Sociodigital Determinants of eHealth Literacy and Related Impact on Health Outcomes and eHealth Use in Korean Older Adults: Community-Based Cross-Sectional Survey.

Background: eHealth literacy is an essential skill for pursuing electronic health information, particularly for older people whose health needs increase with age. South Korea is now at the intersection of a rapidly digitalizing society and an increasingly aged population. eHealth literacy enables older people to maximize the effective use of emerging digital technology for their health and quality of life. Understanding the eHealth literacy of Korean older adults is critical to eliminating the gray digital divide and inequity in health information access. Objective: This study aims to investigate factors influencing eHealth literacy in older Korean adults and its impact on health outcomes and eHealth use. Methods: This was a cross-sectional survey. Community-dwelling older adults 65 years and older in 2 urban cities in South Korea were included. eHealth literacy was measured by the eHealth Literacy Scale. Ordinal logistic regression was used to analyze factors associated with eHealth literacy and multivariate ANOVA for the impact of eHealth literacy on health outcomes and eHealth use. Results: In total, 434 participants were analyzed. A total of 22.3% (97/434) of participants had high eHealth literacy skills. Increasing age, higher monthly income, and time spent on the internet were significantly associated with eHealth literacy (P<.001), and social media users were 3.97 times (adjusted odds ratio 3.97, 95% CI 1.02-15.43; P=.04) more likely to have higher skill. Higher eHealth literacy was associated with better self-perceived health and frequent use of digital technologies for accessing health and care services (P<.001). Conclusions: Disparity in socioeconomic status and engagement on the internet and social media can result in different levels of eHealth literacy skills, which can have consequential impacts on health outcomes and eHealth use. Tailored eHealth interventions, grounded on the social and digital determinants of eHealth literacy, could facilitate eHealth information access among older adults and foster a digitally inclusive healthy aging community.

eHealth Literacy and Web-Based Health Information-Seeking Behaviors on COVID-19 in Japan: Internet-Based Mixed Methods Study.

BACKGROUND: During the COVID-19 pandemic, much misinformation and disinformation emerged and spread rapidly via the internet, posing a severe public health challenge. While the need for eHealth literacy (eHL) has been emphasized, few studies have compared the difficulties involved in seeking and using COVID-19 information between adult internet users with low or high eHL. OBJECTIVE: This study examines the association between eHL and web-based health information-seeking behaviors among adult Japanese internet users. Moreover, this study qualitatively shed light on the difficulties encountered in seeking and using this information and examined its relationship with eHL. METHODS: This cross-sectional internet-based survey (October 2021) collected data from 6000 adult internet users who were equally divided into sample groups by gender, age, and income. We used the Japanese version of the eHL Scale (eHEALS). We also used a Digital Health Literacy Instrument (DHLI) adapted to the COVID-19 pandemic to assess eHL after we translated it to Japanese. Web-based health information-seeking behaviors were assessed by using a 10-item list of web sources and evaluating 10 topics participants searched for regarding COVID-19. Sociodemographic and other factors (eg, health-related behavior) were selected as covariates. Furthermore, we qualitatively explored the difficulties in information seeking and using. The descriptive contents of the responses regarding difficulties in seeking and using COVID-19 information were analyzed using an inductive qualitative content analysis approach. RESULTS: Participants with high eHEALS and DHLI scores on information searching, adding self-generated information, evaluating reliability, determining relevance, and operational skills were more likely to use all web sources of information about COVID-19 than those with low scores. However, there were negative associations between navigation skills and privacy protection scores when using several information sources, such as YouTube (Google LLC), to search for COVID-19 information. While half of the participants reported no difficulty seeking and using COVID-19 information, participants who reported any difficulties, including information discernment, incomprehensible information, information overload, and disinformation, had lower DHLI score. Participants expressed significant concerns regarding "information quality and credibility," "abundance and shortage of relevant information," "public trust and skepticism," and "credibility of COVID-19-related information." Additionally, they disclosed more specific concerns, including "privacy and security concerns," "information retrieval challenges," "anxieties and panic," and "movement restriction." CONCLUSIONS: Although Japanese internet users with higher eHEALS and total DHLI scores were more actively using various web sources for COVID-19 information, those with high navigation skills and privacy protection used web-based information about COVID-19 cautiously compared with those with lower proficiency. The study also highlighted an increased need for information discernment when using social networking sites in the "Health 2.0" era. The identified categories and themes from the qualitative content analysis, such as "information quality and credibility," suggest a framework for addressing the myriad challenges anticipated in future infodemics.

