Georgsson Mattias, Odzakovic Elzana, Björk Maria, Kaldo Viktor, Jernelöv Susanna, Blom Kerstin, Ulander Martin, Fridlund Bengt, Knutsson Susanne, Sandlund Christina, Pakpour Amir, Broström Anders
Department of Nursing, School of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, 553 18, Sweden, 46 036101000.
Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden.
J Med Internet Res. 2025 Sep 10;27:e68474. doi: 10.2196/68474.
An increased use of the internet and digital health care for patients with long-term conditions implies a need for assuring digital health literacy skills. Patients with restless legs syndrome (RLS) represent a group where digital sources of information are highly valued. This is due to a difficult diagnosis and complex treatment situation that contributes to patients seeking out digital resources themselves to handle the perceived shortcomings in their care. To benefit from these resources, patients need to have the digital skills to explore information to optimize their understanding of the disease and its treatments. The eHealth Literacy Scale (eHEALS), which has been used in both general populations and patients with long-term conditions, could, if proven valid, be used by researchers and clinicians to assess digital health literacy among patients with RLS to inform the development of patient-centered digital health care information and interventions.
The aim of the study is to investigate the psychometric properties of eHEALS in patients with RLS to determine its adequacy and potential utility.
A cross-sectional design including patients with RLS from the Swedish national RLS patient organization was used. Data were collected via a mail-based survey comprising back-and-forth translated Swedish versions of the following instruments: eHEALS, Restless Legs Syndrome-6 Scale (RLS symptoms), Pittsburgh Sleep Quality Inventory (sleep quality), Epworth Sleepiness Scale (daytime sleepiness), Patient Health Questionnaire-9 (depressive symptoms), and CollaboRATE (shared decision-making). Confirmatory factor analysis and Rasch models were used to assess the validity and reliability of the eHEALS. Measurement invariance, unidimensionality, and differential item functioning across age, gender, medication use, sleep quality, level of depressive symptoms, and participation in care decisions were assessed.
A total of 788 patients with a mean age of 70.8 (SD 11.3) years participated. Among them, 64.7% (n=510) were women, 73.8% (n=582) were married or living together, and 43.5% (n=343) had attained a university education. A median eHEALS score of 28 (IQR 22-33) was reported. The unidimensionality of the eHEALS was supported by the confirmatory factor analysis and the Rasch model. The reliability of the eHEALS was confirmed using composite reliability and Cronbach α. No differential item functioning was identified for age, gender, medication use, shared decision-making condition, depressive symptoms, or sleep quality, meaning that these groups do not have different probabilities of endorsing a given item after controlling for the overall score.
The eHEALS showed good validity and reliability and operated equivalently for men and women of different ages with various clinical and treatment conditions related to RLS. Accordingly, health care professionals can use eHEALS as a psychometrically sound tool to explore the digital health literacy level among patients with RLS.
长期病患者对互联网和数字医疗保健的使用增加，这意味着需要确保其具备数字健康素养技能。不安腿综合征（RLS）患者群体高度重视数字信息来源。这是因为诊断困难且治疗情况复杂，促使患者自行寻找数字资源来弥补他们认为的护理不足。为了从这些资源中受益，患者需要具备数字技能来探索信息，以优化他们对疾病及其治疗方法的理解。电子健康素养量表（eHEALS）已在普通人群和长期病患者中使用，如果被证明有效，研究人员和临床医生可使用它来评估RLS患者的数字健康素养，为以患者为中心的数字医疗保健信息和干预措施的开发提供参考。
本研究旨在调查eHEALS在RLS患者中的心理测量特性，以确定其适用性和潜在效用。
采用横断面设计，纳入来自瑞典全国RLS患者组织的RLS患者。通过基于邮件的调查收集数据，该调查包括以下工具的瑞典语版本，这些版本经过来回翻译：eHEALS、不安腿综合征 - 6量表（RLS症状）、匹兹堡睡眠质量指数（睡眠质量）、爱泼华嗜睡量表（日间嗜睡）、患者健康问卷 - 9（抑郁症状）和CollaboRATE（共同决策）。使用验证性因素分析和拉施模型来评估eHEALS的有效性和可靠性。评估了年龄、性别、药物使用、睡眠质量、抑郁症状水平以及参与护理决策等方面的测量不变性、单维度性和项目功能差异。
共有788名患者参与，平均年龄为70.8（标准差11.3）岁。其中，64.7%（n = 510）为女性，73.8%（n = 582）已婚或同居，43.5%（n = 343）拥有大学学历。报告的eHEALS中位数得分为28（四分位间距22 - 33）。验证性因素分析和拉施模型支持了eHEALS的单维度性。使用组合信度和克朗巴哈α系数确认了eHEALS的可靠性。未发现年龄、性别、药物使用、共同决策情况、抑郁症状或睡眠质量方面的项目功能差异，这意味着在控制总分后，这些组认可给定项目的概率没有差异。
eHEALS显示出良好的有效性和可靠性，并且在与RLS相关的各种临床和治疗条件下，对不同年龄的男性和女性的作用相同。因此，医疗保健专业人员可以将eHEALS作为一种心理测量合理的工具，来探索RLS患者的数字健康素养水平。
