Abstract
BackgroundVariations in an individual’s electronic health (eHealth) literacy may influence the degree to which health consumers can benefit from eHealth. The eHealth Literacy Scale (eHEALS) is a common measure of eHealth literacy. However, the lack of guidelines for the standardized interpretation of eHEALS scores limits its research and clinical utility. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points.ObjectiveThe aim of this cross-sectional study was to identify classes of patients reporting similar eHealth literacy and assess characteristics associated with class membership.MethodsMedical imaging outpatients were recruited consecutively in the waiting room of one major public hospital in New South Wales, Australia. Participants completed a self-report questionnaire assessing their sociodemographic characteristics and eHealth literacy, using the eHEALS. Latent class analysis was used to explore eHealth literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership.ResultsOf the 268 eligible and consenting participants, 256 (95.5%) completed the eHEALS. Consistent with distance-based findings, 4 latent classes were identified, which were labeled as low (21.1%, 54/256), moderate (26.2%, 67/256), high (32.8%, 84/256), and very high (19.9%, 51/256) eHealth literacy. Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy (odds ratio 16.67, 95% CI 1.67-100.00; P=.02), and those who used the internet at least daily reported significantly higher odds of high eHealth literacy (odds ratio 4.76, 95% CI 1.59-14.29; P=.007).ConclusionsThe identification of multiple classes of eHealth literacy, using both distance-based and latent class analyses, highlights the limitations of using the eHEALS global score as a dichotomous measurement tool. The findings suggest that eHealth literacy support needs vary in this population. The identification of low and moderate eHealth literacy classes indicate that the design of eHealth resources should be tailored to patients’ varying levels of eHealth literacy. eHealth literacy improvement interventions are needed, and these should be targeted based on individuals’ internet use frequency and health information amount preferences.
Highlights
Electronic Health Literacy Is Important for the Use and Receipt of Benefits From Electronic Health ProgramsWeb-based interventions have been reported to be consistently more effective than non-Web-based modalities in changing patient health behaviors and health-related knowledge [1]
Latent class analysis was used to explore Electronic health (eHealth) literacy clusters identified by a distance-based cluster analysis, and to identify characteristics associated with class membership
Compared with the low class, participants who preferred to receive a lot of health information reported significantly higher odds of moderate eHealth literacy, and those who used the internet at least daily reported significantly higher odds of high eHealth literacy
Summary
Electronic Health Literacy Is Important for the Use and Receipt of Benefits From Electronic Health ProgramsWeb-based interventions have been reported to be consistently more effective than non-Web-based modalities in changing patient health behaviors and health-related knowledge [1]. Electronic health (eHealth) literacy is one important factor influencing the use and receipt of benefits from Web-based health resources [8,9,10]. EHealth literacy refers to an individual’s ability to seek, find, understand, and appraise health information from electronic sources, and apply the knowledge gained to addressing or solving a health problem [11]. Inadequate eHealth literacy has been self-reported as a barrier to use of the internet for health information seeking purposes among the chronically ill [12]. Cut points are often arbitrarily applied at the eHEALS item or global level, which assumes a dichotomy of high and low eHealth literacy. This approach disregards scale constructs and results in inaccurate and inconsistent conclusions. Cluster analysis is an exploratory technique, which can be used to overcome these issues, by identifying classes of patients reporting similar eHealth literacy without imposing data cut points
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