Assessing Electronic Health Literacy in Individuals With the Post-COVID-19 Condition Using the German Revised eHealth Literacy Scale: Validation Study.

BACKGROUND: The eHealth Literacy Scale (eHEALS) is a widely used instrument for measuring eHealth literacy (eHL). However, little is known so far about whether the instrument is valid for the assessment of eHL in persons who are affected by the post-COVID-19 condition. This is particularly important as people with the post-COVID-19 condition are frequently affected by false information from the internet. OBJECTIVE: The objective of our study was to evaluate the validity and reliability of the German Revised eHealth Literacy Scale (GR-eHEALS) in individuals with the post-COVID-19 condition. METHODS: A cross-sectional study was conducted from January to May 2022. The self-assessment survey consisted of the GR-eHEALS, health status- and internet use-related variables, sociodemographic data, and (post)-COVID-19-related medical data. Confirmatory factor analysis (CFA), correlational analyses, and tests of measurement invariance were deployed. RESULTS: In total, 330 participants were included in the statistical analyses. CFA revealed that the 2-factor model reached an excellent model fit (comparative fit index=1.00, Tucker-Lewis index=0.99, root mean square error of approximation=0.036, standardized root mean square residual=0.038). Convergent validity was confirmed by significant positive correlations between eHL and knowledge of internet-based health promotion programs, experience in using these programs, and the duration of private internet use. In addition, a significantly negative relationship of eHL with internet anxiety supported convergent validity. Further, significant relationships of eHL with mental health status and internal health locus of control confirmed the criterion validity of the instrument. However, relationships of eHL with physical health status and quality of life could not be confirmed. The 2-factor model was fully measurement invariant regarding gender. Regarding age and educational level, partial measurement invariance was confirmed. The subscales as well as the overall GR-eHEALS reached good-to-excellent reliability (Cronbach α≥.86). CONCLUSIONS: The GR-eHEALS is a reliable and largely valid instrument for assessing eHL in individuals with the post-COVID-19 condition. Measurement invariance regarding gender was fully confirmed and allows the interpretation of group differences. Regarding age and educational level, group differences should be interpreted with caution. Given the high likelihood that individuals with the post-COVID-19 condition will be confronted with misinformation on the Internet, eHL is a core competency that is highly relevant in this context, in both research and clinical practice. Therefore, future research should also explore alternative instruments to capture eHL to overcome shortcomings in the validity of the GR-eHEALS.

Structural Validation and Measurement Invariance Testing of the Chinese Version of the eHealth Literacy Scale Among Undergraduates: Cross-Sectional Study.

BACKGROUND: The eHealth Literacy Scale (eHEALS) was introduced in China in 2013 as one of the most important electronic health literacy measurement instruments. After a decade of development in China, it has received widespread attention, although its theoretical underpinnings have been challenged, thus demanding more robust research evidence of factorial validity and multigroup measurement properties. OBJECTIVE: This study aimed to evaluate the Chinese version of the eHEALS in terms of its measurement properties. METHODS: A cross-sectional survey was conducted in a university setting in China. Item statistics were checked for response distributions and floor and ceiling effects. Internal consistency reliability was confirmed with Cronbach α, split-half reliability, Cronbach α if an item was deleted, and item-total correlation. A total of 5 representative eHEALS factor structures were examined and contrasted using confirmatory factor analysis. The study used the item-level content validity index (I-CVI) and the average of the I-CVI scores of all items on the scale to assess the content validity of the dominance model. Furthermore, the validated dominance model was subsequently used to evaluate the relevance and representation of elements in the instrument and to assess measurement invariance across genders. RESULTS: A total of 972 respondents were identified, with a Cronbach α of .92, split-half reliability of 0.88, and item-total score correlation coefficients ranging from 0.715 to 0.781. Cronbach α if an item was deleted showed that all items should be retained. Acceptable content validity was supported by I-CVIs ≥0.80. The confirmatory factor analysis confirmed that the 3-factor model was acceptable. The measurement model met all relevant fit indices: average variance extracted from 0.663 to 0.680, composite reliability from 0.810 to 0.857, chi-square divided by the df of 4.768, root mean square error of approximation of 0.062, standardized root mean squared residual of 0.020, comparative fit index (CFI) of 0.987, and Tucker-Lewis index of 0.979. In addition, the scale demonstrated error variance invariance (Δnormed fit index=-0.016, Δincremental fit index=-0.012, ΔTucker-Lewis index=0.005, Δcomparative fit index=-0.012, Δrelative fit index=0.005, and Δroot mean square error of approximation=0.005). CONCLUSIONS: A 3-factor model of the Chinese version of the eHEALS fits best, and our findings provide evidence for the strict measurement invariance of the instrument regarding gender.

