Previously submitted to: Journal of Medical Internet Research (no longer under consideration since Aug 26, 2024)
Date Submitted: Oct 25, 2023
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
Evaluation of the psychometric properties of the Digital Health Literacy Instrument (DHLI-BrA) for use in Brazilian adolescents
ABSTRACT
Background:
With the increasing digitalization of health care and the high familiarity of adolescents with communication technologies, an effective instrument is necessary to assess levels of health literacy in this age group.
Objective:
This study aimed to evaluate the psychometric properties of the Digital Health Literacy Instrument for Brazilian Adolescents (DHLI-BrA).
Methods:
Two hundred and sixty Brazilian adolescents answered the adapted version of the DHLI-BrA, the Brazilian version of the instruments: World Health Organization Quality of Life-Bref (WHOQOL-Bref), eHealth Literacy Scale (eHEALS-BrA), Newest Vital Sign (NVS-BR), and Rapid Estimate Adult Literacy in Medicine and Dentistry (REALMD-20). Then, they answered a questionnaire on sociodemographics, health, Internet access, and digital health aspects. The statistical analysis evaluated internal consistency, stability, discriminant and convergent validities, exploratory factor analysis (EFA), and confirmatory factor analysis (AFC).
Results:
The DHLI-BrA self-reported questions demonstrated almost perfect internal consistency (α and ω =0.83) and good stability (ICC=0.906; 95% CI: 0.75 - 0.95). In EFA and AFC, the best-adjusted model was composed of six factors (χ²= 229.173 (DF=174, p=0.0032), CFI= 0.944, TLI= 0.933, RMSEA=0.035, and RMSR=0.047). The performance-based DHLI-BrA demonstrated moderate internal consistency (α= 0.57e ω = 0.58) and good stability (ICC=0.86, 95% CI:0.76-0.92). In EFA and AFC, the best-adjusted model was composed of a single factor (χ²= 17.901 (DF=14, p=0.2113), CFI= 0.952, TLI= 0.927, RMSEA=0.033, and RMSR=0.038). Convergent validity of the self-reported DHLI-BrA was obtained by its correlation with the eHEALS-BrA (r=0.45) and REALMD-20 (r=0.19), besides the performance-based DHLI-BrA with its correlation with the NVS (r=0.47) and REALMD-20 (r=0.44). Furthermore, convergent validity was determined by correlating self-reported items with three domains of the WHOQOL-Bref, and by associating performance-based items with searching and reading health information on the Internet (p<0.005). Older adolescents with higher family income had better self-reported and performance-based DHL (p<0.001) (Discriminant validity).
Conclusions:
The DHLI-BrA demonstrated adequate psychometric properties to measure the self-reported, performance-based digital health literacy of adolescents in Brazil. Clinical Trial: Not applicable.
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