Reconceptualizing Health Literacy and the eHealth Literacy Scale (eHEALS): Evaluation of Psychometric Properties, Subdimensions, and Health-Related Internet Searching Behavior in Adult Outpatients Visiting a Tertiary Care Clinic

Recent reconceptualizations of health literacy have expanded beyond traditional literacy and numeracy skills to look more broadly at how patients interact within the healthcare environment. With the widespread use of the internet for health information, health literacy needs to be reframed to include eHealth literacy skills required to find, evaluate, and apply electronic health information to solve health problems. There is only one instrument to measure eHealth literacy, the eHealth Literacy Scale (eHEALS), and this instrument was originally validated in a group of high school students without disease. This study reevaluated the reliability and validity of the 8-item eHEALS in an adult outpatient population. Attention was paid to determine whether subdimensions existed within eHEALS that could be used to develop subscales to better categorize eHealth literacy deficiencies, and to further understand associations between low eHealth literacy, patient characteristics, and health-related internet use. Varimax rotated factor analysis provided preliminary evidence to support two eHealth Literacy subscales: Utilizing info & Evaluating info. A multivariate linear regression model revealed statistically significant associations between low eHealth Literacy and patient characteristics including age, education, and access to smart phones. Furthermore, eHEALS demonstrated convergent validity in relation to the use of high quality websites. The likelihood of using high quality websites was significantly lower (OR = 0.26; 95% CI, 0.08 - 0.83; P = .02) for patients with low eHealth Literacy. Further research is needed to improve the eHealth Literacy Scale to better categorize patient deficits in finding, evaluating, and applying electronic health information to solve health problems