Literacy Measurement Tools Research Articles

Measurements of traditional Chinese medicine health literacy regarding chronic pain: a scoping review.

Chronic pain is a prevalent health condition that imposes a significant burden on the global health system. Health literacy is a determinant of the quality of pain management which directly impacts public and individual health. However, the existing health literacy measurements have predominantly focused on medical models stemmed from Western culture and the knowledge of non-Western health models has largely been neglected. This review scopes refereed health literacy publications with regard to traditional Chinese medicine and chronic pain to explore and identify 1) the conceptual basis underlying the development of traditional Chinese medicine health literacy in this area, and 2) measurement tools used in this area and their associated psychometric qualities. Twenty-eight journal articles were assessed and the results showed that most studies' conceptual frameworks were unable to cover three key health literacy aspects defined by the World Health Organization (access, understand, and apply). Furthermore, the identified health literacy measurement tools generally lacked rigorous psychometric evaluation. Future studies should focus on exploring a comprehensive model that encompasses various health models and developing measurement tools with more culturally representative psychometric assessments.

Development and preliminary evaluation of a food literacy measure for use with young people in Canada

This paper presents the culmination of a multi-year research project aimed at creating a comprehensive food literacy framework and corresponding measure. Specifically, this paper documents the development and validation of a food literacy measure for young people facing social inequities. This study aimed to: 1) identify items to measure 12 attributes of food literacy 2) test the measure with the identified target groups, considering attribute, face, and content validity, inter-rater reliability and test-retest reliability; and 3) refine the measure. The study's design consisted of a five-phase approach, which included drafting the food literacy measure, expert review, cognitive interviews, pilot testing, and validity and reliability testing. Seven international experts provided feedback on the measure and 25 individuals aged 16-25 years old participated in cognitive interviews. Two-hundred and fifty-five (255) young people completed the test survey and 147 completed a retest survey two weeks later. These surveys identified food literacy factors. To further evaluate the validity of these factors. 193 participants completed a confirmatory test, which was used for confirmatory factor analysis (CFA) to assess the final model's fit. Interview participants were recruited from local programs and services from across Ontario, Canada, while survey participants were recruited from across Canada via social media. The research study was conducted between January 2018 and December 2019. The main outcome measures were validity and reliability scores for a food literacy measurement tool, which consisted of 50 questions across 10 attributes of food literacy. Interview analyses were guided by the four stages of cognitive processing. Exploratory factor analysis (EFA) was used to identify the factors that improved the Cronbach alpha of the food literacy measure. Test-retest reliability was assessed using percent agreement, Cohen Kappa, and weighted Kappa. Confirmatory factor analysis (CFA) was used to produce an acceptable final model with an RMSEA estimate. The final food literacy measure consisted of 50 questions addressing 10 food literacy attributes. EFA showed an improvement in Cronbach alpha when compared to the initial attribute construction. Test-retest reliability showed percent agreement ranging from 64% to 97%, with most items having fair (0.21-0.40) to moderate (0.41-0.60) Kappa values. CFA produced an acceptable final model with an RMSEA estimate of 0.0437. The food literacy measure is a comprehensive tool for assessing food literacy among young people. Additional research is needed to explore the measure's modularity, its use as an evaluation tool, and its suitability for use with diverse samples, including individuals from varied gender, geographic locations, ethnicities and cultural backgrounds.

Generating qualitative evidence of the validity of the Health Literacy Questionnaire Parent