Rational Drug and Antibiotic Use Status, E-Health Literacy in Syrian Immigrants and Related Factors: A Cross-Sectional Study.

Rational drug use is a pivotal concept linked with morbidity and mortality. Immigration plays a significant role as a determinant affecting individuals' health-related attitudes, behaviors, and the pursuit of health services. Within this context, the study was initiated to assess the factors influencing health literacy and rational drug use among Syrian immigrants in Istanbul. A cross-sectional study was undertaken on 542 Syrian adults utilizing a three-part questionnaire encompassing sociodemographics, rational drug use, and the e-health literacy scale (eHEALS). With an average age of 39.19 ± 13.10 years, a majority of participants believed medications should solely be doctor-prescribed (97%) and opposed keeping antibiotics at home (93.7%). Yet, 62.5% thought excessive herbal medicine use was harmless. The mean eHEALS score stood at 20.57 ± 7.26, and factors like age, marital status, income, and duration of stay in Turkey influenced e-health literacy. Associations were seen between low e-health literacy and being female, being older, having a lower education level, and regular medication use. Syrian immigrants displayed proper knowledge concerning antibiotics yet exhibited gaps in their understanding of general drug usage, treatment adherence, and herbal medicines. Approximately 80.3% had limited health literacy, pointing to the need for targeted interventions for enhanced health and societal assimilation.

Childhood environmental harshness and unpredictability negatively predict eHealth literacy through fast life-history strategy.

Background: eHealth literacy-the ability to obtain, understand, evaluate, and use health information from the Internet-is important to maintaining and improving personal health. Prior research found that people differ notably in the levels of eHealth literacy, and this study tests a theoretical account of some of those individual differences. Drawing on life history theory, we propose that low eHealth literacy is partly the outcome of people adopting a resource-allocation strategy emphasizing early and fast reproduction, namely, a fast life-history strategy. Methods: We conducted a cross-sectional survey study (N = 1,036) that measured Chinese adult respondents' eHealth literacy, childhood environmental harshness and unpredictability, and fast life-history strategy. Covariates included health-information seeking online, self-rated health, sex, age, education level, and monthly income. Results: Supporting a life-history explanation of eHealth literacy, childhood environmental harshness and unpredictability negatively predicted eHealth literacy through fast life-history strategy and mainly the insight-planning-control dimension of it. Harshness, not unpredictability, also directly and negatively predicted eHealth literacy after fast life-history strategy was controlled for. Conclusion: Our findings suggest that the psychological mechanisms associated with human life-history strategies produce at least some of the individual differences in levels of eHealth literacy, including those related to neuroticism, socioeconomic status, self-rated health and social capital. Thus, a possible way to increase future generation's eHealth literacy and thereby their health is to reduce the harshness and unpredictability of the environment in which they grow up, thereby making them more likely to adopt a relatively slow life-history in their adulthood.

Psychometric properties of the German revised version of the eHealth literacy scale in individuals with cardiac diseases: Validation and test of measurement invariance.

