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Original Article

The Concept of eHealth Literacy and Its Measurement

German Translation of the eHEALS

Published Online:https://doi.org/10.1027/1864-1105/a000104

The objective of this study was to translate the eHealth Literacy Scale (eHEALS) into German, to evaluate this translation through psychometric testing in a German sample of adolescents, and to analyze whether the content-derived hypothesis of two eHEALS subscales was confirmed by the data. We hypothesized that the first subscale would cover self-perceived competence in seeking health information online, and the second subscale information appraisal of health information on the Internet. A cross-sectional survey among 18-year-old students (N = 327) using our translation of the eHEALS was conducted. A confirmatory factor analysis compared the 1-factor model based on Norman and Skinners’ analyses with the a priori specified 2-factor model. The results indicated a better fit for the 2-factor model (chi-square difference of 150.93, p < .0001), supporting the division into subscales.

References

  • Brown, C. A. , Dickson, R. (2010). Healthcare students’ e-literacy skills. Journal of Allied Health, 39(3), 179–184. First citation in articleGoogle Scholar

  • Bühner, M. (2006). Einführung in die Test- und Fragebogenkonstruktion [Introduction to test and questionnaire construction]. Munich: Pearson. First citation in articleGoogle Scholar

  • Comrey, A. L. , Lee, H. B. (1992). A first course in factor analysis (2nd ed.). Hillsdale, NJ: Erlbaum. First citation in articleGoogle Scholar

  • Department of Health . (2004). Better information, better choices, better health: Putting information at the centre of care. London, UK: Department of Health. Retrieved from www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/@dh/@en/documents/digitalasset/dh_4098599.pdf First citation in articleGoogle Scholar

  • Dumitru, R. C. , Bürkle, T. , Potapov, S. , Lausen, B. , Wiese, B. , & Prokosch, H.-U. (2007). Use and perception of Internet for health related purposes in Germany: Results of a national survey. International Journal of Public Health, 52(5), 275–285. First citation in articleCrossrefGoogle Scholar

  • Field, A. (2009). Discovering statistics using SPSS (3rd ed.). London: Sage. First citation in articleGoogle Scholar

  • Fisher, B. , Dixon, A. , & Honeyman, A. (2005). Informed patients, reformed clinicians. Journal of the Royal Society of Medicine, 98(12), 530–531. First citation in articleCrossrefGoogle Scholar

  • Ghaddar, S. , Valerio, M. A. , Garcia, C. M. , Hansen, L. (2012). Adolescent health literacy: The importance of credible sources for online health information. Journal of School Health, 82(1), 28–36. First citation in articleCrossrefGoogle Scholar

  • Hu, L.-T. , & Bentler, P. M. (1999). Cutoff criteria for fit indices in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling: A Multidisciplinary Journal, 6(1), 1–55. First citation in articleCrossrefGoogle Scholar

  • Jerusalem, M. , Schwarzer, R. (1999). Allgemeine Selbstwirksamkeitserwartung [General self-efficacy expectation]. In R. Schwarzer, M. Jerusalem, (Eds.) Skalen zur Erfassung von Lehrer- und Schülermerkmalen. Dokumentation der psychometrischen Verfahren im Rahmen der Wissenschaftlichen Begleitung des Modellversuchs Selbstwirksame Schulen [Scales for measurement of teacher and student characteristics: Documentation of psychometric techniques in the context of the scientific monitoring of the model project self-efficacious schools]. (pp. 13–14). Berlin: Freie Universität Berlin. First citation in articleGoogle Scholar

  • Knapp, C. , Madden, V. , Wang, H. , Sloyer, P. , & Shenkman, E. (2011). Internet use and e-Health literacy of low-income parents whose children have special health care needs. Journal of Medical Internet Research, 13(3), e75. First citation in articleGoogle Scholar

  • Koo, M. , Norman, C. D. , Chang, H.-M. (2012). Psychometric evaluation of a Chinese version of the eHealth Literacy Scale (eHEALS) in school age children. International Electronic Journal of Health Education, 15, 29–36. First citation in articleGoogle Scholar

  • Kruger, J. , & Dunning, D. (1999). Unskilled and unaware of it: How difficulties in recognizing one’s own incompetence lead to inflated self-assessments. Journal of Personality and Social Psychology, 77, 1121–1134. First citation in articleCrossrefGoogle Scholar

  • Kummervold, P. E. , Chronaki, C. E. , Lausen, B. , Prokosch, H.-U. , Rasmussen, J. , Santana, S. , … Wangberg, S. C. (2008). eHealth trends in Europe 2005–2007: A population-based survey. Journal of Medical Internet Research, 10(4), e42. First citation in articleGoogle Scholar

  • Leutner, D. , Hartig, J. , Jude, N. (2008). Measuring competencies: Introduction to concepts and questions of assessment in education. In J. Hartig, E. Klimee, D. Leutner, (Eds.), Assessment of competencies in educational contexts (pp. 177–192). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Marteau, T. M. , Dormandy, E. , Michie, S. (2011). A measure of informed choice. Health Expectations, 4(2), 99–108. First citation in articleCrossrefGoogle Scholar

