JMIR Publications

ABSTRACT

Background:

In this era of digitalization, eHealth interventions are used to engage patients in healthcare and help them manage their own health. Prior studies showed that this can be particularly interesting for chronic disease self-management and self-care in older adults. Despite of older adults becoming increasingly active on the Internet, they continue to struggle in seeking, finding, understanding, and evaluating health information from electronic sources, as well as applying the acquired knowledge to address or solve a health problem, due to lack or inadequate eHealth literacy. Thus, assessing and monitoring eHealth literacy is critical to support eHealth interventions and contribute to its effectiveness.

Objective:

This study aimed to describe the process of translation, adaptation, and validation of eHealth Literacy Scale (eHEALS) in Portuguese older adults.

Methods:

We adapted the eHEALS in Portuguese older adults and test its full psychometric properties by carrying out two studies: a) general psychometric analysis (n=80) (Study 1); b) confirmatory factor analysis (n=301) (Study 2). The cross-cultural adaption followed the steps of forward-(blind)backward translation, evaluation of the translations by a committee of judges, pilot testing, and full psychometric testing of the pre-final version of the scale.

Results:

We tested stability, reliability, construct validity (exploratory and confirmatory factor analyses and hypothesis testing) and model fit. In Study 1, 58.8% of the respondents were male and 41.3% female, with ages between 65 and 88 years old. In Study 2, 56.5% were male and 43.5% female, with ages between 65 and 88 years old. Scale and items stability showed moderate and strong Pearson’s correlations between all items (Study 1: 0.42≤r≤0.91; Study 2: 0.81≤r≤0.96), statistically significant (P<.001). Reliability was adequate for Study 1 (α=0.92) and Study 2 (α=0.98). The exploratory factor analysis yielded a single-factor structure, explaining 58,3% of the variance in Study 1 and 86,4% in Study 2. In confirmatory analysis (Study 2), the model fit was mixed: Chi-Square test was significant (χ²=265, df=20, P<.001), CFI (0.94) and TLI (0.91) were acceptable, and RMSEA (0.20) indicated a poor fit. In such case, we compared one, two and three-factor structures, deciding for the unidimensional one. In Study 1, eHEALS-PT24 mean score was 27.25 (SD 5.61), with 43.8% of participants showing low levels of eHealth literacy and 11.3% high levels. In Study 2, eHEALS-PT24 mean score was 23.31 (SD 9.53), with 38.2% of participants showing low levels of eHealth literacy and 23.6% high levels. The analysis by subgroups showed statistically significant differences in demographic variables (age, residence area and education levels), with exception for gender.

Conclusions:

The findings suggest eHEALS-PT24 as a reliable and valid instrument to assess eHealth literacy in Portuguese older adults. Therefore, this instrument can be integrated to support the implementation process of eHealth interventions.