Background: The internet is most people's primary source of (health) information. However, no validated instrument exists to assess eHealth literacy in the group of patient with cardiac diseases. Objective: The objective of this study was the evaluation of the psychometric properties of the German revised version of the eHealth literacy scale (GR-eHEALS) in individuals with coronary artery disease (CAD) and congestive heart failure (CHF). Methods: A cross-sectional study was conducted. N = 455 were included in the statistical analyses. The assessment compromised the GR-eHEALS, medical history, sociodemographic data, and technology-related data. Confirmatory factor analyses, correlational analyses, and tests of measurement invariance were performed. Results: The two-factorial model reached a good model fit. The sub-scales information seeking and information appraisal, as well as the eHealth literacy total score, reached high reliability coefficients. Construct and criterion validity was fully confirmed For the two-factorial model, measurement invariance up to the scalar level could be confirmed regarding the sociodemographic characteristics sex, age, and educational level. Conclusions: This study confirmed the two-factor structure, construct, and criterion validity as well as measurement invariance at the scalar level for sex, age, and educational level of the GR-eHEALS scale in a sample of individuals with CAD and CHF.

Assessing eHealth Literacy and Identifying Factors Influencing Its Adoption Among Cancer Inpatients: A Cross-Sectional Study in Guangdong Population.

Purpose: The purpose of this study was to investigate the current state of eHealth literacy among cancer patients in a grade A tertiary hospital in Guangzhou, Guangdong Province, and to identify the factors that influence it, in order to provide a basis for improving the eHealth literacy of cancer patients. Patients and Methods: From September to November 2021, a convenience sampling method was employed to survey cancer patients in the oncology department of a grade A tertiary hospital in Guangzhou, using a self-administered general information questionnaire and the eHealth literacy scale (eHEALS). A total of 130 questionnaires were distributed, and 117 valid questionnaires were returned. Results: The mean total score of eHealth literacy among cancer patients was 21.32±8.35. Multiple linear regression analysis revealed that the frequency of searching for health information and education level were significant factors influencing eHealth literacy (p<0.05). Specifically, the education level (junior high school vs primary school or below) was found to have a significant association with eHealth literacy (beta=0.26, p=0.039). Conclusion: The results of this study suggest that the eHealth literacy of cancer patients is relatively low, with low scores on the dimensions of judgment and decision-making ability. The government and relevant regulatory authorities should focus on strengthening the reliability of online health information and implementing targeted e-interventions to enhance the eHealth literacy of cancer patients.

Performance-Based Measurement of eHealth Literacy: Systematic Scoping Review.

BACKGROUND: eHealth literacy describes the ability to locate, comprehend, evaluate, and apply web-based health information to a health problem. In studies of eHealth literacy, researchers have primarily assessed participants' perceived eHealth literacy using a short self-report instrument, for which ample research has shown little to no association with actual performed eHealth-related skills. Performance-based measures of eHealth literacy may be more effective at assessing actual eHealth skills, yet such measures seem to be scarcer in the literature. OBJECTIVE: The primary purpose of this study was to identify tools that currently exist to measure eHealth literacy based on objective performance. A secondary purpose of this study was to characterize the prevalence of performance-based measurement of eHealth literacy in the literature compared with subjective measurement. METHODS: We conducted a systematic scoping review of the literature, aligning with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist, in 3 stages: conducting the search, screening articles, and extracting data into a summary table. The summary table includes terminology for eHealth literacy, description of participants, instrument design, health topics used, and a brief note on the evidence of validity for each performance-based measurement tool. A total of 1444 unique articles retrieved from 6 relevant databases (MEDLINE; PsycINFO; CINAHL; Library and Information Science Abstracts [LISA]; Library, Information Science & Technology Abstracts [LISTA]; and Education Resources Information Center [ERIC]) were considered for inclusion, of which 313 (21.68%) included a measure of eHealth literacy. RESULTS: Among the 313 articles that included a measure of eHealth literacy, we identified 33 (10.5%) that reported on 29 unique performance-based eHealth literacy measurement tools. The types of tools ranged from having participants answer health-related questions using the internet, having participants engage in simulated internet tasks, and having participants evaluate website quality to quizzing participants on their knowledge of health and the web-based health information-seeking process. In addition, among the 313 articles, we identified 280 (89.5%) that measured eHealth literacy using only a self-rating tool. CONCLUSIONS: This study is the first research synthesis looking specifically at performance-based measures of eHealth literacy and may direct researchers toward existing performance-based measurement tools to be applied in future projects. We discuss some of the key benefits and drawbacks of different approaches to performance-based measurement of eHealth literacy. Researchers with an interest in gauging participants' actual eHealth literacy (as opposed to perceived eHealth literacy) should make efforts to incorporate tools such as those identified in this systematic scoping review.

