Correlation Between eHealth Literacy and Health Literacy Using the eHealth Literacy Scale and Real-Life Experiences in the Health Sector as a Proxy Measure of Functional Health Literacy: Cross-Sectional Web-Based Survey

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Abstract

Background

The eHealth Literacy Scale (eHEALS) is a tool for the self-assessment of perceived comfort and skills in using the internet as a source for health-related information. Although evidence exists of the reliability and construct and structural validity of the scale, there is a lack of evidence in relation to what is proposed by Norman and Skinner in their theoretical lily model of eHealth literacy; in particular it is not clear whether having a higher level of health literacy can positively influence electronic health (eHealth) literacy as measured by the eHEALS.

Objective

Our study aim was to assess whether real-life experiences from studying or working in the health field, as a proxy of higher functional health literacy, correlate with self-referred eHealth literacy as measured by the eHEALS.

Methods

A Web-based survey was conducted among adults living in Northeast Italy using an Italian version of the eHEALS (IT-eHEALS). In order to be able to measure the effect of higher functional health literacy on eHealth literacy, we divided our sample into two groups, respectively characterized by studying or working experience in the health sector and by lack thereof. Mean differences between eHEALS were calculated using t test and effect size evaluated using Cohen d. To ensure the validity of the IT-eHEALS, we evaluated its psychometric properties (internal consistency and dimensionality) and construct validity (by evaluating its correlation with respondents age, gender, educational attainment, self-rated health, use of internet for health-related purposes, and working status).

Results

A total of 868 respondents that completed the IT-eHEALS were included for analysis, of which 259 had working or studying experience in the health field. Mean (SD) eHEALS total score was 28.2 (6.2) for the whole sample, with statistically significant differences ( P<.001) between the two groups, with the higher health literate group scoring significantly better (31.9 (5.9) vs 26.7 (5.6), respectively), with a standardized mean difference (Cohen d) of 0.9. Interestingly, we found a weak, yet significant, correlation between eHealth literacy and respondent characteristics for the higher health literate group only, as measured by positive Spearman correlation coefficients for age (0.11, P=.001), educational attainment (0.19, P=.002) and self-rated health (0.14, P=.024). Also, in line with current literature, correlation of eHEALS score with frequency of internet use for health-related purposes was significant for both groups (0.32, P<.001 and 0.15, P<.001 for higher and lower health literacy group, respectively). In our study we could not find any difference related to gender, while a significant difference for working status was only present when considering the sample as a whole ( P=.03).

Conclusions

Our study demonstrates a sizeable effect of higher levels of functional health literacy on the eHEALS score, corroborating what was initially proposed by Norman and Skinner in the lily model of eHealth literacy.

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Most cited references 23

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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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Development of the Digital Health Literacy Instrument: Measuring a Broad Spectrum of Health 1.0 and Health 2.0 Skills

Rosalie van der Vaart, Constance H.C Drossaert (2017)

