The Swedish Version of the Electronic Health Literacy Scale: Prospective Psychometric Evaluation Study Including Thresholds Levels

Abstract

Background To enhance the efficacy of information and communication, health care has increasingly turned to digitalization. Electronic health (eHealth) is an important factor that influences the use and receipt of benefits from Web-based health resources. Consequently, the concept of eHealth literacy has emerged, and in 2006 Norman and Skinner developed an 8-item self-report instrument to measure these skills: the eHealth Literacy Scale (eHEALS). However, the eHEALS has not been tested for reliability and validity in the general Swedish population and no threshold values have been established. Objective The aim of this study was to translate and adapt eHEALS into a Swedish version; evaluate convergent validity and psychometric properties; and determine threshold levels for inadequate, problematic, and sufficient eHealth literacy. Methods Prospective psychometric evaluation study included 323 participants equally distributed between sexes with a mean age of 49 years recruited from 12 different arenas. Results There were some difficulties translating the English concept health resources. This resulted in this concept being translated as health information (ie, Hälsoinformation in Swedish). The eHEALS total score was 29.3 (SD 6.2), Cronbach alpha .94, Spearman-Brown coefficient .96, and response rate 94.6%. All a priori hypotheses were confirmed, supporting convergent validity. The test-retest reliability indicated an almost perfect agreement, .86 (P<.001). An exploratory factor analysis found one component explaining 64% of the total variance. No floor or ceiling effect was noted. Thresholds levels were set at 8 to 20 = inadequate, 21 to 26 = problematic, and 27 to 40 = sufficient, and there were no significant differences in distribution of the three levels between the Swedish version of eHEALS and the HLS-EU-Q16. Conclusions The Swedish version of eHEALS was assessed as being unidimensional with high internal consistency of the instrument, making the reliability adequate. Adapted threshold levels for inadequate, problematic, and sufficient levels of eHealth literacy seem to be relevant. However, there are some linguistic issues relating to the concept of health resources.

Arabic Version of the Electronic Health Literacy Scale in Arabic-Speaking Individuals in Sweden: Prospective Psychometric Evaluation Study

“…The translated eHEALS (Arabic) version was compared with the Swedish version (Sw-eHEALS [ 17 ]) to ensure that the Arabic version was in line with both original English and Swedish versions. The translator and one researcher went through each item together to verify its content, the use of plain language, and similarity.…”

“…The English-version term health resources was translated as health information in Arabic, partly because the meaning of the word better matches and partly because it is more common in everyday Arabic. Health resources has also been translated as health information in the Swedish version of eHEALS [ 15 , 17 ].…”

“…The general self-perceived health question “How do you assess your overall health status?” had “very poor, poor, fair, good, or very good” as response options [ 14 , 32 , 41 , 42 ]; the question “How useful is the Internet in helping you make decisions about your health?” had “not useful at all, not useful, unsure, useful, or very useful” as response options and was used to measure the usability of the internet. Importance of the internet was measured by the question “How important is it for you to be able to access health resources on the Internet?” with “not important at all, not important, unsure, important, and very important” as response options [ 15 , 17 ]. The question “How often do you use the Internet?” had “every day (or almost every day), several days a week, around once a week, less than day a week and never (or almost never)” as response options [ 17 , 28 ].…”

“…Importance of the internet was measured by the question “How important is it for you to be able to access health resources on the Internet?” with “not important at all, not important, unsure, important, and very important” as response options [ 15 , 17 ]. The question “How often do you use the Internet?” had “every day (or almost every day), several days a week, around once a week, less than day a week and never (or almost never)” as response options [ 17 , 28 ].…”

“…The internet is an important resource for health-related information and health services. To navigate and find this information requires a range of digital skills [ 17 ], which is challenging for both patients and health care staff [ 18 ]. Another potential challenge is limited language proficiency, which can result in lower understanding of health information and instructions [ 14 , 19 , 20 ].…”