Abstract Background Health literacy refers to the skills needed to access, understand, and navigate health information and services. The Health Literacy Questionnaire (HLQ) is a widely used validated measure of health literacy capturing nine distinct domains. The HLQ-Parent is a recent adaption of the HLQ which has been designed to capture the nuanced health literacy skills required by primary care givers of children. Generating qualitative evidence of validity of such tools is an important element of the validation process as it captures understanding and interpretation of items which is not achievable by quantitative methods alone. Therefore, the purpose of this study was to generate qualitative evidence of the validity of the HLQ-Parent. Methods A qualitative study implementing the HLQ-Parent during face-to-face cognitive interviews with concurrent probing was conducted. Primary carers of children aged 16 or under living in England were recruited via voluntary organisations supporting families. Qualitative data analysis was conducted on the audio recordings in the form of text summaries. Parents’ chosen HLQ-Parent responses were compared to their narrative responses and coded by the researcher as match, no match or unclear. Parents’ narrative responses were also compared to the HLQ-Parent item intent descriptions and coded as concordant, discordant, or unclear. Results Overall, participants (n = 9, mean age 40 years, 88.9% female) narrative responses matched to their chosen HLQ-Parent response, while their narrative responses were concordant with the HLQ-Parent item intent descriptions. Two participants narratives did not match their responses for the item:’ I have enough information to help me deal with my child’s health’. Conclusions The qualitative data provided evidence that participants understood and answered the HLQ-Parent items as intended. Study results contribute validity evidence for the use of HLQ-Parent to measure parental health literacy. Key messages • This study contributes evidence to the validity of the HLQ-Parent. • Qualitative methods provide valuable insights that enhance the overall understanding of health literacy measurement tools.

Public Health Literacy: a concept to develop – Qualitative study among public health professionals

Abstract Background Health literacy can be defined as individuals’ motivation and skills to access, understand, evaluate, and utilize information to make decisions about their health. Despite Sorensen’s widely used definition encompassing both individual and population levels, also known as Public Health Literacy, it remains poorly detailed and is rarely taken into account by measurement tools. As evidenced by the Covid-19 health crisis, limited public health literacy impacts reluctance to accept government recommendations, vaccine hesitancy, and fosters mistrust of science and conspiracy theories in the health field. The main objective of this study was to derive specific public health knowledge and skills from public health professionals for the general population constituted the first step of the development of a public health literacy measurement tools. Methods A qualitative study, based on ten semi-structured interviews with public health professionals from various settings (academic, hospital, health prevention, and promotion), working across various public health fields (nutrition, sexual health, mental health), has been conducted since March 2024. Results Preliminary analysis identified three main themes: (1) fundamental concepts including identification of health determinants, epidemiology and the purpose of public health interventions, (2) critical skills including the assessment of the level of evidence and reliability of public health information, and (3) civic orientation including environmental impact on health and community approach to interventions. Conclusions These detailed insights will guide the creation of a valid measurement tool for public health literacy. This will facilitate the investigation of specific impacts on people’s adherence to public health interventions or messages and the development of actions targeting literacy in a more holistic manner. Key messages • Specific public health dimensions have been identified to enrich the existed definition of health literacy. • Public health concepts, reliability of public health information and community approach constitute the core of public health literacy.

THE IMPULSES OF MODERNJADIDISM AND THE ROLEOF PRINTING

Jadidism, a reform movement among Muslims of the Russian Empire in the late 19th and early 20th centuries, played a key role in cultural and educational evolution. One of the main factors that contributed to its development began to be distributed in the form of newspapers, magazines, fiction books, scientific manuals, etc. The purpose of this study is to analyze the role of the press in the development and spread of Jadidism.The scientific originality of the work lies in deepening the understanding of the processes of the cultural revolution among the Turkic-Muslim peoples living on the territory of the Russia n Empire, and the role of the press in these processes. Practical originality lies in the possibility of using the data obtained to develop modern traditions of cultural and educational development of the Turkic peoples.The article uses historical analysis as well as descriptive and sociocultural methods to determine the relationships between technological advances in printing and ideological changes in Jadidism, using print methods such as a literacy measurement tool, the promotion of secular education, and the formation of modern Turkic identity.The study showed that print media are a central mechanism in disseminating Jadidist idea s and establishing the positions of reformers. The analysis found that the use of printed materials significantly accelerated economic development and led to profound changes in socia l development.The results of the study can be used to develop strategies for supporting and developing cultural and educational initiatives , as well as to study contemporary media in the field of socia l movement and progressive trends in other cultural contexts.

