EHealth literacy in chronic disease patients: An item response theory analysis of the eHealth literacy scale (eHEALS)

Abstract

BackgroundChronic disease patients are affected by low computer and health literacy, which negatively affects their ability to benefit from access to online health information. ObjectiveTo estimate reliability and confirm model specifications for eHealth Literacy Scale (eHEALS) scores among chronic disease patients using Classical Test (CTT) and Item Response Theory techniques. MethodsA stratified sample of Black/African American (N=341) and Caucasian (N=343) adults with chronic disease completed an online survey including the eHEALS. Item discrimination was explored using bi-variate correlations and Cronbach’s alpha for internal consistency. A categorical confirmatory factor analysis tested a one-factor structure of eHEALS scores. Item characteristic curves, in-fit/outfit statistics, omega coefficient, and item reliability and separation estimates were computed. ResultsA 1-factor structure of eHEALS was confirmed by statistically significant standardized item loadings, acceptable model fit indices (CFI/TLI>0.90), and 70% variance explained by the model. Item response categories increased with higher theta levels, and there was evidence of acceptable reliability (ω=0.94; item reliability=89; item separation=8.54). ConclusioneHEALS scores are a valid and reliable measure of self-reported eHealth literacy among Internet-using chronic disease patients. Practice implicationsProviders can use eHEALS to help identify patients’ eHealth literacy skills.