Validation of the eHealth Literacy Assessment tool (eHLA)

Introduction: eHealth has the potential to support integrative care by increasing citizens’ involvement in own health, but to succeed, one must understand the end-users, their capabilities and resources for engaging with technology. eHealth literacy describes the interaction between users and systems in a health context and was first defined in 2006 by Norman & Skinner, who developed a related questionnaire [1].Based on a need for more comprehensive measures, a process was initiated in 2010 to identify existing, suitable instruments that could be combined to evaluate eHealth literacy by using digital and health literacy. This resulted in a suite named eHealth Literacy Assessment toolkit (eHLA) [2]. The study aims to further develop and validate eHLA as a tool for measuring eHealth literacy.Methods: In the beginning of 2015, eHLA included seven tools of which four were based on principles from existing instruments [3][6], one used a selection of items from an existing instrument [7] and two were developed from scratch.Three tools related to health literacy; Functional Health literacy [3], Health literacy Self assessment [7] and Health literacy performance. Four tools related to digital literacy; Computer familiarity [4], Computer confidence [5], Computer incentive and Computer performance [6].The digital performance tool was removed before Step 1 in order to allow for self-administration.Step 1: Several tools were originally designed for a narrow target population (e.g. college students, veterans) and needed adaption to fit a broader target population. The adapted tools were tested in cognitive interviews [8].Step 2: An electronic version of eHLA was distributed on social media through authors’ networks.Step 3: Further adjustments were tested in cognitive interviews.Step 4: Validation in a sample of more than 300 people _(in progress, November 2015)_Step 5: Finalized toolkit _(expected by the start of 2016)_Results:Step 1: Eight cognitive interviews resulted in minor adjustments.Step 2: 187 respondents completed an electronic version of eHLA distributed on Facebook and LinkedIn. 124 respondents were female, and aged 18 to 69 years (mean: 29,6). 123 were university students or graduates. See table 1 for results. There were almost no incorrect answers in _Functional Health Literacy_ and _Health Literacy Performance_ tools.Table 1. Ceiling effects Cronbach's alphaHealth Literacy Self-Assessment No 0.67Health Literacy Performance Yes 0.25Functional Health Liter