  • McCormack, L. , Bann, C. , Squiers, L. , Berkman, N. D. , Squire, C. , Schillinger, D. , … Hibbard, J. (2010). Measuring health literacy: A pilot study of a new skills-based instrument. Journal of Health Communication, 15(2), 51–71. First citation in articleCrossrefGoogle Scholar

  • Mitsutake, S. , Shibata, A. , Ishii, K. , Okazaki, K. , & Oka, K. (2011). Developing Japanese version of the eHealth Literacy Scale (eHEALS). Japanese Journal of Public Health, 58(5), 361–371. First citation in articleGoogle Scholar

  • Nielsen-Bohlman, L. , Panzer, A. M. , Kindig, D. A. (2004). Health literacy: A prescription to end confusion. Washington, DC: National Academies Press. First citation in articleGoogle Scholar

  • Norman, C. D. (2011). eHealth literacy 2.0: Problems and opportunities with an evolving concept. Journal of Medical Internet Research, 13(4), e125. First citation in articleGoogle Scholar

  • Norman, C. D. , Skinner, H. A. (2006a). eHealth literacy: Essential skills for consumer health in a networked world. Journal of Medical Internet Research, 8(2), e9. First citation in articleGoogle Scholar

  • Norman, C. D. , Skinner, H. A. (2006b). eHEALS: The eHealth literacy scale. Journal of Medical Internet Research, 8(4), e27. First citation in articleGoogle Scholar

  • Nutbeam, D. (1998). Health promotion glossary. Health Promotion International, 13(4), 349–364. First citation in articleCrossrefGoogle Scholar

  • Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. First citation in articleCrossrefGoogle Scholar

  • Parker, R. (2000). Health literacy: A challenge for American patients and their health care providers. Health Promotion International, 15(4), 277–283. First citation in articleCrossrefGoogle Scholar

  • Raffle, A. E. (2001). Information about screening: Is it to achieve high uptake or to ensure informed choice? Health Expectations, 4(2), 92–98. First citation in articleCrossrefGoogle Scholar

  • Rideout, V. (2001). Generation Rx.com: How young people use the internet for health information. Menlo Park, CA: Henry J. Kaiser Family Foundation. First citation in articleGoogle Scholar

  • Robinson, C. , Graham, J. (2010). Perceived Internet health literacy of HIV-positive people through the provision of a computer and Internet health education intervention. Health Information & Libraries Journal, 27(4), 295–303. First citation in articleCrossrefGoogle Scholar

  • Schreiber, J. B. , Nora, A. , Stage, F. K. , Barlow, E. A. , King, J. (2006). Reporting structural equation modeling and confirmatory factor analysis results: A review. The Journal of Educational Research, 99(6), 323–338. First citation in articleGoogle Scholar

  • Soellner, R. , Huber, S. , Lenartz, N. , & Rudinger, G. (2009). Gesundheitskompetenz – ein vielschichtiger Begriff [Health competence: A complex concept]. Zeitschrift für Gesundheitspsychologie, 17(3), 105–113. First citation in articleLinkGoogle Scholar

  • Soellner, R. , Huber, S. , Lenartz, N. , & Rudinger, G. (2010). Facetten der Gesundheitskompetenz – eine Expertenbefragung. Projekt Gesundheitskompetenz [Facets of health competence: An expert consultation: Project health competence]. Zeitschrift für Pädagogik, Beiheft, 56, 104–114. First citation in articleGoogle Scholar

  • Steckelberg, A. , Hülfenhaus, C. , Kasper, J. , Rost, J. , Mühlhauser, I. (2009). How to measure critical health competences: Development and validation of the Critical Health Competence Test (CHC Test). Advances in Health Sciences Education, 14, 11–22. First citation in articleCrossrefGoogle Scholar

  • Tousignant, M. , DesMarchais, J. E. (2002). Accuracy of student self-assessment ability compared to their own performance in a problem-based learning medical program: A correlation study. Advances in Health Science Education, 7, 19–27. First citation in articleCrossrefGoogle Scholar

  • van Deursen, A. J. A. M. , van Dijk, J. A. G. M. (2011). Internet skills performance tests: Are people ready for eHealth? Journal of Medical Internet Research, 13(2), e35. First citation in articleGoogle Scholar

  • van der Vaart, R. , van Deursen, A. J. A. M. , Drossaert, C. H. C. , Taal, E. , van Dijk, J. A. G. M. , van de Laar, M. A. F. J. (2011). Does the eHealth Literacy Scale (eHEALS) measure what it intends to measure? Validation of a Dutch version of the eHEALS in two adult populations. Journal of Medical Internet Research, 13(4), e86. First citation in articleGoogle Scholar

  • World Health Organization . (2012). Process of translation and adaptation of instruments. Retrieved from www.who.int/substance_abuse/research_tools/translation/en/ First citation in articleGoogle Scholar