Exploring the Measurement Properties of the eHealth Literacy Scale (eHEALS) Among Baby Boomers: A Multinational Test of Measurement Invariance

Abstract

BackgroundThe eHealth Literacy Scale (eHEALS) is one of only a few available measurement scales to assess eHealth literacy. Perhaps due to the relative paucity of such measures and the rising importance of eHealth literacy, the eHEALS is increasingly a choice for inclusion in a range of studies across different groups, cultures, and nations. However, despite its growing popularity, questions have been raised over its theoretical foundations, and the factorial validity and multigroup measurement properties of the scale are yet to be investigated fully.ObjectiveThe objective of our study was to examine the factorial validity and measurement invariance of the eHEALS among baby boomers (born between 1946 and 1964) in the United States, United Kingdom, and New Zealand who had used the Internet to search for health information in the last 6 months.MethodsOnline questionnaires collected data from a random sample of baby boomers from the 3 countries of interest. The theoretical underpinning to eHEALS comprises social cognitive theory and self-efficacy theory. Close scrutiny of eHEALS with analysis of these theories suggests a 3-factor structure to be worth investigating, which has never before been explored. Structural equation modeling tested a 3-factor structure based on the theoretical underpinning to eHEALS and investigated multinational measurement invariance of the eHEALS.ResultsWe collected responses (N=996) to the questionnaires using random samples from the 3 countries. Results suggest that the eHEALS comprises a 3-factor structure with a measurement model that falls within all relevant fit indices (root mean square error of approximation, RMSEA=.041, comparative fit index, CFI=.986). Additionally, the scale demonstrates metric invariance (RMSEA=.040, CFI=.984, ΔCFI=.002) and even scalar invariance (RMSEA=.042, CFI=.978, ΔCFI=.008).ConclusionsTo our knowledge, this is the first study to demonstrate multigroup factorial equivalence of the eHEALS, and did so based on data from 3 diverse nations and random samples drawn from an increasingly important cohort. The results give increased confidence to researchers using the scale in a range of eHealth assessment applications from primary care to health promotions.

Electronic Health Literacy Across the Lifespan: Measurement Invariance Study (Preprint)

“…This suggests that eHEALS scores can be interpreted equivalently, regardless of respondents' age group membership. Despite invariance between groups in the current sample, Sudbury-Riley and colleagues [39] found an inconsistent number and type of items comprising each of the factors. An item that assessed confidence in the capacity to evaluate health information found on the Internet loaded on the health information seeking skill factor.…”

“…Consistent with these studies, a 3-factor model has also been confirmed among baby boomers and older adults [36], including chronic disease patients [34] and adults, with an average age of 53, in a magnetic resonance imaging and computed tomography medical imaging outpatient clinic [40]. Despite evidence for measurement invariance among middle-to-older age adults in multiple nations [39], empirical attention is needed to confirm the 3-factor structure among a general population consisting of younger and older adults. This will have important implications for eHealth practitioners and researchers to monitor eHealth literacy surveillance across the lifespan and to evaluate the efficacy of age-targeted interventions, which are primarily delivered to older adults, with a valid and reliable instrument.…”

“…Evidence for the 2-factor eHEALS model, which captured information seeking and appraising, was derived from rating scales translated to Hebrew [37] and German [38] languages. Finally, evidence for the 3-factor eHEALS structure has been suggested in previous literature [34,40], and defined as awareness, information accessibility skills, and information evaluation skills among a sample of middle-to-older age adults [39]. In the current study, evidence for the 3-factor model of the English-version of eHEALS among young and old adults encompasses a comprehensive assessment of eHealth literacy beyond information awareness and seeking, as it includes a factor specifically dedicated to both health information evaluation and action.…”

“…The Mdn age value of the current sample was 49, and an inspection of a histogram showed a bimodal age distribution. Consistent with principles of SEM and the average age value in existing exploratory eHEALS measurement studies [ [34][35][36]39], using age 49 as a cut-off value was appropriate to create two age groups: young and old . Frequency and descriptive statistics were computed to describe the sample and eHealth literacy scores.…”

“…Recent evidence supports, however, that the scale comprises a 2-factor model that measures information seeking and appraisal among the general population in European and Middle-Eastern nations [37,38]. Sudbury-Riley and colleagues [39] also found that a 3-factor model of information awareness, seeking, and appraisal skills among baby boomers and older adults from European and North American nations. Consistent with these studies, a 3-factor model has also been confirmed among baby boomers and older adults [36], including chronic disease patients [34] and adults, with an average age of 53, in a magnetic resonance imaging and computed tomography medical imaging outpatient clinic [40].…”