Clinic for Psychosomatic Medicine and Psychotherapy, LVR-University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
Institute for Patient Safety, University Hospital Bonn, Bonn, Germany.
J Med Internet Res. 2022 Feb 2;24(2):e28252. doi: 10.2196/28252.
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.
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.
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.
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.
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.
万维网已成为获取健康信息的重要来源。然而，所提供的信息量和质量可能会导致信息过载。因此，人们需要一定的技能来搜索、识别和评估互联网上的信息。在健康信息方面，这些能力被概括为电子健康素养的结构。先前的研究已经强调了电子健康素养在与健康相关的结果方面的相关性。然而，现有的评估德语电子健康素养的工具在测试开发和验证方面存在方法学限制。开发和验证这一重要结构的修订量表具有重要意义。
本研究旨在开发和验证一个修订的德国电子健康素养量表。特别是，本研究旨在关注高方法学和心理测量学标准，为德语电子健康素养的测量提供一个有效和可靠的工具。
两个国际上经过验证的工具被合并，以涵盖电子健康素养结构的广泛范围，并创建一个修订的电子健康素养量表。翻译遵循科学指南和建议，以确保内容效度。2020 年 10 月至 11 月，从德语使用者（n=470）中以方便样本收集数据。通过因子分析进行验证。此外，还进行了相关性分析，以检验收敛、区分和标准有效性。此外，还对性别、年龄和教育水平的测量不变性进行了分析。
分析显示电子健康素养的 2 因素模型。通过项目减少，信息搜索和信息评估的 2 个因素用 8 个项目来衡量，具有可接受至良好的模型拟合度（比较拟合指数[CFI]：0.942，塔克-刘易斯指数[TLI]：0.915，均方根误差近似值[RMSEA]：0.127，标准化均方根残差[SRMR]：0.055）。信息搜索和信息评估与健康素养、互联网信心和互联网焦虑的显著相关性全面证实了收敛有效性。通过与各种量表的相关分析检验了区分和标准有效性，并部分得到了证实。性别（CFI：0.932，TLI：0.923，RMSEA：0.122，SRMR：0.068）和教育水平（CFI：0.937，TLI：0.934，RMSEA：0.112，SRMR：0.063）的标量水平测量不变性得到了确认。年龄的测量不变性被拒绝。
本研究遵循翻译和测试验证的科学指南，开发了一个修订的德国电子健康素养量表（GR-eHEALS）。我们的因子分析证实了可接受至良好的模型拟合度。在收敛、区分和标准有效性方面的结构验证主要得到了证实。我们的研究结果提供了工具在性别和教育水平方面的测量不变性的证据。新修订的 GR-eHEALS 问卷是衡量电子健康素养这一重要健康相关结构的有效工具。
