JMIR Publications

ABSTRACT

Background:

As health resources and services are increasingly delivered through digital platforms, electronic health (eHealth) literacy has become a set of essential capabilities to improve consumer health in the digital era. To understand eHealth literacy needs, a meaningful measure of the concept is required. Strong initial evidence for the reliability and construct validity of inferences drawn from the eHealth Literacy Questionnaire (eHLQ) was obtained during its development in Denmark but validity testing for varying purposes is an ongoing and cumulative process.

Objective:

This study aimed to examine validity evidence based on relations to other variables, using data collected from known-groups approach, to further explore if the eHLQ is a robust tool to understand eHealth literacy needs in different contexts.

Methods:

A priori hypotheses were set for expected score differences between age, sex, education and information and communication (ICT) use for each of the 7 eHealth literacy scales of the eHLQ. A Bayesian mediated multiple indicators multiple causes (MIMIC) model approach was used to simultaneously identify group differences and test measurement invariance through differential item functioning (DIF) across groups with ICT use as a mediator. Data were collected at 3 diverse health sites in Australia.

Results:

Being older was significantly related to lower scores in 4 scales with ‘3. Ability to actively engage with digital services’ (total effect=-.37, P=.00) being the strongest, followed by ‘1. Using technology to process health information’ (total effect=-.32, P=.00), ‘5. Motivated to engage with digital services’ (total effect=-.21, P=.01) and ‘7. Digital services that suit individual needs’ (total effect=-.21, P=.02). However, the effects were only partially mediated by ICT use. Higher education was associated with higher scores in the latent variables representing ‘1. Using technology to process health information’ (total effect=.22, P=.01), and ‘3. Ability to actively engage with digital services’ (total effect=.25, P=.00). Most of the effects were mediated by ICT use. Higher ICT use was related to higher scores in latent variables representing most of the eHLQ scales except ‘2. Understanding health concepts and language’ and ‘4. Feel safe and in control’. No or ignorable DIF were found across the 4 groups.

Conclusions:

By using a Bayesian mediated MIMIC model, this study provides supportive validity evidence for the eHLQ based on relations to other variables and also established evidence on internal structure related to measurement invariance across groups for the 7 scales in the Australian community health context. It has also demonstrated that the eHLQ can be used to gain valuable insights into people’s eHealth literacy needs to help optimize access and use of digital health among users and promote health equity. Clinical Trial: Not applicable