A Systematic Review of Questionnaire Measuring eHealth Literacy

Purpose: This review aims to summarize the characteristics of currently used questionnaires measuring eHealth literacy and assess the quality of their psychometric properties in self-reported assessments within community settings. Methods: The systematic analysis was conducted using the COnsensus-based Standards for the selection of health Measurement INstruments checklist to evaluate the methodological quality of studies on measurement properties. Results: A total of 21 studies, including 19 questionnaires, were reviewed. The findings indicated that the quality of psychometric assessments for eHealth literacy was generally rated as 'good,' with most studies addressing multiple aspects of reliability and validity. Internal reliability, content validity, hypothesis testing, and responsiveness were particularly well-supported, each receiving over 10 sufficient ratings. However, there was limited evidence regarding measurement errors, test-retest reliability, criterion validity, and analyses of floor and ceiling effects. Conclusion: This study contributes to the enhancement of eHealth literacy measurement tool selection and improves the reporting of their validity and reliability, thereby increasing the credibility of future research.

LITERATURE ANALYSIS: MEASURING TOOL FOR ENVIRONMENTAL LITERACY IN PEATLAND INTEGRATION SCIENCE LEARNING

Peatlands play a crucial role in maintaining environmental balance and mitigating global climate change. Peatland damage due to human activities continues to occur. One of the efforts to deal with this problem is to improve students' environmental literacy through science learning that integrates peatlands. This study aims to analyze the dimensions and indicators used in the development of environmental literacy measurement tools in peatland integration science learning. The method used is Systematic Literature Review (SLR). The results of the analysis show that environmental literacy measurement tools generally cover four main dimensions, namely environmental knowledge, attitudes towards the environment, cognitive skills, and environmental behavior or participation, with specific indicators in each dimension. The majority of existing measurement tools have not specifically integrated the peatland context. However, some recent studies have begun to develop environmental literacy measurement tools by integrating the peatland context. One example is the development of a questionnaire specifically designed to measure environmental literacy in peatland areas. The development of peatland-integrated environmental literacy measurement tools in science learning to increase students' understanding and concern for peatland conservation is urgently needed.

연령대별 디지털 리터러시 척도의 구인동등성 검증 및 잠재평균 분석

This study tested the equivalence of a digital literacy measurement tool across different age groups and examined differences in latent means. It measured digital literacy using the same items among 994 elementary students, 348 middle school students, and 220 university students representing childhood, adolescent, and early-adulthood groups, respectively. The digital literacy scale originally developed for the adolescent group was modified to accommodate the vocabulary and contexts appropriate for childhood and early-adulthood groups. The results confirmed complete configural and metric invariance across the groups, though scalar invariance was partially achieved. After partial scalar invariance was established, partial strict invariance was secured for comparing latent means. The comparison revealed that the childhood group scored higher on data and content literacy than the adolescents, but lower on community literacy. The early-adulthood group scored significantly higher than the adolescent group on data and media literacy. This paper interprets of these results, discussing the implications and limitations of the study.

Development of a digital literacy measurement tool for middle and high school students in the context of scientific practice

Development of a digital literacy measurement tool for middle and high school students in the context of scientific practice

연령대별 디지털 리터러시 척도의 구인동등성 검증 및 잠재평균 분석

This study tested the equivalence of a digital literacy measurement tool across different age groups and examined differences in latent means. It measured digital literacy using the same items among 994 elementary students, 348 middle school students, and 220 university students representing childhood, adolescent, and early-adulthood groups, respectively. The digital literacy scale originally developed for the adolescent group was modified to accommodate the vocabulary and contexts appropriate for childhood and early-adulthood groups. The results confirmed complete configural and metric invariance across the groups, though scalar invariance was partially achieved. After partial scalar invariance was established, partial strict invariance was secured for comparing latent means. The comparison revealed that the childhood group scored higher on data and content literacy than the adolescents, but lower on community literacy. The early-adulthood group scored significantly higher than the adolescent group on data and media literacy. This paper interprets of these results, discussing the implications and limitations of the study.

