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      Does the eHealth Literacy Scale (eHEALS) Measure What it Intends to Measure? Validation of a Dutch Version of the eHEALS in Two Adult Populations

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          Abstract

          Background

          The Internet increases the availability of health information, which consequently expands the amount of skills that health care consumers must have to obtain and evaluate health information. Norman and Skinner in 2006 developed an 8-item self-report eHealth literacy scale to measure these skills: the eHealth Literacy Scale (eHEALS). This instrument has been available only in English and there are no data on its validity.

          Objectives

          The objective of our study was to assess the internal consistency and the construct and predictive validity of a Dutch translation of the eHEALS in two populations.

          Methods

          We examined the translated scale in a sample of patients with rheumatic diseases (n = 189; study 1) and in a stratified sample of the Dutch population (n = 88; study 2). We determined Cronbach alpha coefficients and analyzed the principal components. Convergent validity was determined by studying correlations with age, education, and current (health-related) Internet use. Furthermore, in study 2 we assessed the predictive validity of the instrument by comparing scores on the eHEALS with an actual performance test.

          Results

          The internal consistency of the scale was sufficient: alpha = .93 in study 1 and alpha = .92 in study 2. In both studies the 8 items loaded on 1 single component (respectively 67% and 63% of variance). Correlations between eHEALS and age and education were not found. Significant, though weak, correlations were found between the eHEALS and quantity of Internet use ( r = .24, P = .001 and r = .24, P = .02, respectively). Contrary to expectations, correlations between the eHEALS and successfully completed tasks on a performance test were weak and nonsignificant: r = .18 ( P = .09). The t tests showed no significant differences in scores on the eHEALS between participants who scored below and above median scores of the performance test.

          Conclusions

          The eHEALS was assessed as unidimensional in a principal component analysis and the internal consistency of the scale was high, which makes the reliability adequate. However, findings suggest that the validity of the eHEALS instrument requires further study, since the relationship with Internet use was weak and expected relationships with age, education, and actual performance were not significant. Further research to develop a self-report instrument with high correlations with people’s actual eHealth literacy skills is warranted.

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          Most cited references30

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          Coefficient alpha and the internal structure of tests

          Psychometrika, 16(3), 297-334
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            World Health Organization.

            Ala Alwan (2007)
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              Measuring functional, communicative, and critical health literacy among diabetic patients.

              Health literacy (HL), the capacity of individuals to access, understand, and use health information to make informed and appropriate health-related decisions, has been recognized as an important concept in patient education and disease management. This study examined the psychometric properties of newly developed scales for measuring three different levels of HL (i.e., functional, communicative, and critical) in patients with diabetes. The reliability and validity of the three HL scales were evaluated in a sample of 138 outpatients with type 2 diabetes. In addition, sociodemographic and clinical characteristics, knowledge of diabetes, information-seeking behaviors, and self-efficacy were assessed for each patient through a self-report questionnaire and review of electronic medical records. Scale items were constructed to directly reflect the definition of HL. Internal consistency of functional, communicative, and critical HL scales was adequately high (alpha = 0.84, alpha = 0.77, and alpha = 0.65, respectively). Three interpretable factors were identified in exploratory factor analysis. Correlations between HL scales and other measures supported the construct validity of the scales. The three HL scales were only moderately correlated with each other, suggesting that each represents a different domain of HL abilities and skills. Our newly developed HL scales are reliable and valid measures of three types of HL in diabetic patients. Exploring a patient's HL levels may provide a better understanding of the patient's potential barriers to self-management of disease and health-promoting behaviors.
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                Author and article information

                Contributors
                Journal
                J Med Internet Res
                JMIR
                Journal of Medical Internet Research
                Gunther Eysenbach (JMIR Publications Inc., Toronto, Canada )
                1438-8871
                Oct-Dec 2011
                09 November 2011
                : 13
                : 4
                : e86
                Affiliations
                [1] 1simpleDepartment of Psychology, Health and Technology simpleUniversity of Twente EnschedeNetherlands
                [2] 2simpleDepartment of Media, Communication and Organization simpleUniversity of Twente EnschedeNetherlands
                [3] 3simpleArthritis Centre Twente EnschedeNetherlands
                Article
                v13i4e86
                10.2196/jmir.1840
                3222202
                22071338
                e7823879-0e4f-487a-901b-054922e8b25a
                ©Rosalie van der Vaart, Alexander JAM van Deursen, Constance HC Drossaert, Erik Taal, Jan AMG van Dijk, Mart AFJ van de Laar. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 09.11.2011.

                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
                : 29 April 2011
                : 16 May 2011
                : 04 July 2011
                Categories
                Original Paper

                Medicine
                e-health, literacy, internet, online, skills, health care, information
                Medicine
                e-health, literacy, internet, online, skills, health care, information

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