JMIR Publications

ABSTRACT

Background:

Parents often use digital media for searching children’s health information. As the quantity and quality of parent-specific digital sources expands, the digital health literacy of parents is increasingly important for parents to be able to process the information found in such health media. One of the earliest developed and widely used instruments to assess digital health literacy is the eHEALS self-report measure. To date, however, the eHEALS has not been psychometrically validated in a parent sample. This gap becomes more-so important in the context of past, inconsistent reports for the eHEALS underlying factor structure.

Objective:

To determine the factor structure of the German eHEALS measure in a sample of parents by adopting classical 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 with survey methodology was conducted across two purposive sampling frames: 1) online, and 2) paper administrations. Responses were collected between January to May 2018 from 703 Swiss-German parents. In addition to describing sampling characteristic differences, we also conducted exploratory factor analysis of the eHEALS by considering its ordinal structure via polychoric correlations. This analysis was performed separately for each sampling frame (online and paper) in order to examine general factor strength of the eHEALS as a unidimensional index. Furthermore, item response theory (IRT) analyses were conducted by fitting the eHEALS to a bifactor model to further inspect unidimensionality and subscale viability of the eHEALS measure.

Results:

Sampling characteristics indicated that parents in both samples were comprised of predominantly mothers (88.5%), were highly educated (76.9%), of Swiss nationality (71.8%) and living in a partnership (98.4%). Factor analyses of the eHEALS indicated the presence of a strong general factor across paper and online samples, and a Wilcoxon rank-sum test indicated a non-significant difference on the eHEALS total sum score (P =0.12). Finally, IRT analyses including bifactor modeling of the eHEALS indicated ignorable multidimensionality, insufficient subscale reliability after accounting for eHEALS general factor, and a reduced subset of items that may serve as a unidimensional index of the eHEALS across 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.