Validity Testing and Cultural Adaptation of the eHealth Literacy Questionnaire (eHLQ) Among People With Chronic Diseases in Taiwan: Mixed Methods Study

Abstract

Background Advancements in digital technologies seek to promote health and access to services. However, people lacking abilities and confidence to use technology are likely to be left behind, leading to health disparities. In providing digital health services, health care providers need to be aware of users’ diverse electronic health (eHealth) literacy to address their particular needs and ensure equitable uptake and use of digital services. To understand such needs, an instrument that captures users’ knowledge, skills, trust, motivation, and experiences in relation to technology is required. The eHealth Literacy Questionnaire (eHLQ) is a multidimensional tool with 7 scales covering diverse dimensions of eHealth literacy. The tool was simultaneously developed in English and Danish using a grounded and validity-driven approach and has been shown to have strong psychometric properties. Objective This study aims to translate and culturally adapt the eHLQ for application among Mandarin-speaking people with chronic diseases in Taiwan and then undertake a rigorous set of validity-testing procedures. Methods The cross-cultural adaptation of the eHLQ included translation and evaluation of the translations. The measurement properties were assessed using classical test theory and item response theory (IRT) approaches. Content validity, known-group validity, and internal consistency were explored, as well as item characteristic curves (ICCs), item discrimination, and item location/difficulty. Results The adapted version was reviewed, and a recommended forward translation was confirmed through consensus. The tool exhibited good content validity. A total of 420 people with 1 or more chronic diseases participated in a validity-testing survey. The eHLQ showed good internal consistency (Cronbach α=.75-.95). For known-group validity, all 7 eHLQ scales showed strong associations with education. Unidimensionality and local independence assumptions were met except for scale 2. IRT analysis showed that all items demonstrated good discrimination (range 0.27-12.15) and a good range of difficulty (range 0.59-1.67) except for 2 items in scale 7. Conclusions Using a rigorous process, the eHLQ was translated from English into a culturally appropriate tool for use in the Mandarin language. Validity testing provided evidence of satisfactory-to-strong psychometric properties of the eHLQ. The 7 scales are likely to be useful research tools for evaluating digital health interventions and for informing the development of health technology products and interventions that equitably suit diverse users’ needs.

The Swedish Version of the eHealth Literacy Questionnaire: Translation, Cultural Adaptation, and Validation Study

“…We used a systematic and rigorous translation and cultural adaptation process to reproduce the original instrument’s concepts and meanings. Our data from a diverse validation sample demonstrated that the Swedish eHLQ has strong psychometric properties and is in line with the psychometric outcomes of the versions in Danish and other languages [ 20 , 21 , 33 ].…”

What are the roles of eHealth literacy and empowerment in self‐management in an eHealth care context? A cross‐sectional study

“…Finally, we found that the participants in our study had lower eHLQ scores than those in previous studies (Chen et al, 2022; Kayser et al, 2018). A possible reason for this is that nearly 50% of our study participants were elder adults with multiple comorbidities and relied on caregivers to complete self‐management.…”

“…For the validity of the known group, the seven eHLQ scales showed strong associations with education. All elements demonstrated good discrimination (range: 0.27–12.15) and a good range of difficulty (range: 0.59–1.67) (Chen et al, 2022). The Cronbach's α was 0.97 in this study.…”

eHealth Literacy of Australian Undergraduate Health Profession Students: A Descriptive Study

“…Subsequent extensive studies in Australia using the English version in a large primary care sample showed that the tool has robust psychometric properties [ 28 , 41 ]. A further study in Taiwan also provided good evidence of reliability, content and construct validity from data obtained from the urban and regional hospital settings [ 27 ].…”

“…This field began in the web 1.0 era with the emergence of the Lily model, which focused on six technical skills needed to find and use health information from electronic sources [ 25 ] and advanced the field through development the eHealth Literacy Scale (eHEALS) questionnaire. Subsequently, Norgaard, Kayser et al [ 26 ] developed the eHealth Literacy Framework (eHLF), a Web 2.0 era tool developed from extensive community consultations [ 26 , 27 , 28 , 29 ] using a grounded validity-driven approach to instrument development [ 30 , 31 ]. This model provides a framework to understand individual skills, system requirements, and the interactions between these two.…”