JMIR Publications

ABSTRACT

Background:

In contemporary time a Web-based technology has become an important source for sharing health information with patients after an acute cardiac event. Therefore, consideration of patients’ perceived eHealth literacy skills, is crucial for improving patient-centred health information.

Objective:

The aim of this study was to translate and adapt the eHealth literacy Scale (eHEALS) to conditions in Norway, and to determine the psychometric properties. More specifically, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing and cross-cultural validity) of the eHEALS in self-report format administered to patients after PCI.

Methods:

The original English version of the eHEALS was translated into Norwegian, following a widely used cross-cultural adaptation process. Internal consistency was calculated using Cronbach alpha. Intra-class correlation (ICC) was used to assess test-retest reliability. A confirmatory factor analysis (CFA) was performed for a priori specified 1-, 2- and 3-factor models. Demographic information, health-related internet use, health literacy and health status were collected to correlate with eHEALS scores.

Results:

For the validation, 1695 patients were included after PCI. Mean age was 66 years. Most of the patients were male (78%). Cronbach’s alpha for the eHEALS was α >.999. The corresponding Cronbach’s alpha for the 2-week retest was α >.937. Test-retest ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P<.001). With a root mean square error of approximation (RMSEA) >0.06, the CFA showed a modest model fit of the 1- and 2-factor model. After modifications in the 3-factor model, all the goodness-of-fit indices indicated a good fit. A weak correlation with age (r=-0.206) was found. Between-groups analysis of variance showed a difference according to educational groups and the eHEALS score (mean difference between 2.24 (P=.002) and 4.61 (P<.001)), and a higher eHEALS score for the patients who were employed compared to those who were retired (mean difference 2.31, P<.001). The eHEALS score was higher among the patients who reported to use the internet to find health information (95% CI -21.40, -17.21 (P<.001)), and there was a moderate correlation with the patients’ perceived usefulness (r=0.587) and importance (r=0.574) of using the internet for health information. There was a moderate correlation with the health literacy domains appraisal of health information (r= 0.380) and ability to find good health information (r=0.561). A weak correlation with mental health composite score (r=0.116) and physical health composite score (r=0.116) was found.

Conclusions:

The study provides new information on the psychometric properties of the eHEALS for patients after PCI, suggesting a multidimensional construct rather than unidimensional. However, the study indicated a redundancy of items. Therefore, further validation studies are needed. Clinical Trial: Clinicaltrials.gov identifier: NCT03810612.