Medical Students' and Radiology Technician Trainees' eHealth Literacy and Hygiene Awareness-Asynchronous and Synchronous Digital Hand Hygiene Training in a Single-Center Trial.

Next to the known nosocomial infections, the COVID-19 pandemic was an example for the need for the immediate implementation of functioning hygiene concepts and knowledge transfer. The aim of this study was to evaluate the self-assessment of ehealth literacy in terms of finding, using and critically evaluating health information and theoretical and practical hygiene awareness on a voluntary participation basis at the Jena University Hospital in 2022. The well-established and validated eHEALS and WHO questionnaire on hand hygiene (HH) knowledge for healthcare workers was completely filled by 204 participants (191 medical students; 13 healthcare trainees). In a second step, after the questionnaire, 77 participants completed additional asynchronous, digitally guided self-training using DesiCoach 2Go. In the end, a synchronous hand disinfection was carried out in the hospital using Visirub, by separating it into a group without (n = 191; with and without HH questionnaire) and a group with (n = 31; with HH questionnaire) previously completed self-training. For the eHL, the respondents tended to have a positive self-assessment of finding, using and critically evaluating health information. The voluntary participants of the practical hand disinfection who had received self-training were able to achieve significantly better results (p = 0.0047), resulting in fewer wetting gaps in a subsequent performance with Visirub than those who had not received digital self-training. The survey showed that healthcare-related participants belonging to the "digital native" generation have above-average knowledge on HH and profit by digitally guided self-training.

Comparison of eHealth Literacy Scale (eHEALS) and Digital Health Literacy Instrument (DHLI) in Assessing Electronic Health Literacy in Chinese Older Adults: A Mixed-Methods Approach.

This study compared the reliability, construct validity, and respondents' preference of the Chinese version of 8-item eHEALS (C-eHEALS) and 21-item DHLI (C-DHLI) in assessing older adults' electronic health (eHealth) literacy using a mixed-methods approach. A web-based, cross-sectional survey was conducted among 277 Chinese older adults from September to October 2021, and 15 respondents were subsequently interviewed to understand their preference of scale to use in practice. Results showed that the internal consistency and test-retest reliability of both scales were satisfactory. For the construct validity, the C-DHLI score showed stronger positive correlations with having Internet use for health information and higher educational attainments, occupational skill levels, self-rated Internet skills, and health literacy than the C-eHEALS score. In addition, younger age, higher household income, urban residence, and longer Internet use history were only positively correlated with C-DHLI score. Qualitative data suggested that most interviewees perceived the C-DHLI as more readable than C-eHEALS for its clear structure, specific description, short sentence length, and less semantic complexity. Findings revealed that both scales are reliable tools to measure eHealth literacy among Chinese older adults, and the C-DHLI seemed to be a more valid and favored instrument for the general Chinese older population based on the quantitative and qualitative results.

Testing reliability and validity of the Vietnamese version of the eHealth literacy scale (eHEALS) among medical students in Vietnam.

