Three-Factor Structure of the eHealth Literacy Scale Among Magnetic Resonance Imaging and Computed Tomography Outpatients: A Confirmatory Factor Analysis.

Lisa L Hyde,Allison W Boyes,Lisa J Mackenzie,Tiffany-Jane Evans,Rob Sanson-Fisher

doi:10.2196/humanfactors.9039

Abstract

BackgroundElectronic health (eHealth) literacy is needed to effectively engage with Web-based health resources. The 8-item eHealth literacy scale (eHEALS) is a commonly used self-report measure of eHealth literacy. Accumulated evidence has suggested that the eHEALS is unidimensional. However, a recent study by Sudbury-Riley and colleagues suggested that a theoretically-informed three-factor model fit better than a one-factor model. The 3 factors identified were awareness (2 items), skills (3 items), and evaluate (3 items). It is important to determine whether these findings can be replicated in other populations.ObjectiveThe aim of this cross-sectional study was to verify the three-factor eHEALS structure among magnetic resonance imaging (MRI) and computed tomography (CT) medical imaging outpatients.MethodsMRI and CT outpatients were recruited consecutively in the waiting room of one major public hospital. Participants self-completed a touchscreen computer survey, assessing their sociodemographic, scan, and internet use characteristics. The eHEALS was administered to internet users, and the three-factor structure was tested using structural equation modeling.ResultsOf 405 invited patients, 87.4% (354/405) were interested in participating in the study, and of these, 75.7% (268/354) were eligible. Of the eligible participants, 95.5% (256/268) completed all eHEALS items. Factor loadings were 0.80 to 0.94 and statistically significant (P<.001). All reliability measures were acceptable (indicator reliability: awareness=.71-.89, skills=.78-.80, evaluate=.64-.79; composite reliability: awareness=.89, skills=.92, evaluate=.89; variance extracted estimates: awareness=.80, skills=.79, evaluate=.72). Two out of three goodness-of-fit indices were adequate (standardized root mean square residual (SRMR)=.038; comparative fit index (CFI)=.944; root mean square error of approximation (RMSEA)=.156). Item 3 was removed because of its significant correlation with item 2 (Lagrange multiplier [LM] estimate 104.02; P<.001) and high loading on 2 factors (LM estimate 91.11; P<.001). All 3 indices of the resulting 7-item model indicated goodness of fit (χ211=11.3; SRMR=.013; CFI=.999; RMSEA=.011).ConclusionsThe three-factor eHEALS structure was supported in this sample of MRI and CT medical imaging outpatients. Although further factorial validation studies are needed, these 3 scale factors may be used to identify individuals who could benefit from interventions to improve eHealth literacy awareness, skill, and evaluation competencies.

Highlights

Consumer Electronic health (eHealth) Literacy is Critical to Maximizing the Benefits of eHealthTechnologically-enabled health care is important at both the patient and service level, given the increasing resource and timing pressures on the health care system [1], the digital transformation of health-related industries [2], and changing consumer expectations about their role in care [3]
The three-factor eHealth literacy scale (eHEALS) structure was supported in this sample of magnetic resonance imaging (MRI) and computed tomography (CT) medical imaging outpatients
Further factorial validation studies are needed, these 3 scale factors may be used to identify individuals who could benefit from interventions to improve eHealth literacy awareness, skill, and evaluation competencies

Summary

Introduction

Consumer eHealth Literacy is Critical to Maximizing the Benefits of eHealthTechnologically-enabled health care is important at both the patient and service level, given the increasing resource and timing pressures on the health care system [1], the digital transformation of health-related industries [2], and changing consumer expectations about their role in care [3]. Consumer eHealth Literacy is Critical to Maximizing the Benefits of eHealth. Electronic health (eHealth) refers to the organization and delivery of health services and information using the internet and related technologies [4]. 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 [6]. Find, understand, and appraise electronic health information has been recognized as a key self-reported barrier to the utilization of the internet for health purposes [7]. The 8-item eHealth literacy scale (eHEALS) is a commonly used self-report measure of eHealth literacy. It is important to determine whether these findings can be replicated in other populations

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