<p>Validation of the Ethiopian Version of eHealth Literacy Scale (ET-eHEALS) in a Population with Chronic Disease</p>

Abstract

Background: Although the measurement scale developed by Norman and Skinner is the widely used scale to assess consumers' eHealth literacy, translating and validating the scale for the language of the target population under consideration is necessary. Amharic is the official national language of Ethiopia, with 29.3% of native speakers. Methods: The total sample size calculated was 187 with 6% non-response rate. The internal consistency of the ET-eHEALS was measured using Cronbach's alpha coefficient. Test-retest reliability was assessed by re-administering the ET-eHEALS questionnaire to 74 patients which is 40% of the total sample size. Construct validity was evaluated using exploratory factor analysis. The Kaiser-Meyer-Olkin (KMO) statistic and Bartlett's test of sphericity were used to check the suitability of performing the factor analysis. Results: Of the respondents, 63.1% (n=118) were males and 55.1% (n=103) were aged between 18 and 35 years, with 57.2% (n=107) of the participants being educated to high school diploma level or higher. Cronbach's alpha coefficient for the translated ET-eHEALS total score was 0.94. Test-retest reliability of ET-eHEALS total score was acceptable for both agreements and consistent with ICC (interclass correlation coefficient) of 0.92. The KMO ratio of sampling appropriateness was acceptable (0.91), and Bartlett's test of sphericity was significant with p < 0.001. The EFA (exploratory factor analysis) extracted two factors based on an extraction principle of a minimum eigenvalue of one. The extracted factor explained 80.2% of the common variance which is 51.8% for factor 1 and 28.4% for factor 2. Except for item, item fit for both infit and outfit mean squares were within the adequate range (0.5-1.5). Conclusion: This study depicted that ET-eHEALS is a consistent and valid instrument to evaluate Amharic-speaking chronic patients' eHealth literacy level. Since there is no prior validation of eHEALS in low-income country, this finding may indicate important directions for further improvement in eHEALS item performance in resource-limited settings.

eHealth Literacy Instruments: Systematic Review of Measurement Properties

“…The characteristics of the included eHealth literacy instruments and studies are presented in Multimedia Appendix 2 [ 24 - 64 ]. The eHEALS, which consists of 8 items scored on a 5-point Likert scale, was originally developed in English [ 24 ], and its psychometrics have been studied in diverse languages: Amharic [ 50 ], Mandarin Chinese [ 26 ], Simplified Chinese [ 34 , 36 , 41 ], Dutch [ 25 ], English [ 27 - 30 , 47 , 53 , 54 , 57 , 58 ], German [ 39 , 44 ], Greek [ 48 ], Hebrew [ 45 ], Hungarian [ 37 ], Indonesian [ 43 ], Italian [ 31 , 33 ], Korean [ 32 , 42 , 55 ], Persian [ 38 , 46 ], Polish [ 35 ], Portuguese [ 52 ], Norwegian [ 49 , 56 ], Serbian [ 51 ], and Swedish [ 40 ]. The eHEALS has been used to evaluate diverse populations, including not only youths, adults, and older adults, but also healthy people, patients, caregivers, and health professionals in school, community, and clinic settings.…”

“…However, there was inconsistent moderate-quality evidence for convergent validity. The two-factor structure yielded from another 5 studies (IDs 35-39) [ 47 - 50 ] demonstrated insufficient high-quality evidence for structural validity, sufficient high-quality evidence for internal consistency, and sufficient very low-quality evidence for reliability and convergent validity. The three-factor structure of the eHEALS derived from 3 studies (IDs 43-45) [ 54 - 56 ] and a single study ID 47 [ 58 ] demonstrated sufficient high-quality evidence for internal consistency, cross-cultural validity, and known-groups validity.…”

“… g Factor 1 (items 3, 4), factor 2 (items 1, 2, 5, 6, 7, 8) [ 46 ]. h Factor 1 (items 1, 2, 3, 4, 5), factor 2 (items 6, 7, 8) [ 47 - 50 ]. i Factor 1 (items 2, 6, 7, 8), factor 2 (items 1, 3, 4, 5) [ 51 ].…”

Evaluating the psychometric properties of the eHealth Literacy Scale in Brazilian adults

“…The scale was originally developed in English (9) and validated in many populations, including adolescents (9)(10)(11) , university students (12) , adults (13)(14)(15) , and the elderly [16][17] This is the main measure used to evaluate digital health literacy, and it is validated in the languages European Portuguese (11) , Spanish (12) , Korean (13) , German (14) , Polish (15), Chinese (18) , Japanese (19) , Italian (20) , Hungarian (21) , Serbian (22) , Amharic (Ethiopia) (23) , Swedish (24) , and Greek (25) . The scale showed good psychometric properties in all these languages.…”

The Antecedents and Consequences of E-Health Literacy in the Pharmaceutical Industry: An Agenda for Future Research

“…Skills related to e-Health literacy will enable the patients and empower them to involve in healthcare decision making [18] which will improve patients' health outcomes including quality healthcare [20]. Prior empirical studies have recognized that e-Health literacy is significantly and positively related with patients' health behaviors, knowledge and patients ability to participate in health screening, using mobile technology to accomplish healthcare objectives and goals, research related to healthcare, seeking medical advice among others [21][22][23][24].…”