BACKGROUND: In the context of COVID-19 pandemic, eHealth Literacy is important and essential for healthcare workers, especially medical students; eHealth Literacy Scale (eHEALS) was developed to measured eHealth literacy of individuals, with higher eHEALS scores indicated greater ehealth literacy. OBJECTIVES: The study evaluates the reliability and validity of Vietnamese version of eHEALS and analyzed some factors affecting on eHEALS score among Hanoi Medical University students in Vietnam. METHODS: A cross-sectional study design was adopted, and data were elicited from 494 medical students. Exploratory Factor Analysis (EFA); Cronbach's alpha and correlation coefficients; split-half assessment; Poisson regression analysis were applied. RESULTS: The total score of our subjects in the eHEALS was 30.34 ± 4.57. The results from Bartlett's test, Kaiser-Meyer-Olkin (KMO) test, calculated Cronbach's alpha coefficient and test-retest reliability were high. Poisson regression identified that eHEALS scores of participants was significantly associated with device, ongoing medical condition and trustworthiness of health information source (p < 0.05). DISCUSSION: Our study helps researchers who conduct studies in eHealth develop optimal applied and intervention researches in subjects with medical knowledge. Additional studies need to be required with numerous different groups of people in Vietnam. CONCLUSION: The Vietnamese version of eHEALS is a reliable and valid measure. Device, medical condition and trustworthiness of health information source are factors affecting on eHEALS score of students in Hanoi Medical University.

Translation and Validation Study of the French Version of the eHealth Literacy Scale: Web-Based Survey on a Student Population.

BACKGROUND: eHealth literacy is emerging as a crucial concept for promoting patient self-management in an overloaded hospital system. However, to the best of our knowledge, no tool currently exists to measure the level of eHealth literacy among French-speaking people. The eHealth Literacy Scale (eHEALS) is an easy-to-administer 8-item questionnaire (5-point Likert scale, ranging from strongly disagree to strongly agree) that has already been translated into many languages. Currently, it is the most cited questionnaire in the literature. OBJECTIVE: The aim of this study was to translate eHEALS to French and validate the French version of eHEALS (F-eHEALS). METHODS: The validation of the F-eHEALS scale followed the 5 steps of the transcultural validation method: double reverse translation, validation by a committee of experts (n=4), pretest measurement to check the clarity of the items (n=22), administration of the scale in French via a web-based quantitative study combined with two other questionnaires (Health Literacy Survey-Europe-16 and Patient Activation Measure-13; N=328 students), and finally test-retest (n=78) to check the temporal stability of the measurements obtained from the scale. RESULTS: The results obtained for the measurement of factor structure, internal consistency, and temporal stability (intraclass correlation coefficient=0.84; 95% CI 0.76-0.9; F77,77=6.416; P<.001) prove the validity and fidelity of the proposed scale. The internal consistency of F-eHEALS was estimated by Cronbach α of .89. The factor analysis with varimax rotation used to validate the construct showed a 2-factor scale. The effect of the construct was analyzed using 3 hypotheses related to the theory. The F-eHEALS score was correlated with the Health Literacy Survey-Europe-16 score (r=0.34; P<.001) and the Patient Activation Measure-13 score (r=0.31; P<.001). CONCLUSIONS: F-eHEALS is consistent with the original version. It presents adequate levels of validity and fidelity. This 2D scale will need to be generalized to other populations in a French-speaking context. Finally, a version taking into account collaborative applications (ie, Health 2.0; eg, Digital Health Literacy Instrument scale) should be considered on the basis of this study.

Evaluating the Psychometric Properties of the eHealth Literacy Scale (eHEALS) among Polish Social Media Users.

Social media have become mainstream online tools that allow individuals to connect and share information. Such platforms also influence people's health behavior in the way they communicate about personal health, treatment, or physicians. Individuals' ability to find and apply online health information on specific health problems can be measured using a valid and reliable instrument, the eHealth Literacy Scale (eHEALS). The objective of this study was to evaluate the psychometric aspects of the Polish version of this instrument (eHEALS-Pl) among social media users, which has not been explored so far. We examined the translated version of the eHEALS in a representative sample of Polish social media users (n = 1527). CAWI (computer-assisted web interviews) was a method to collect data. The reliability of the eHEALS-Pl was measured by calculating the Cronbach alpha coefficients and analyzing the principal components. Exploratory factor analysis and hypothesis testing was used to assess the construct validity of the instrument. The internal consistency of the eHEALS-Pl was sufficient: Cronbach alpha = 0.84. The item-to-total correlations ranged from r = 0.514 to 0.666. EFA revealed a single structure explaining 47.42% of the variance, with high factor loadings of the item ranging from 0.623 to 0.769. Hypothesis testing also supported the validity of eHEALS-Pl. The eHEALS-Pl evaluation supported by social media users reviled its equivalence to the original instrument developed by Norman and Skinner in 2006 and it can be used to measure e-health literacy. Since there is no prior validation of the eHEALS among social media users, these findings may indicate important directions in evaluating digital skills, especially in relation to the current challenges related to the COVID-19 pandemic.