Digital health applications and health literacy: an explorative analysis

Introduction. In 2020, Digital Health Applications (known as DiGA) have been introduced to the German healthcare system. DiGA are medical devices based on digital technologies that can be prescribed by physician and psychotherapists and reimbursed by health insurance companies. DiGA must demonstrate a positive healthcare effect, e.g. by improving of health literacy. Health literacy as a concept has received increasing attention in recent years but has also been subject to a vivid debate on its theoretical underpinning and methodological challenges. Method & Analysis. For this study, all 53 DiGA listed in the official registry were reviewed. We searched the DiGA registry to answer the following research question: do DiGA measure health literacy and which health literacy measurement instruments are applied? Results. Of the 53 DiGA listed, 29 are permanently and 24 provisionally listed in the DiGA directory. Although seven DiGA use health literacy measurement tools, the theoretical or conceptual explanation of these tools and the decision to use them is lacking. Conclusion. This paper argues that there is a need to empirically investigate the motivation of DiGA developers, taking into account the use and non-use of health literacy measurement tools.

Development and validation of a photograph-based instrument to assess nutrition literacy: The NUTLY project

Most instruments measuring nutrition literacy evaluate theoretical knowledge, not necessarily reflecting skills relevant to food choices. We aimed to develop and validate a photograph-based instrument to assess nutrition literacy (NUTLY) among adults in Portugal. NUTLY assesses the ability to distinguish foods with different nutritional profiles; from each of several combinations of three photographs (two foods with similar contents and one with higher content) participants are asked to identify the food with the highest energy/sodium content. The NUTLY version with 79 combinations, obtained after experts/lay people evaluations, was applied to a sample representing different age, gender and education groups (n = 329). Dimensionality was evaluated through latent trait models. Combinations with negative or with positive small factor loadings were excluded after critical assessment. Internal consistency was measured using Cronbach's alpha and construct validity by comparing NUTLY scores with those obtained in the Medical Term Recognition Test and the Newest Vital Sign (NVS), and across education and training in nutrition/health groups. The cut-off to distinguish adequate/inadequate nutrition literacy was defined through ROC analysis using the Youden index criterion, after performing a Latent class analysis which identified a two-class model to have the best goodness of fit. Test-retest reliability was assessed after one month (n = 158). The final NUTLY scale was unidimensional and included 48 combinations (energy: 33; sodium: 15; α = 0.74). Mean scores (±standard deviation) were highest among nutritionists (39.9 ± 4.4), followed by health professionals (38.5 ± 4.1) and declined with decreasing education (p < 0.001). Those with adequate nutrition literacy according to NVS showed higher NUTLY scores (37.9 ± 4.3 vs. 33.9 ± 6.9, p < 0.001). Adequate nutrition literacy was defined as a NUTLY score≥35 (sensitivity: 89.3%; specificity: 93.7%). Test-retest reliability was high (ICC = 0.77). NUTLY is a valid and reliable nutrition literacy measurement tool.

Using co-design to develop the Adolescent Health Literacy Questionnaire for adolescents in Ireland.

Health literacy measurement studies are important for the success of health promotion efforts targeting adolescents. However, the majority of health literacy measurement tools were originally developed for adult populations and may not be reflective of health literacy in the context of adolescence. The present study sought to co-design a health literacy questionnaire and vignettes for adolescents in Ireland aged 12-18 years. This article describes the qualitative phase of the study. In 2019-2021, eight adolescents from the Irish Heart Foundation's Youth Advisory Panel participated in two concept mapping workshops during which they defined healthy living. Results of the thematic analysis indicated that adolescents defined 'healthy living' as a life that was balanced, prioritizing mental health and sleep. According to their definition, healthy living was comprised of six main constructs, namely, knowledge; sources of quality health information; facilitators and barriers; influence of others; self-efficacy, self-management and resilience; and citizenship and communication. These constructs were used to develop vignettes and items for the Adolescent Health Literacy Questionnaire (AHLQ). These were tested on a sample of 80 adolescents to check whether the respondents understood the items and vignettes as intended. Results of the nine cognitive interviews indicated that the adolescents understood the content of the 10 vignettes and 41 items. While the vignettes and AHLQ were developed with Irish adolescents, the approaches taken can be generalized to adolescents living in other countries. This will allow for the development of tailored and relevant solutions for health literacy development and health promotion for this sub-population.

