Electronic Health Literacy in Swiss-German Parents: Cross-Sectional Study of eHealth Literacy Scale Unidimensionality

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Abstract

Background

Parents often use digital media to search for information related to their children’s health. As the quantity and quality of digital sources meant specifically for parents expand, parents’ digital health literacy is increasingly important to process the information they retrieve. One of the earliest developed and widely used instruments to assess digital health literacy is the self-reported eHealth Literacy Scale (eHEALS). However, the eHEALS has not been psychometrically validated in a sample of parents. Given the inconsistency of the eHEALS underlying factor structure across previous reports, it is particularly important for validation to occur.

Objective

This study aimed to determine the factor structure of the German eHEALS measure in a sample of parents by adopting classic and modern psychometric approaches. In particular, this study sought to identify the eHEALS validity as a unidimensional index as well as the viability for potential subscales.

Methods

A cross-sectional design was used across two purposive sampling frames: online and paper administrations. Responses were collected between January 2018 and May 2018 from 703 Swiss-German parents. In addition to determining the sampling characteristics, we conducted exploratory factor analysis of the eHEALS by considering its ordinal structure using polychoric correlations. This analysis was performed separately for online–based and paper–based responses to examine the general factor strength of the eHEALS as a unidimensional index. Furthermore, item response theory (IRT) analyses were conducted by fitting eHEALS to a bifactor model to further inspect its unidimensionality and subscale viability.

Results

Parents in both samples were predominantly mothers (622/703, 88.5%), highly educated (538/703, 76.9%), of Swiss nationality (489/703, 71.8%), and living with a partner (692/703, 98.4%). Factor analyses of the eHEALS indicated the presence of a strong general factor across both paper and online samples, and the Wilcoxon rank-sum test indicated that the eHEALS total sum score was not significantly different between the paper and online samples ( P=.12). Finally, the IRT analyses indicated negligible multidimensionality, insufficient subscale reliability after accounting for the eHEALS general factor, and a reduced subset of items that could serve as a unidimensional index of the eHEALS across the paper and online samples.

Conclusions

The German eHEALS evidenced good psychometric properties in a parent-specific study sample. Factor analyses indicated a strong general factor across purposively distinct sample frames (online and paper). IRT analyses validated the eHEALS as a unidimensional index while failing to find support for subscale usage.

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Most cited references 30

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SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test

Brian O'Connor (2000)

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The role of the bifactor model in resolving dimensionality issues in health outcomes measures.

Steven P Reise, Julien Morizot, Ron D Hays (2007)

We propose the application of a bifactor model for exploring the dimensional structure of an item response matrix, and for handling multidimensionality. We argue that a bifactor analysis can complement traditional dimensionality investigations by: (a) providing an evaluation of the distortion that may occur when unidimensional models are fit to multidimensional data, (b) allowing researchers to examine the utility of forming subscales, and, (c) providing an alternative to non-hierarchical multidimensional models for scaling individual differences. To demonstrate our arguments, we use responses (N = 1,000 Medicaid recipients) to 16 items in the Consumer Assessment of Healthcare Providers and Systems (CAHPS2.0) survey. Exploratory and confirmatory factor analytic and item response theory models (unidimensional, multidimensional, and bifactor) were estimated. CAHPS items are consistent with both unidimensional and multidimensional solutions. However, the bifactor model revealed that the overwhelming majority of common variance was due to a general factor. After controlling for the general factor, subscales provided little measurement precision. The bifactor model provides a valuable tool for exploring dimensionality related questions. In the Discussion, we describe contexts where a bifactor analysis is most productively used, and we contrast bifactor with multidimensional IRT models (MIRT). We also describe implications of bifactor models for IRT applications, and raise some limitations.

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Parenthood, information and support on the internet. A literature review of research on parents and professionals online

Lars Plantin, Kristian Daneback (2009)

Background The aim of this article was to address questions on how parents use the internet to find information and support regarding children, health and family life. Another aim was to find out how professionals use the internet to provide support and information to parents. This was done by a literature review. Methods Articles were searched for in five databases with a search strategy called "building block" approach. Results The review showed that the majority of today's parents search for both information and social support on the internet. However, there are considerable differences due to gender, age and socio-economic differences. First time middle class mothers aged 30–35 are most active in looking up health and parent information on the internet. In the same time, several studies report diminishing class differences on parent web sites. An important reason to the increasing number of parents who turn to the internet for information and interaction has shown to be the weakened support many of today's parents experience from their own parents, relatives and friends. Professionals have recognized the parents' great interest for going online and offer both information and support on the net. Conclusion Many benefits are reported, for example the possibility to reach out to a wider audience and to increase access to organisations without an increase in costs. Other benefits include the possibility for parents to remain anonymous in their contacts with professionals and that parents' perceived need for information can be effectively met around the clock. Interventions for wider groups of parents, such as parent training on the net, are still very rare and more research is needed to evaluate different types of interventions on the net. However, most studies were empirical and lacked theoretical frameworks which leave questions on how we can more fully understand this phenomenon unanswered.

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Author and article information

Contributors

Matthew J Kerry:

ORCID: https://orcid.org/0000-0002-1339-899X

Institute of Health SciencesDepartment of HealthZurich University of Applied SciencesTechnikumstrasse 71Winterthur, 8400Switzerland41 58 934 41 79matthewj.kerry@zhaw.ch

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: March 2020

Publication date (Electronic): 13 March 2020

Volume: 22

Issue: 3

Electronic Location Identifier: e14492

Affiliations

[1 ] Institute of Health Sciences Department of Health Zurich University of Applied Sciences Winterthur Switzerland

[2 ] University of Basel Basel Switzerland

Author notes

Corresponding Author: Matthew J Kerry matthewj.kerry@ 123456zhaw.ch

Author information

Sibylle Juvalta https://orcid.org/0000-0002-1378-847X

Matthew J Kerry https://orcid.org/0000-0002-1339-899X

Rebecca Jaks https://orcid.org/0000-0002-4998-2792

Isabel Baumann https://orcid.org/0000-0002-8813-9722

Julia Dratva https://orcid.org/0000-0002-9003-2027

Article

Publisher ID: v22i3e14492

DOI: 10.2196/14492

PMC ID: 7101498

PubMed ID: 32167476

SO-VID: ff0705fc-5f3b-46f5-8f0b-36c494694da0

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 : 16 July 2019

Date revision requested : 6 September 2019

Date revision received : 22 October 2019

Date accepted : 12 November 2019

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