Abstract
Background Electronic health resources are helpful only when people are able to use them, yet there remain few tools available to assess consumers’ capacity for engaging in eHealth. Over 40% of US and Canadian adults have low basic literacy levels, suggesting that eHealth resources are likely to be inaccessible to large segments of the population. Using information technology for health requires eHealth literacy—the ability to read, use computers, search for information, understand health information, and put it into context. The eHealth Literacy Scale (eHEALS) was designed (1) to assess consumers’ perceived skills at using information technology for health and (2) to aid in determining the fit between eHealth programs and consumers.Objectives The eHEALS is an 8-item measure of eHealth literacy developed to measure consumers’ combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. The objective of the study was to psychometrically evaluate the properties of the eHEALS within a population context. A youth population was chosen as the focus for the initial development primarily because they have high levels of eHealth use and familiarity with information technology tools.Methods Data were collected at baseline, post-intervention, and 3- and 6-month follow-up using control group data as part of a single session, randomized intervention trial evaluating Web-based eHealth programs. Scale reliability was tested using item analysis for internal consistency (coefficient alpha) and test-retest reliability estimates. Principal components factor analysis was used to determine the theoretical fit of the measures with the data.Results A total of 664 participants (370 boys; 294 girls) aged 13 to 21 (mean = 14.95; SD = 1.24) completed the eHEALS at four time points over 6 months. Item analysis was performed on the 8-item scale at baseline, producing a tight fitting scale with α = .88. Item-scale correlations ranged from r = .51 to .76. Test-retest reliability showed modest stability over time from baseline to 6-month follow-up (r = .68 to .40). Principal components analysis produced a single factor solution (56% of variance). Factor loadings ranged from .60 to .84 among the 8 items.Conclusions The eHEALS reliably and consistently captures the eHealth literacy concept in repeated administrations, showing promise as tool for assessing consumer comfort and skill in using information technology for health. Within a clinical environment, the eHEALS has the potential to serve as a means of identifying those who may or may not benefit from referrals to an eHealth intervention or resource. Further research needs to examine the applicability of the eHEALS to other populations and settings while exploring the relationship between eHealth literacy and health care outcomes.
Highlights
The 2003 National Assessment of Adult Literacy (NAAL) measures the English literacy of America's adults.The average quantitative literacy scores of adults increased 8 points between 1992 and 2003, though average prose and document literacy did not differ significantly from 1992
NOTE: Adults are defined as people 16 years of age and older living in households or prisons
A nonresponse bias adjustment was performed to reduce the bias due to respondent refusal.The adjustment corrected for the initial nonresponse bias, resulting in negligible bias for the household sample.The adjustment procedures are discussed in detail in the forthcoming 2003 NAAL Technical Report.The analyses presented in this report are based on data from the corrected household sample and the prison sample
Summary
The 2003 National Assessment of Adult Literacy (NAAL) measures the English literacy of America's adults (people age 16 and older living in households or prisons).The average quantitative literacy scores of adults increased 8 points between 1992 and 2003, though average prose and document literacy did not differ significantly from 1992 (figure 1). In 2003, 2 percent of respondents identified multiple races and are not included in the White, Black, or Asian/Pacific Islander categories in this figure. The National Center for Education Statistics (NCES) asked the National Research Council’s Board on Testing and Assessment (BOTA) to recommend a set of literacy levels for the 2003 assessment that would permit comparisons with results from the 1992 assessment. NCES has decided to report the assessment results by using four literacy levels. The knowledge and skills needed to perform prose tasks (i.e., to search, comprehend, and use information from continuous texts)
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