Yetişkinler İçin Ekolojik Okuryazarlık Ölçme Aracı (EKOY): Güvenirlik ve Geçerlik Çalışması

The aim of this study is to develop a valid and reliable measurement tool for obtaining information about the ecological literacy of adults. For this purpose, a 72-item and three-part measurement tool was created in accordance with information in the literature and presented to experts for their opinions. After finalizing the scale in accordance with the feedback received, the 25-item 5-point Likert-type Ecological Literacy Awareness Scale, the 17-item true/false-type Ecological Literacy Knowledge Test (1), and the 17-item multiple-choice Ecological Literacy Knowledge Test (2) were created. The 59-item draft measurement tool was administered to two study groups. These study groups were selected by convenience sampling method, a non-probability sampling method. The data of the first group were used for exploratory factor analysis and the data of the second group were used for confirmatory factor analysis. It was determined that the finalized 37-item and three-part Ecological Literacy Measurement Tool for Adults (ELMT) was valid and reliable in determining the awareness and knowledge of teacher candidates about ecological literacy.

A Review of Health Literacy Measurement Tools from the Health Literacy Tool Shed Database

A Review of Health Literacy Measurement Tools from the Health Literacy Tool Shed Database

Health literacy strengths and challenges of people in New South Wales prisons: a cross-sectional survey using the Health Literacy Questionnaire (HLQ)

BackgroundHealth literacy is an important factor for enabling people to manage their health and live long fulfilling lives. People in prison are frequently from marginalised communities, often out of reach of conventional community based health organisations, and have poorer health outcomes. It is essential to understanding the health literacy profiles of people in prison, and its contribution to the well-established health inequities and outcomes of this population. This study aimed to use a multi-dimensional health literacy measurement tool to describe the strengths and challenges of adults incarcerated in NSW prisons.MethodsA cross-sectional survey was conducted for people in prison across 14 publicly operated metropolitan prisons. Data were collected from 471 participants using the Health Literacy Questionnaire (HLQ). Participant characteristics and health conditions were also collected. Data were analysed using descriptive statistics. Effect sizes (ES) for standardised differences in means were used to describe the magnitude of difference between participant characteristic groups.ResultsParticipants’ median age was 38.0 (range 19 – 91) years. Males comprised 81% of the sample, 21% identified as Aboriginal and/or Torres Strait Islander, and 53% reported a health problem. People in prison had lower scores for all nine HLQ scales when compared to the general Australian population. Small to medium ES were seen for mean differences between most demographic groups. Compared to males, females had lower scores for several of the HLQ scales including ‘having sufficient information to manage health’ (ES 0.30 [95% Confidence Interval (CI) 0.07, 0.53]), ‘ability to actively engage with health care professionals’ (ES 0.30 [95% CI 0.06, 0.53]), ‘navigating the healthcare system’ (ES 0.30 [95% CI 0.06, 0.53]), and, ‘ability to find good health information’ (ES 0.33 [95% CI 0.10, 0.57]). Differing health literacy scale scores with small to medium ES were found when comparing participants by legal status. Mainly small ES were seen when comparing other participant characteristic groups.ConclusionsThis study provides insights into the health literacy strengths and challenges for people in NSW prisons. These findings highlight the important role health literacy could have in addressing health disparities in this vulnerable population and can inform prison health services.

Development and Validation of a Sexual Health Literacy Measurement Tool for Pregnancy Prevention Among Adolescents (SHL-PPA).