Measuring Electronic Health Literacy: Development, Validation, and Test of Measurement Invariance of a Revised German Version of the eHealth Literacy Scale.

BACKGROUND: The World Wide Web has become an essential source of health information. Nevertheless, the amount and quality of information provided may lead to information overload. Therefore, people need certain skills to search for, identify, and evaluate information from the internet. In the context of health information, these competencies are summarized as the construct of eHealth literacy. Previous research has highlighted the relevance of eHealth literacy in terms of health-related outcomes. However, the existing instrument assessing eHealth literacy in the German language reveals methodological limitations regarding test development and validation. The development and validation of a revised scale for this important construct is highly relevant. OBJECTIVE: The objective of this study was the development and validation of a revised German eHealth literacy scale. In particular, this study aimed to focus on high methodological and psychometric standards to provide a valid and reliable instrument for measuring eHealth literacy in the German language. METHODS: Two internationally validated instruments were merged to cover a wide scope of the construct of eHealth literacy and create a revised eHealth literacy scale. Translation into the German language followed scientific guidelines and recommendations to ensure content validity. Data from German-speaking people (n=470) were collected in a convenience sample from October to November 2020. Validation was performed by factor analyses. Further, correlations were performed to examine convergent, discriminant, and criterion validity. Additionally, analyses of measurement invariance of gender, age, and educational level were conducted. RESULTS: Analyses revealed a 2-factorial model of eHealth literacy. By item-reduction, the 2 factors information seeking and information appraisal were measured with 8 items reaching acceptable-to-good model fits (comparative fit index [CFI]: 0.942, Tucker Lewis index [TLI]: 0.915, root mean square error of approximation [RMSEA]: 0.127, and standardized root mean square residual [SRMR]: 0.055). Convergent validity was comprehensively confirmed by significant correlations of information seeking and information appraisal with health literacy, internet confidence, and internet anxiety. Discriminant and criterion validity were examined by correlation analyses with various scales and could partly be confirmed. Scalar level of measurement invariance for gender (CFI: 0.932, TLI: 0.923, RMSEA: 0.122, and SRMR: 0.068) and educational level (CFI: 0.937, TLI: 0.934, RMSEA: 0.112, and SRMR: 0.063) were confirmed. Measurement invariance of age was rejected. CONCLUSIONS: Following scientific guidelines for translation and test validation, we developed a revised German eHealth Literacy Scale (GR-eHEALS). Our factor analyses confirmed an acceptable-to-good model fit. Construct validation in terms of convergent, discriminant, and criterion validity could mainly be confirmed. Our findings provide evidence for measurement invariance of the instrument regarding gender and educational level. The newly revised GR-eHEALS questionnaire represents a valid instrument to measure the important health-related construct eHealth literacy.

Validation of the PAM-13 instrument in the Hungarian general population 40 years old and above.

