JMIR Publications

ABSTRACT

Background:

The increasing development of digital health services, especially after COVID-19, must be accompanied by health literacy policies so that it can respond to people’s needs in an equitable and inclusive way. Spain is one of the countries with a highly developed digital health infrastructure, but to date there is no validated instrument currently available to measure literacy related to the complexity of digital health services. The eHealth Literacy Questionnaire (eHLQ) is an instrument that meets this need by comprehensively describing the relational nature of health literacy by evaluating not only individual skills, but also the intersection between users and technologies and their experience of using them.

Objective:

This study aims to translate, culturally adapt, and validate the eHLQ, creating a simultaneous process for 2 of the official languages used in Spain: Spanish and Catalan.

Methods:

A systematic translation and cultural adaptation process was followed to maximize construct equivalence. Data from Spanish-speaking people (n=400) and Catalan-speaking people (n=400) were collected in a representative sample from May 2021 to May 2022. For reliability, Cronbach’s ???? was calculated for every scale and overall for the whole questionnaire. Confirmatory factor analysis (CFA) was used in order to confirm the established factor structure. Convergent validity with the correlation of the total score of the eHEALS and eHLQ questionnaires, and known-group validity was evaluated through extreme values for educational, socioeconomic, and use of technology variables.

Results:

Results:

Reliability was considered good since all the scales in both versions had ????>0.75, with scale 2 having the lowest ???? (????=.8943 Spanish; ????=.8561 Catalan). Regarding the CFA, the full 7-factor model fitted for each version reported adequate fitting values; and the same applied for the 7 fitted 1-factor models. For the convergent validity, the eHEALS showed moderate correlation with eHLQ scales in both versions, and the correlation with scale 4 was the lowest in both versions (r=.4350 in both). According to the known-group validity, all the eHLQ scales in both languages were able to discriminate among the maximum and minimum categories in level of studies, socioeconomic level, and level of technology use.

Conclusions:

The Spanish and Catalan eHLQ versions appear to be robust questionnaires for assessing digital health literacy. They could both be useful tools in Spain and Catalonia for researchers, policymakers, and health service managers to explore people’s needs, skills, competences, and interesting insights into their interactions and engagement around their own experience with digital health services in a context of digital health growth in the country.