Several measurement tools have been developed for health literacy. However, little emphasis has been placed on the development of sexual health literacy (SHL) in adolescents. This paper describes the development and validation of an SHL measurement tool for pregnancy prevention among adolescents (SHL-PPA). This study explores research and development (R&D) and presents three stages of R&D, including a literature review, the Delphi approach, and a valid and reliable questionnaire. Three groups were used for the population and sampling: 18 experts, five competent people, and 654 adolescents. An online self-assessment tool was used. The data analysis methods used were median, interquartile range, content validity index, Cronbach's alpha coefficient, and exploratory factor analysis. The results show that the definition of SHL for adolescents was "cognitive, social, and cultural skills that determine the motivation and ability of an adolescent to access and sufficiently understand sexual health information and services, which results in them being capable of sexual health assessment and making decisions to prevent pregnancy". The final devised SHL-PPA included 33 items and the three following components: 1) accessibility to sexual health information and services, 2) an understanding of sexual health information and services and appraisal of sexual health to prevent pregnancy, and 3) applying the obtained sexual health information and skills to prevent pregnancy. This study proves that the SHL-PPA is appropriate for Generation Z teenagers, particularly for online self-assessment of SHL. An online self-evaluation using the SHL-PPA demonstrated that related organizations should develop online activities or programs to improve teenage girls' pregnancy-prevention behavior.

Health literacy of patients with heart failure in a dutch population

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): The Dutch Research Council (NWO) Background Limited Health Literacy affects about 3 in 10 persons in the Netherlands. Especially for people with chronic conditions like heart failure, adequate health literacy is needed to maintain, monitor and manage their health and their chronic condition. While nurses are expected to meet the specific support needs of their patients, many find it difficult to recognize and assess the level of health literacy of their patients. Purpose To examine and compare health literacy in patients with heart failure patients from the nurses’ perspective against two health literacy measurement tools. Methods Patients with heart failure were recruited in the outpatient cardiology departments of four different hospitals in the Netherlands. Information about health literacy of the patients was collected with a self-reported questionnaire (Set of Brief Screening Questions - SBSQ) and with the Newest Vital Sign-Dutch (NVS-D). Finally, nurses and nurse practitioners assessed health literacy of the patients on a visual analogue scale from 0-6. Additionally, demographic data (gender, age, level of education and native language) and clinical data (NYHA class and medication use) were collected. Results 61 patients with heart failure were recruited during 2022. Mean age was 68.5 (±14.6), 66% were men, 61% had a lower educational level. Most patients (86%) were native Dutch speakers and had a NYHA classification between II-III (46%). The mean number of used cardiac medication was 5.8 (±1.7). 55 patients completed the SBSQ, fifteen (27%) scored an average ≤ 2, indicating inadequate health literacy. The NVS-D was completed by 53 patients. Twenty-seven patients (51%) scored 0-1, suggesting limited health literacy. Fourteen patients (26%) scored 2-3, indicating possible limited health literacy. The nurses’ assessments (using &amp;gt;3 on the visual analogue scale as adequate health literacy), indicated 35 patients (63%) as having adequate health literacy. There was only poor to slight agreement with the results of the SBSQ (Kappa: 0.198). For comparison with the NVS-D, the visual analogue scale was divided into three groups (limited health literacy (&amp;lt;2), possibly limited health literacy (2-4) and adequate health literacy (&amp;gt;4). This resulted in 10 patients (18%) with limited health literacy according to nurses, 23 (41%) with possibly limited health literacy and 23 (41%) with adequate health literacy. There was also poor agreement between the nurses’ assessment and the NVS-D results (Kappa: 0.133). Conclusion(s) Health literacy is vital for patients with heart failure to process and apply health related information. Alhough there is no gold standard measuring health literacy yet, this study shows that nurses’ assessment does not agree with the SBSQ and the NVS-D. To take health literacy into account during communication, nurses can use the SBSQ, noting that the SBSQ seems to underestimate limited health literacy, while the NVS-D seems to overestimate it.Table 1:Characteristics of patientsTable 2:HL of heart failure patients