BACKGROUND: Patient activation comprises the skills, knowledge and motivation necessary for patients' effective contribution to their care. We adapted and validated the 13-item Patient Activation Measure (PAM-13) in the ≥ 40 years old Hungarian general population. METHODS: A cross-sectional web survey was conducted among 900 respondents selected from an online panel via quota sampling. After 10 days, the survey was repeated on 100 respondents. The distribution, internal consistency, test-retest reliability, factor structure, convergent, discriminant and known-groups validity of PAM-13 were assessed according to the COSMIN guidelines. RESULTS: The sample comprised 779 respondents. Mean (± SD) age was 60.4 ± 10.6 years, 54% were female and 67% had chronic illness. Mean (± SD) PAM-13 score was 60.6 ± 10.0. We found good internal consistency (Cronbach alpha: 0.77), moderate test-retest reliability (ICC: 0.62; n = 75), a single-factor structure and good content validity: PAM-13 showed moderate correlation with the eHealth Literacy Scale (r = 0.40), and no correlation with age (r = 0.02), education (r = 0.04) or income (ρ = 0.04). Higher PAM-13 scores were associated with fewer lifestyle risks (p < 0.001), more frequent health information seeking (p < 0.001), participation in patient education (p = 0.018) and various online health-related behaviours. When controlling for health literacy, sociodemographic factors and health status, the association of higher PAM-13 scores with overall fewer lifestyle risks, normal body mass index, physical activity and adequate diet remained significant. Similar properties were observed in the subgroup of participants with chronic morbidity, but not in the age group 65+. CONCLUSION: PAM-13 demonstrated good validity in the general population. Its properties in clinical populations and the elderly as well as responsiveness to interventions warrant further research.

eHealth Literacy Among Health Sciences Students in Greece.

eÎUealth literacy is a necessary skill to find and make good use of online health information. However, the general public lacks this skill; it is essential for future health professionals to be able to guide and facilitate the public. The study aimed to examine the perceived eHealth literacy level of health sciences students in Greece. A cross-sectional, online survey was conducted (N=113 students). The questionnaire included socio-demographic data and the eHealth Literacy Scale (eHEALS). Participants' mean eHEALS score was 31.9 with medicine and dentistry students having the highest score (33.7) and other health and caring sciences students the lowest (29.8). There was no statistically significant difference at eHEALS score among participants of different academic year. However, there was a statistically significant difference at eHEALS score among University Departments (p=0.009). Further research in representative samples is required to assess specific needs and improve current educational curricula.

Health literacy among visiting college students in the U.S.: A pilot study.

Objective This study examined the health literacy of international college students from Colombia visiting the United States. Participants: Thirty (30) students from a Colombian university completed the survey in October 2017. Methods: This pilot study surveyed international college students using the eHEALS and Newest Vital Signs (NVS) health literacy tools to determine the health literacy of this group. Although these students spoke English, a translator was provided. Results: The results show 63% of participants agreed they were confident with filling out health forms alone. In terms of finding helpful health resources on the Internet, 87% of participants felt they knew how to find health information, while 80% felt they knew where to find the resources. Conclusion: There was no association between the health literacy and the confidence of completing forms alone or the perception of using the Internet to answer health questions and knowing where to find helpful resources on the Internet.

The association between perceived level of COVID-19-related eHealth literacy and adherence to preventive practices against COVID-19 infection among adult patients in healthway family clinics in Marikina and Rizal: An analytical cross-sectional study

Background@#The internet contains both accurate and false coronavirus-related information. Is the public equipped with electronic health literacy in navigating online material to make informed health decisions?@*Objective@#This study measured Filipino adults’ perceived level of COVID-19-related eHealth literacy, and how this affects their adherence to preventive practices against COVID-19 infection.@*Methods@#In this analytical cross-sectional study, data were collected from 345 adult respondents who were patients, and their companions, consulting in Healthway Family Clinics in Marikina and Rizal. They answered self-administered electronic questionnaires in English or Filipino. The data collection tool was adapted from the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) with permission from the authors. Pearson correlation determined the relationship between mean CoV-eHEALS and mean Protective Behavior Adherence (PBA) score. ANOVA determined the relationship of CoV-eHEALS and PBA with sociodemographic variables. @*Results@#Higher Covid-related eHealth literacy is associated with better adherence to protective behaviors against COVID-19. The overall mean CoV-eHEALS is 23.67 while the overall mean PBA score is 3.81 (r=0.32). Younger age, female sex, and high educational attainment are associated with high CoV-eHEALS. Female sex and high educational attainment are associated with high PBA score@*Conclusion@#eHealth literacy is essential for COVID-19 awareness since it influences the public‘s engagement in preventive behavior. Sociodemographic variables should be considered in health education, targeting individuals of younger age, male sex, and lower education. Evaluation of the reliability of online sources Filipinos use to gather health-related information is a possible focus for future research.