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

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.

The Measurements and an Elaborated Understanding of Chinese eHealth Literacy (C-eHEALS) in Chronic Patients in China

“…The hospital is a major and comprehensive Grade 2A hospital with approximately 2000 employees and 1200 hospital beds. Randomized clinical studies are usually based on convenient sampling [ 33 , 38 ]. In this study, trained interviewers approached patients awaiting admittance at an outpatient department at the hospital.…”

“…The established eHEALS model is a theoretically informed concept with an eight-item baseline for assessing a person’s ability to use eHealth resources [ 14 , 15 , 31 , 34 ]. Several studies have criticized the eHEALS model as adopting a unidimensional approach and performing insufficiently in psychometric evaluation [ 24 , 35 , 36 , 37 , 38 ]. However, others have concluded that eHEALS was a valid measurement for predicting health outcomes, and, furthermore, that it improved users’ health communication and the benefit they derive for health care services.…”

“…The eHEALS measures the use of online health resources and content while considering cultural sensitivities in health information and online communication. However, the considerable body of research on the validity and reliability of eHEALS has been largely limited to the developed Western countries [ 33 , 38 , 39 , 42 ]; they have not been examined systematically in simplified Chinese for users in China. Considering China’s recent rapid and extraordinary economic growth, it is inevitable that it will encounter the public health problems currently experienced by the developed countries.…”

“…Therefore, the dual objectives of the present study are first to compare the Chinese eHEALS (C-eHEALS) with other eHEALS findings to determine whether C-eHEALS model provided reliability evidence with chronic disease patients in China. In addition, previous studies have concluded that patients’ access to online health information was affected by their low computer skills and low level of health literacy [ 33 , 38 ]. Thus, the second objective is to examine and compare how the large patient segments access eHealth resources to find and apply eHealth information to their health problems in China.…”

Electronic Health Literacy Across the Lifespan: Measurement Invariance Study

“…Sudbury-Riley and colleagues [ 49 ] report that eHEALS scores produce a 3-factor model of information awareness, seeking, and appraisal skills among baby boomers. Similarly, the 3-factor model of eHEALS has been confirmed among baby boomers and older adults [ 55 ], chronic disease patients [ 53 ], as well as middle age adults, with an average age of 53, in a magnetic resonance imaging and computed tomography medical imaging outpatient clinic [ 59 ]. The 3-factor structure of eHEALS scores, however, has not been reported or confirmed among younger age groups, like Millennials or members of Generation X.…”