Performance-Based Measurement of eHealth Literacy: Systematic Scoping Review

eHealth literacy describes the ability to locate, comprehend, evaluate, and apply web-based health information to a health problem. In studies of eHealth literacy, researchers have primarily assessed participants' perceived eHealth literacy using a short self-report instrument, for which ample research has shown little to no association with actual performed eHealth-related skills. Performance-based measures of eHealth literacy may be more effective at assessing actual eHealth skills, yet such measures seem to be scarcer in the literature. The primary purpose of this study was to identify tools that currently exist to measure eHealth literacy based on objective performance. A secondary purpose of this study was to characterize the prevalence of performance-based measurement of eHealth literacy in the literature compared with subjective measurement. We conducted a systematic scoping review of the literature, aligning with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, in 3 stages: conducting the search, screening articles, and extracting data into a summary table. The summary table includes terminology for eHealth literacy, description of participants, instrument design, health topics used, and a brief note on the evidence of validity for each performance-based measurement tool. A total of 1444 unique articles retrieved from 6 relevant databases (MEDLINE; PsycINFO; CINAHL; Library and Information Science Abstracts [LISA]; Library, Information Science & Technology Abstracts [LISTA]; and Education Resources Information Center [ERIC]) were considered for inclusion, of which 313 (21.68%) included a measure of eHealth literacy. Among the 313 articles that included a measure of eHealth literacy, we identified 33 (10.5%) that reported on 29 unique performance-based eHealth literacy measurement tools. The types of tools ranged from having participants answer health-related questions using the internet, having participants engage in simulated internet tasks, and having participants evaluate website quality to quizzing participants on their knowledge of health and the web-based health information-seeking process. In addition, among the 313 articles, we identified 280 (89.5%) that measured eHealth literacy using only a self-rating tool. This study is the first research synthesis looking specifically at performance-based measures of eHealth literacy and may direct researchers toward existing performance-based measurement tools to be applied in future projects. We discuss some of the key benefits and drawbacks of different approaches to performance-based measurement of eHealth literacy. Researchers with an interest in gauging participants' actual eHealth literacy (as opposed to perceived eHealth literacy) should make efforts to incorporate tools such as those identified in this systematic scoping review.

Diagnostic accuracy of eHealth literacy measurement tools in older adults: a systematic review

BackgroundIn Canada, virtual health care rapidly expanded during the COVID-19 pandemic. There is substantial variability between older adults in terms of digital literacy skills, which precludes equitable participation of some older adults in virtual care. Little is known about how to measure older adults’ electronic health (eHealth) literacy, which could help healthcare providers to support older adults in accessing virtual care. Our study objective was to examine the diagnostic accuracy of eHealth literacy tools in older adults.MethodsWe completed a systematic review examining the validity of eHealth literacy tools compared to a reference standard or another tool. We searched MEDLINE, EMBASE, CENTRAL/CDSR, PsycINFO and grey literature for articles published from inception until January 13, 2021. We included studies where the mean population age was at least 60 years old. Two reviewers independently completed article screening, data abstraction, and risk of bias assessment using the Quality Assessment for Diagnostic Accuracy Studies-2 tool. We implemented the PROGRESS-Plus framework to describe the reporting of social determinants of health.ResultsWe identified 14,940 citations and included two studies. Included studies described three methods for assessing eHealth literacy: computer simulation, eHealth Literacy Scale (eHEALS), and Transactional Model of eHealth Literacy (TMeHL). eHEALS correlated moderately with participants’ computer simulation performance (r = 0.34) and TMeHL correlated moderately to highly with eHEALS (r = 0.47–0.66). Using the PROGRESS-Plus framework, we identified shortcomings in the reporting of study participants’ social determinants of health, including social capital and time-dependent relationships.ConclusionsWe found two tools to support clinicians in identifying older adults’ eHealth literacy. However, given the shortcomings highlighted in the validation of eHealth literacy tools in older adults, future primary research describing the diagnostic accuracy of tools for measuring eHealth literacy in this population and how social determinants of health impact the assessment of eHealth literacy is needed to strengthen tool implementation in clinical practice.Protocol registrationWe registered our systematic review of the literature a priori with PROSPERO (CRD42021238365).