Background With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy or eHealth literacy. Current instruments to measure digital health literacy focus only on information gathering (Health 1.0 skills) and do not pay attention to interactivity on the Web (Health 2.0). To measure the complete spectrum of Health 1.0 and Health 2.0 skills, including actual competencies, we developed a new instrument. The Digital Health Literacy Instrument (DHLI) measures operational skills, navigation skills, information searching, evaluating reliability, determining relevance, adding self-generated content, and protecting privacy. Objective Our objective was to study the distributional properties, reliability, content validity, and construct validity of the DHLI’s self-report scale (21 items) and to explore the feasibility of an additional set of performance-based items (7 items). Methods We used a paper-and-pencil survey among a sample of the general Dutch population, stratified by age, sex, and educational level (T1; N=200). The survey consisted of the DHLI, sociodemographics, Internet use, health status, health literacy and the eHealth Literacy Scale (eHEALS). After 2 weeks, we asked participants to complete the DHLI again (T2; n=67). Cronbach alpha and intraclass correlation analysis between T1 and T2 were used to investigate reliability. Principal component analysis was performed to determine content validity. Correlation analyses were used to determine the construct validity. Results Respondents (107 female and 93 male) ranged in age from 18 to 84 years (mean 46.4, SD 19.0); 23.0% (46/200) had a lower educational level. Internal consistencies of the total scale (alpha=.87) and the subscales (alpha range .70-.89) were satisfactory, except for protecting privacy (alpha=.57). Distributional properties showed an approximately normal distribution. Test-retest analysis was satisfactory overall (total scale intraclass correlation coefficient=.77; subscale intraclass correlation coefficient range .49-.81). The performance-based items did not together form a single construct (alpha=.47) and should be interpreted individually. Results showed that more complex skills were reflected in a lower number of correct responses. Principal component analysis confirmed the theoretical structure of the self-report scale (76% explained variance). Correlations were as expected, showing significant relations with age (ρ=–.41, P<.001), education (ρ=.14, P=.047), Internet use (ρ=.39, P<.001), health-related Internet use (ρ=.27, P<.001), health status (ρ range .17-.27, P<.001), health literacy (ρ=.31, P<.001), and the eHEALS (ρ=.51, P<.001). Conclusions This instrument can be accepted as a new self-report measure to assess digital health literacy, using multiple subscales. Its performance-based items provide an indication of actual skills but should be studied and adapted further. Future research should examine the acceptability of this instrument in other languages and among different populations.

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eHealth Literacy 2.0: Problems and Opportunities With an Evolving Concept

Cameron Norman (2011)

As the use of eHealth grows and diversifies globally, the concept of eHealth literacy – a foundational skill set that underpins the use of information and communication technologies (ICT) for health – becomes more important than ever to understand and advance. EHealth literacy draws our collective attention to the knowledge and complex skill set that is often taken for granted when people interact with technology to address information, focusing our attention on learning and usability issues from the clinical through to population health level. Just as the field of eHealth is dynamic and evolving, so too is the context where eHealth literacy is applied and understood. The original Lily Model of eHealth literacy and scale used to assess it were developed at a time when the first generation of web tools gained prominence before the rise of social media. The rapid shifts in the informational landscape created by Web 2.0 tools and environments suggests it might be time to revisit the concept of eHealth Literacy and consider what a second release might look like.

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Author and article information

Contributors

Giulia Bravo:

Department of MedicineUniversity of UdinePiazzale M Kolbe, 4Udine, 33100Italy39 0432559601giulia.bravo@uniud.it

ORCID: http://orcid.org/0000-0002-3149-2883

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: October 2018

Publication date (Electronic): 31 October 2018

Volume: 20

Issue: 10

Electronic Location Identifier: e281

Affiliations

[1 ] Department of Medicine University of Udine Udine Italy

Author notes

Corresponding Author: Giulia Bravo giulia.bravo@ 123456uniud.it

Author information

Pietro Del Giudice http://orcid.org/0000-0001-9476-4957

Giulia Bravo http://orcid.org/0000-0002-3149-2883

Marco Poletto http://orcid.org/0000-0002-5206-2815

Anna De Odorico http://orcid.org/0000-0001-9222-2601

Alessandro Conte http://orcid.org/0000-0003-2572-6556

Laura Brunelli http://orcid.org/0000-0002-5475-0021

Luca Arnoldo http://orcid.org/0000-0002-8068-5219

Silvio Brusaferro http://orcid.org/0000-0003-1018-7094

Article

Publisher ID: v20i10e281

DOI: 10.2196/jmir.9401

PMC ID: 6246968

PubMed ID: 30381283

SO-VID: c509aec5-0266-4eab-b05a-1f9dd698d008

Copyright © ©Pietro Del Giudice, Giulia Bravo, Marco Poletto, Anna De Odorico, Alessandro Conte, Laura Brunelli, Luca Arnoldo, Silvio Brusaferro. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 31.10.2018.

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License ( https://creativecommons.org/licenses/by/4.0/), 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 : 29 December 2017

Date revision requested : 15 March 2018

Date revision received : 28 June 2018

Date accepted : 20 July 2018

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