JMIR Publications

ABSTRACT

Background:

Japan is likely the world’s leading aging society, and implementing digital health services holds great potential for addressing healthcare system challenges. Effective development and implementation of these services requires evaluation of digital health literacy levels. However, the status of digital health literacy in Japan, especially among the elderly, remains unclear, despite the need for targeted support due to age-related cognitive and physical challenges.

Objective:

This study aims to translate the eHLQ into Japanese and validate the translation. Additionally, it examines digital health literacy levels among the population of Japan and explores effective strategies for implementing digital health services to support a super-aging society.

Methods:

The translation process prioritized achieving conceptual equivalence with the source language. To validate its accuracy, psychometric assessments by survey were conducted based on classical test theory and item response theory (IRT). Comparative statistical analysis was used to examine the impact of demographic factors. Japanese eHLQ scores were compared with those previously reported for seven languages across six countries.

Results:

A total of 504 individuals aged 18 to 88 y.o. completed the survey, with 444 responding online and 60 in physical face-to-face interviews. The eHLQ showed good internal consistency, with Cronbach’s alpha values of ≥ 0.78. Fit indices, including the Comparative Fit Index at > 0.95, Standardized Root Mean Square Residual at ≤ 0.08, and Standardized Expected Parameter Change at > 0.25, indicating good to acceptable fit. IRT analysis found adequate item location, discrimination, and factor loading. Boundary characteristic curve plotting demonstrated that all items fit well. Comparative analysis revealed significant associations among digital health service usage frequency, self-reported health status, and eHLQ scores across all seven scales: (1) using technology to process health information, (2) understanding health concepts and language, (3) actively engaging with digital services, (4) feeling safe and in control, (5) being motivated to engage with digital services, (6) accessing digital services that work, and (7) utilizing digital services tailored to individual needs. Multi-group comparison by age showed statistical significance in six of the seven scales. To our surprise, those aged < 65 y.o. had higher scores in statistically significant scales compared to those aged ≥ 65 y.o. Japan scored the highest in scale 5 among the seven countries.

Conclusions:

Psychometric analysis indicated the Japanese version eHLQ is a valid and reliable tool for assessing digital health literacy. Given the high motivation observed, digital health holds great potential to support the healthcare system of Japan’s super-aging society.