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Background With increased reliance on digital health care, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with using these services. Objective The goal of this study was to develop and validate a brief scale that assesses digital health care literacy. Methods We first developed an item pool using existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either on the web or over the telephone. We randomized participants into development and confirmatory samples, stratifying by language so that exploratory factor analysis and confirmatory factor analysis could be performed with separate samples of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital health care use. Results Participants (N=508) were, on average, aged 34.7 (SD 7.7) years, and 89.4% (454/508) were women. Of the 508 participants, 280 (55.1%) preferred English as their primary language, 157 (30.9%) preferred Spanish, and 71 (14%) preferred Arabic; 228 (45%) had a high school degree or less; and 230 (45.3%) had an annual household income of <US $35,000. Using exploratory factor analysis, 3 items were retained in a reduced scale with excellent reliability (Cronbach α=.90) and a high variance explained (78%). The reduced scale had excellent fit, with factor loadings between 0.82 and 0.94. All fit statistics exceeded the criteria for good fit between the proposed factor structure and the data. We refer to this scale as the Digital Health Care Literacy Scale. The scale was positively associated with education (ρ=0.139; P=.005) and income (ρ=0.379; P<.001). Arabic speakers had lower scores than English (P<.001) and Spanish speakers (P=.02), and Spanish speakers had lower scores than English speakers (P<.001). Participants who did not own a smartphone (P=.13) or laptop computer (P<.001) had lower scores than those who owned these devices. Finally, participants who had not used digital tools, including health apps (P<.001) and video telehealth (P<.001), had lower scores than those who had used these tools. Conclusions Despite the potential for digital health care to improve quality of life and clinical outcomes, many individuals may not have the skills to engage with and benefit from it. Moreover, these individuals may be those who already experience worse outcomes. A screening tool such as the Digital Health Care Literacy Scale could be a useful resource to identify patients who require additional assistance to use digital health services and help ensure health equity.

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BACKGROUND With increased reliance on digital healthcare, including telehealth, efficient and effective ways are needed to assess patients’ comfort and confidence with utilizing these services. OBJECTIVE The goal of this study was to develop and validate a brief scale that assesses digital healthcare literacy. METHODS We first developed an item pool using the existing literature and expert review. We then administered the items to participants as part of a larger study. Participants were caregivers of children receiving care at a pediatric clinic who completed a survey either online or over the phone. We randomized participants into a development and confirmatory sample stratifying by language so that exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) could be performed with a separate sample of participants. We assessed the scale’s validity by examining its associations with participants’ demographics, digital access, and prior digital healthcare use. RESULTS Participants (N=507) were, on average, aged 33.7 (SD 7.7) years and 89% female. Approximately half (55%) preferred English as their primary language, 31% preferred Spanish, and 14% Arabic. Around half (45%) had a high school degree or less and 45% had an annual household income less than US $35,000. Using the EFA, three items were retained in a reduced score with excellent reliability (Cronbach’s alpha = 0.90) and a high variance explained (78%). The reduced scale had excellent CFA fit with factor loadings between 0.82 and 0.94. All fit statistics exceeded the criteria for good fit between the proposed factor structure and the data. We refer to this scale as the Digital Healthcare Literacy Scale (DHLS). The scale was positively associated with education (ρ =0.139, p=.005) and income (ρ =0.379, p<.001). Arabic speakers had lower scores compared to English (p<.001) and Spanish speakers (p=.015), and Spanish speakers had lower scores relative to English speakers (p<.001). Participants who did not own a smartphone (p=0.13) or laptop (p<.001) had lower scores than those who did own these devices. Finally, participants who had not used digital tools, including health apps (p<.001) and video telehealth (p<.001), had lower scores than those who had. CONCLUSIONS Despite the potential for digital healthcare to improve quality of life and clinical outcomes, many individuals may not have the skills to engage with and benefit from it. Moreover, these individuals may be those who already experience worse outcomes. A screening tool like DHLS could be a useful resource to identify patients who require additional assistance to use digital health services and help ensure health equity. CLINICALTRIAL N/A