Accepted for/Published in: Journal of Medical Internet Research
Date Submitted: May 9, 2023
Date Accepted: Nov 20, 2023
Date Submitted to PubMed: Nov 22, 2023
Structural Validation and Measurement Invariance Testing of the Chinese Version of Electronic Health Literacy Scale: Cross-Sectional Study Among Undergraduates
ABSTRACT
Background:
The eHealth Literacy Scale (eHEALS) was introduced to China in 2013 as one of the most important electronic health literacy measurement instruments. After a decade of development in China, it has received widespread attention while its theoretical underpinnings have been challenged, thus demanding more robust research evidence of factorial validity and multi-group measurement properties.
Objective:
This study's objective was to evaluate the C-eHEALS, the Chinese version of the eHealth Literacy Scale, in terms of its measurement properties.
Methods:
A cross-sectional survey was conducted in a university setting in China. Item statistics contain response distributions and checks for floor and ceiling effects, and internal consistency reliability is confirmed with Cronbach's alpha, split-half reliability, Cronbach's alpha if item deleted, and Item-total correlation. Five representative eHEALS factor structures were examined and contrasted using Confirmatory factor analysis (CFA). The confirmation of the dominance model was then used to assess the measurement invariance across gender.
Results:
972 respondents were identified, with a Cronbach's alpha of 0.92, split-half reliability of 0.88, item-total score correlation coefficients ranged from 0.715 to 0.781, and Cronbach's alpha if item deleted showed that all items should be retained. CFA confirmed that a 3-factor model was acceptable. Its measurement model met all relevant fit indices, average variance extracted (AVE) from 0.663 to 0.680, composite reliability (CR) from 0.810 to 0.857, χ2/df (chi-square divided by the degrees of freedom) =4.768, RMSEA (root mean square error of approximation) =0.062, SRMR (standardized root mean squared residual) =0.020, CFI (comparative fit index) =0.987, and TLI (Tucker-Lewis index) =0.979. In addition, the scale even demonstrates error variance invariance (ΔNFI (normed fit index) =-0.016, ΔIFI (incremental fit index) =-0.012, ΔTLI=0.005, ΔCFI=-0.012, ΔRFI (relative fit index) =0.005, ΔRMSEA=0.005).
Conclusions:
A 3-factor model of C-eHEALS fits best, and our findings provide evidence for the strict measurement invariance of the instrument regarding gender.
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