JMIR Publications

ABSTRACT

Background:

Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users diverse electronic health (eHealth) literacy to address particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures user’s knowledge, skills, trust, motivation and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multi-dimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and was shown to have strong psychometric properties.

Objective:

This study aimed to translate and culturally adapt the eHLQ for application among Chinese-speaking people with chronic diseases in Taiwan, and then undertake a rigorous set of validity testing procedures.

Methods:

The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and Item Response Theory (IRT) approaches. Content validity, known groups validity and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination and item location/difficulty.

Results:

The adapted version was reviewed and a recommended forward translation was confirmed through consensus meetings. The tool exhibited good content validity. A total of 420 people with one or more chronic diseases participated in a validity testing survey. The eHLQ showed good internal consistency (Cronbach’s α .75 ~.95). For known groups validity, all 7 eHLQ scales showed strong expected associations with education. Unidimensionality and local independence assumptions were met, except for Scale 2. IRT analysis showed that all items demonstrated good discrimination and a good range of difficulty, except for 2 items in Scale 7.

Conclusions:

Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Chinese language. Validity testing provided evidence of satisfactory to strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs. Clinical Trial: Inapplicable This study was not a clinical trial.