Proposing a Transactional Model of eHealth Literacy: Concept Analysis

Abstract

BackgroundElectronic health (eHealth) literacy was conceptualized in 2006 as the ability of internet users to locate, evaluate, and act upon web-based health information. Now, advances in eHealth technology have cultivated transactional opportunities for patients to access, share, and monitor health information. However, empirical evidence shows that existing models and measures of eHealth literacy have limited theoretical underpinnings that reflect the transactional capabilities of eHealth. This paper describes a conceptual model based on the Transactional Model of Communication (TMC), in which eHealth literacy is described as an intrapersonal skillset hypothesized as being dynamic; reciprocal; and shaped by social, relational, and cultural contexts.ObjectiveThe objective of our study was to systematically examine eHealth literacy definitions, models, and measures to propose a refined conceptual and operational definition based on the TMC.MethodsWalker and Avant’s concept analysis method was used to guide the systematic review of eHealth literacy definitions (n=10), rating scales (n=6), models (n=4), and peer-reviewed model applications (n=16). Subsequent cluster analyses showed salient themes across definitions. Dimensions, antecedents, and consequences reflected in models and measures were extracted and deductively analyzed based on codes consistent with the TMC.ResultsSystematic review evidence revealed incongruity between operational eHealth literacy included in definitions compared with literacies included within models and measures. Theoretical underpinnings of eHealth literacy also remain dismal. Despite the transactional capabilities of eHealth, the role of “communication” in eHealth literacy remains underdeveloped and does not account for physical and cognitive processing abilities necessary for multiway transactions.ConclusionsThe Transactional Model of eHealth Literacy and a corresponding definition are proposed. In this novel model, eHealth literacy comprises a hierarchical intrapersonal skillset that mediates the reciprocal effect of contextual factors (ie, user oriented and task oriented) on patient engagement in health care. More specifically, the intrapersonal skillset counteracts the negative effect of “noise” (or impediments) produced by social and relational contexts. Cutting across health and technology literacies, the intrapersonal skillset of eHealth literacy is operationalized through four literacies that correspond with discrete operative skills: (1) functional (ie, locate and understand); (2) communicative (ie, exchange); (3) critical (ie, evaluate); and (4) translational (ie, apply).

Measures of eHealth Literacy: Options for the Malaysian Population

“…Though the original instrument showed high correlations with related concepts, more recent studies have indicated a weaker correlation between the eHEALS and Internet use (van der Vaart et al, 2011) and traditional health literacy (Quinn, Bond & Nugent, 2017). Paige et al (2018) also point out that the eHEALS is intended to reflect the Lily Model but the items in the instrument are not reflective of the model's competencies. In addition to this, Zrubka et al (2019) describe eHEALS as a "selfefficacy-related measure" because of the focus on self-assessment.…”

“…The researchers examine eHealth literacy from a communication perspective and emphasise the importance of the transactional component to eHealth literacy. Paige et al (2018) began with a systematic review of literature on eHealth literacy models. As a result of the systematic review of literature, the researchers redefined eHealth literacy as "the ability to locate, understand, exchange, and evaluate health information from the Internet in the presence of dynamic contextual factors, and to apply the knowledge gained across ecological levels for the purposes of maintaining or improving health".…”

“…With this definition, they then produced the Transactional Model of eHealth Literacy (TMeHL). Paige et al (2018) suggest that competencies in technology alone do not translate into eHealth literacy. Instead, it is one's ability to use technology and navigate the complexities of health information transactions in order to achieve their health goals.…”

“…The key difference between the TMeHL and previous models of eHealth literacy is that the TMeHL focuses on the individual's ability to communicate and exchange information with others in the process of solving a health problem. Paige et al (2018) posit that there is noise that inhibits this communicative process in the form of personal, relational, social and cultural factors. These noise factors affect the individual's ability to participate in health-related communication.…”

“…The researchers referred to the four health literacies in the Nutbeam (2000) health literacy model to form their dimensions of eHealth literacy: 1) functional eHealth literacy, 2) communicative eHealth literacy, 3) critical eHealth literacy; and 4) translational eHealth literacy. Each of these dimensions were carefully defined in Paige et al (2018) and are presented below: a. Functional eHealth Literacy Nutbeam's (2000) concept of functional health literacy formed the basis of this dimension. Paige et al (2018) defined functional eHealth literacy as "Basic skills in reading and writing (typing) about health to effectively function on the internet" (Proposed Model section, para.…”