Exploring the Measurement Properties of the eHealth Literacy Scale (eHEALS) Among Baby Boomers: A Multinational Test of Measurement Invariance

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Abstract

Background

The eHealth Literacy Scale (eHEALS) is one of only a few available measurement scales to assess eHealth literacy. Perhaps due to the relative paucity of such measures and the rising importance of eHealth literacy, the eHEALS is increasingly a choice for inclusion in a range of studies across different groups, cultures, and nations. However, despite its growing popularity, questions have been raised over its theoretical foundations, and the factorial validity and multigroup measurement properties of the scale are yet to be investigated fully.

Objective

The objective of our study was to examine the factorial validity and measurement invariance of the eHEALS among baby boomers (born between 1946 and 1964) in the United States, United Kingdom, and New Zealand who had used the Internet to search for health information in the last 6 months.

Methods

Online questionnaires collected data from a random sample of baby boomers from the 3 countries of interest. The theoretical underpinning to eHEALS comprises social cognitive theory and self-efficacy theory. Close scrutiny of eHEALS with analysis of these theories suggests a 3-factor structure to be worth investigating, which has never before been explored. Structural equation modeling tested a 3-factor structure based on the theoretical underpinning to eHEALS and investigated multinational measurement invariance of the eHEALS.

Results

We collected responses (N=996) to the questionnaires using random samples from the 3 countries. Results suggest that the eHEALS comprises a 3-factor structure with a measurement model that falls within all relevant fit indices (root mean square error of approximation, RMSEA=.041, comparative fit index, CFI=.986). Additionally, the scale demonstrates metric invariance (RMSEA=.040, CFI=.984, ΔCFI=.002) and even scalar invariance (RMSEA=.042, CFI=.978, ΔCFI=.008).

Conclusions

To our knowledge, this is the first study to demonstrate multigroup factorial equivalence of the eHEALS, and did so based on data from 3 diverse nations and random samples drawn from an increasingly important cohort. The results give increased confidence to researchers using the scale in a range of eHealth assessment applications from primary care to health promotions.

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Most cited references 91

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An Updated Paradigm for Scale Development Incorporating Unidimensionality and Its Assessment

David W. Gerbing, James C Anderson (1988)

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Structural Equation Modeling with AMOS : Basic Concepts, Applications, and Programming

Barbara M. Byrne (2010)

This bestselling text provides a practical guide to the basic concepts of structural equation modeling (SEM) and the AMOS program (Versions 17 & 18). The author reviews SEM applications based on actual data taken from her research. Noted for its non-mathematical language, this book is written for the novice SEM user. With each chapter, the author "walks" the reader through all steps involved in testing the SEM model including: <ul><li>an explanation of the issues addressed </li><li>an illustration of the hypothesized and posthoc models tested </li><li>AMOS input and output with accompanying interpretation and explanation</li><li>The function of the AMOS toolbar icons and their related pull-down menus</li><li>The data and published reference upon which the model was based.</li></ul>With over 50% new material, highlights of the new edition include:<ul><li>All new screen shots featuring Version 17 of the AMOS program </li><li>All data files now available at www.psypress.com/sem-with-amos </li><li>Application of a multitrait-mulitimethod model, latent growth curve model, and second-order model based on categorical data</li><li>All applications based on the most commonly used graphical interface</li><li>The automated multi-group approach to testing for equivalence</li></ul>The book opens with an introduction to the fundamental concepts of SEM and the basics of the AMOS program. The next 3 sections present applications that focus on single-group, multiple-group, and multitrait-mutimethod and latent growth curve models. The book concludes with a discussion about non-normal and missing (incomplete) data and two applications capable of addressing these issues. Intended for researchers, practitioners, and students who use SEM and AMOS in their work, this book is an ideal resource for graduate level courses on SEM taught in departments of psychology, education, business, and other social and health sciences and/or as a supplement in courses on applied statistics, multivariate statistics, statistics II, intermediate or advanced statistics, and/or research design. Appropriate for those with limited or no previous exposure to SEM, a prerequisite of basic statistics through regression analysis is recommended.

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Is Open Access

eHealth Literacy: Extending the Digital Divide to the Realm of Health Information

Efrat Neter, Esther Brainin (2012)

Background eHealth literacy is defined as the ability of people to use emerging information and communications technologies to improve or enable health and health care. Objective The goal of this study was to explore whether literacy disparities are diminished or enhanced in the search for health information on the Internet. The study focused on (1) traditional digital divide variables, such as sociodemographic characteristics, digital access, and digital literacy, (2) information search processes, and (3) the outcomes of Internet use for health information purposes. Methods We used a countrywide representative random-digital-dial telephone household survey of the Israeli adult population (18 years and older, N = 4286). We measured eHealth literacy; Internet access; digital literacy; sociodemographic factors; perceived health; presence of chronic diseases; as well as health information sources, content, search strategies, and evaluation criteria used by consumers. Results Respondents who were highly eHealth literate tended to be younger and more educated than their less eHealth-literate counterparts. They were also more active consumers of all types of information on the Internet, used more search strategies, and scrutinized information more carefully than did the less eHealth-literate respondents. Finally, respondents who were highly eHealth literate gained more positive outcomes from the information search in terms of cognitive, instrumental (self-management of health care needs, health behaviors, and better use of health insurance), and interpersonal (interacting with their physician) gains. Conclusions The present study documented differences between respondents high and low in eHealth literacy in terms of background attributes, information consumption, and outcomes of the information search. The association of eHealth literacy with background attributes indicates that the Internet reinforces existing social differences. The more comprehensive and sophisticated use of the Internet and the subsequent increased gains among the high eHealth literate create new inequalities in the domain of digital health information. There is a need to educate at-risk and needy groups (eg, chronically ill) and to design technology in a mode befitting more consumers.

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Author and article information

Contributors

Lynn Sudbury-Riley:

Management SchoolUniversity of LiverpoolChatham StreetLiverpool, L697ZHUnited Kingdom44 151795 ext 255344 1517953001l.sudbury-riley@liverpool.ac.uk

ORCID: http://orcid.org/0000-0001-5097-3407

Journal

Journal ID (nlm-ta): J Med Internet Res

Journal ID (iso-abbrev): J. Med. Internet Res

Journal ID (publisher-id): JMIR

Title: Journal of Medical Internet Research

Publisher: JMIR Publications (Toronto, Canada )

ISSN (Print): 1439-4456

ISSN (Electronic): 1438-8871

Publication date Collection: February 2017

Publication date (Electronic): 27 February 2017

Volume: 19

Issue: 2

Electronic Location Identifier: e53

Affiliations

[1] ¹Management School University of Liverpool LiverpoolUnited Kingdom

[2] ²Waikato Management School University of Waikato HamiltonNew Zealand

[3] ³Institute of Communication and Health Faculty of Communication Sciences University of Lugano LuganoSwitzerland

Author notes

Corresponding Author: Lynn Sudbury-Riley l.sudbury-riley@ 123456liverpool.ac.uk

Author information

Lynn Sudbury-Riley http://orcid.org/0000-0001-5097-3407

Mary FitzPatrick http://orcid.org/0000-0001-9591-6334

Peter J Schulz http://orcid.org/0000-0003-4281-489X

Article

Publisher ID: v19i2e53

DOI: 10.2196/jmir.5998

PMC ID: 5348620

PubMed ID: 28242590

SO-VID: 914eadd9-c697-41fa-904c-377d87e4a51d

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.

History

Date received : 23 May 2016

Date revision requested : 31 July 2016

Date revision received : 23 October 2016

Date accepted : 30 January 2017

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