the challenges of digital health literacy as recognized during the COVID-19 pandemic. First, basic definitions of health literacy and digital health literacy are provided, followed by, and matched against digital competence frameworks, and health literacy skills content and scales. Based on that, a compatibility analysis is provided, against the expectations for satisfactory levels definition for the respective competences and skills. For the approbation of the approach, results received from the participation of computing students at the Sofia University St. Kliment Ohridski in the COVID-19 Health Literacy Survey are used.

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          Health literacy and public health: A systematic review and integration of definitions and models

          Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.
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            The grounded psychometric development and initial validation of the Health Literacy Questionnaire (HLQ)

            Background Health literacy has become an increasingly important concept in public health. We sought to develop a comprehensive measure of health literacy capable of diagnosing health literacy needs across individuals and organisations by utilizing perspectives from the general population, patients, practitioners and policymakers. Methods Using a validity-driven approach we undertook grounded consultations (workshops and interviews) to identify broad conceptually distinct domains. Questionnaire items were developed directly from the consultation data following a strict process aiming to capture the full range of experiences of people currently engaged in healthcare through to people in the general population. Psychometric analyses included confirmatory factor analysis (CFA) and item response theory. Cognitive interviews were used to ensure questions were understood as intended. Items were initially tested in a calibration sample from community health, home care and hospital settings (N=634) and then in a replication sample (N=405) comprising recent emergency department attendees. Results Initially 91 items were generated across 6 scales with agree/disagree response options and 5 scales with difficulty in undertaking tasks response options. Cognitive testing revealed that most items were well understood and only some minor re-wording was required. Psychometric testing of the calibration sample identified 34 poorly performing or conceptually redundant items and they were removed resulting in 10 scales. These were then tested in a replication sample and refined to yield 9 final scales comprising 44 items. A 9-factor CFA model was fitted to these items with no cross-loadings or correlated residuals allowed. Given the very restricted nature of the model, the fit was quite satisfactory: χ 2 WLSMV(866 d.f.) = 2927, p<0.000, CFI = 0.936, TLI = 0.930, RMSEA = 0.076, and WRMR = 1.698. Final scales included: Feeling understood and supported by healthcare providers; Having sufficient information to manage my health; Actively managing my health; Social support for health; Appraisal of health information; Ability to actively engage with healthcare providers; Navigating the healthcare system; Ability to find good health information; and Understand health information well enough to know what to do. Conclusions The HLQ covers 9 conceptually distinct areas of health literacy to assess the needs and challenges of a wide range of people and organisations. Given the validity-driven approach, the HLQ is likely to be useful in surveys, intervention evaluation, and studies of the needs and capabilities of individuals.
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              A Multidimensional Tool Based on the eHealth Literacy Framework: Development and Initial Validity Testing of the eHealth Literacy Questionnaire (eHLQ)

              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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                Author and article information

                Contributors
                Journal
                Front Public Health
                Front Public Health
                Front. Public Health
                Frontiers in Public Health
                Frontiers Media S.A.
                2296-2565
                24 January 2023
                2022
                : 10
                : 1085842
                Affiliations
                [1] 1Faculty of Mathematics and Informatics, Sofia University St. Kliment Ohridski , Sofia, Bulgaria
                [2] 2Faculty of Public Health, Medical University—Sofia , Sofia, Bulgaria
                [3] 3Department of Data Science and Content Creation, 365 Data Science OOD , Sofia, Bulgaria
                Author notes

                Edited by: Maria Kaneva, Institute of Economics and Industrial Engineering (RAS), Russia

                Reviewed by: Mohamed Awad Abdalaziz Mousnad, International Uinversity of Africa, Sudan; Pavel Sorokin, National Research University Higher School of Economics, Russia

                *Correspondence: Kalinka Kaloyanova ✉ kkaloyanova@ 123456fmi.uni-sofia.bg

                This article was submitted to Public Health Education and Promotion, a section of the journal Frontiers in Public Health

                †These authors have contributed equally to this work

                Article
                10.3389/fpubh.2022.1085842
                9902705
                3ad5d645-6c3b-4ba1-945c-6d6c2e9c196b
                Copyright © 2023 Kaloyanova, Leventi and Kaloyanova.

                This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

                History
                : 01 November 2022
                : 28 December 2022
                Page count
                Figures: 8, Tables: 3, Equations: 0, References: 26, Pages: 15, Words: 7605
                Funding
                This article was prepared with the support of me_HeLi-D: Mental Health Literacy and Diversity. Enhancing Mental Health and Resilience through Digital Resources for Youth, 2022-1-AT01-KA220-SCH-000087294, funded by the Erasmus + Programme, Key Action 2: Partnerships for Cooperation and National program “Young Researchers and Post-doctorates-2” (MES - Bulgaria).
                Categories
                Public Health
                Original Research

                health literacy (hl),digital health literacy,health literacy questionnaire (hlq),digital competences,digital competences frameworks,digcomp 2.2,university students

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