title: Does the eHealth Literacy Scale (eHEALS) measure what it intends to measure? Validation of a Dutch version of the eHEALS in two adult populations.
abstract: BACKGROUND
  The Internet increases the availability of health information, which consequently expands the amount of skills that health care consumers must have to obtain and evaluate health information. Norman and Skinner in 2006 developed an 8-item self-report eHealth literacy scale to measure these skills: the eHealth Literacy Scale (eHEALS). This instrument has been available only in English and there are no data on its validity.
  
  
  OBJECTIVE
  The objective of our study was to assess the internal consistency and the construct and predictive validity of a Dutch translation of the eHEALS in two populations.
  
  
  METHODS
  We examined the translated scale in a sample of patients with rheumatic diseases (n = 189; study 1) and in a stratified sample of the Dutch population (n = 88; study 2). We determined Cronbach alpha coefficients and analyzed the principal components. Convergent validity was determined by studying correlations with age, education, and current (health-related) Internet use. Furthermore, in study 2 we assessed the predictive validity of the instrument by comparing scores on the eHEALS with an actual performance test.
  
  
  RESULTS
  The internal consistency of the scale was sufficient: alpha = .93 in study 1 and alpha = .92 in study 2. In both studies the 8 items loaded on 1 single component (respectively 67% and 63% of variance). Correlations between eHEALS and age and education were not found. Significant, though weak, correlations were found between the eHEALS and quantity of Internet use (r = .24, P = .001 and r = .24, P = .02, respectively). Contrary to expectations, correlations between the eHEALS and successfully completed tasks on a performance test were weak and nonsignificant: r = .18 (P = .09). The t tests showed no significant differences in scores on the eHEALS between participants who scored below and above median scores of the performance test.
  
  
  CONCLUSIONS
  The eHEALS was assessed as unidimensional in a principal component analysis and the internal consistency of the scale was high, which makes the reliability adequate. However, findings suggest that the validity of the eHEALS instrument requires further study, since the relationship with Internet use was weak and expected relationships with age, education, and actual performance were not significant. Further research to develop a self-report instrument with high correlations with people's actual eHealth literacy skills is warranted.
authors.affiliation: Department of Psychology, Health and Technology, University of Twente, Enschede, Netherlands. r.vandervaart@utwente.nl
authors.forename: Rosalie
authors.initials: R
authors.lastname: van der Vaart
authors.forename: Alexander Jam
authors.initials: AJ
authors.lastname: van Deursen
authors.forename: Constance Hc
authors.initials: CH
authors.lastname: Drossaert
authors.forename: Erik
authors.initials: E
authors.lastname: Taal
authors.forename: Jan Amg
authors.initials: JA
authors.lastname: van Dijk
authors.forename: Mart Afj
authors.initials: MA
authors.lastname: van de Laar
mesh_terms: D000328:Adult; D054626:Consumer Health Information / Q000706:statistics & numerical data; D005260:Female; D057220:Health Literacy / Q000706:statistics & numerical data*; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D025341:Principal Component Analysis; D015203:Reproducibility of Results; D012216:Rheumatic Diseases; D011795:Surveys and Questionnaires; D017216:Telemedicine
references.citation: J Allied Health. 2010 Fall;39(3):179-84
references.pmid: 21174023
references.citation: Fam Med. 1993 Jun;25(6):391-5
references.pmid: 8349060
references.citation: J Health Commun. 2010;15 Suppl 2:51-71
references.pmid: 20845193
references.citation: J Med Internet Res. 2006 Jun 16;8(2):e9
references.pmid: 16867972
references.citation: J Am Med Inform Assoc. 2004 Nov-Dec;11(6):448-57
references.pmid: 15299002
references.citation: Ann Fam Med. 2005 Nov-Dec;3(6):514-22
references.pmid: 16338915
references.citation: Rheumatology (Oxford). 2011 Sep;50(9):1618-26
references.pmid: 21551221
references.citation: Soc Sci Med. 2008 Dec;67(12):2072-8
references.pmid: 18952344
references.citation: Diabetes Care. 2008 May;31(5):874-9
references.pmid: 18299446
references.citation: Fam Community Health. 2010 Apr-Jun;33(2):152-62
references.pmid: 20216358
references.citation: Nurs Health Sci. 2009 Mar;11(1):77-89
references.pmid: 19298313
references.citation: J Med Internet Res. 2011 Apr 29;13(2):e35
references.pmid: 21531690
references.citation: Health Mark Q. 2008;25(1-2):175-203
references.pmid: 18935884
references.citation: J Gen Intern Med. 2010 Jul;25(7):675-81
references.pmid: 20224964
references.citation: J Gen Intern Med. 2009 Nov;24(11):1211-6
references.pmid: 19760299
references.citation: JAMA. 1999 Feb 10;281(6):552-7
references.pmid: 10022112
references.citation: Br J Gen Pract. 2009 Oct;59(567):721-3
references.pmid: 19843420
references.citation: Patient Educ Couns. 2010 Apr;79(1):36-42
references.pmid: 19896320
references.citation: Qual Life Res. 2003 May;12(3):229-38
references.pmid: 12769135
references.citation: Ned Tijdschr Geneeskd. 2009;153:A250
references.pmid: 19785884
references.citation: J Am Med Inform Assoc. 2005 Mar-Apr;12(2):152-63
references.pmid: 15561782
references.citation: J Clin Epidemiol. 2007 Jan;60(1):34-42
references.pmid: 17161752
references.citation: J Gen Intern Med. 2006 Aug;21(8):878-83
references.pmid: 16881951
references.citation: Health Info Libr J. 2010 Dec;27(4):295-303
references.pmid: 21050372
references.citation: J Gen Intern Med. 2005 Feb;20(2):175-84
references.pmid: 15836552
references.citation: J Med Internet Res. 2006 Nov 14;8(4):e27
references.pmid: 17213046
references.citation: J Gen Intern Med. 1995 Oct;10(10):537-41
references.pmid: 8576769