title: Perceived and Performed eHealth Literacy: Survey and Simulated Performance Test.
abstract: BACKGROUND
  Electronic health (eHealth) literacy of consumers is essential in order to improve information and communication technology (ICT) use for health purposes by ordinary citizens. However, performed eHealth literacy is seldom studied. Therefore, the present study assessed perceived and performed eHealth literacy using the recent conceptualization of health literacy skills.
  
  
  OBJECTIVE
  The aim of this paper was to examine the association between perceived and performed eHealth literacies.
  
  
  METHODS
  In total, 82 Israeli adults participated in the study, all 50 years and older, with a mean age of 67 (SD 11). Of the participants, 60% (49/82) were women and 72% (59/82) had a post-secondary education. The participants were first surveyed and then tested in a computer simulation of health-related Internet tasks. Performed, perceived (eHealth Literacy Scale, eHEALS), and evaluated eHealth literacy were assessed, and performed eHealth literacy was also recorded and re-evaluated later. Performance was scored for successful completion of tasks, and was also assessed by two researchers for motivation, confidence, and amount of help provided.
  
  
  RESULTS
  The skills of accessing, understanding, appraising, applying, and generating new information had decreasing successful completion rates. Generating new information was least correlated with other skills. Perceived and performed eHealth literacies were moderately correlated (r=.34, P=.01) while facets of performance (ie, digital literacy and eHealth literacy) were highly correlated (r=.82, P<.001). Participants low and high in performed eHealth literacy were significantly different: low performers were older and had used the Internet for less time, required more assistance, and were less confident in their conduct than high performers.
  
  
  CONCLUSIONS
  The moderate association between perceived and performed eHealth literacy indicates that the latter should be assessed separately. In as much, the assessment of performed eHealth literacy in clinical settings should entail the structuring of tasks as well as shortening and automatizing the assessment.
authors.affiliation: Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel.
authors.forename: Efrat
authors.identifier: http://orcid.org/0000-0002-2162-0474
authors.initials: E
authors.lastname: Neter
authors.affiliation: Department of Behavioral Sciences, Ruppin Academic Center, Emeq Hefer, Israel.
authors.forename: Esther
authors.identifier: http://orcid.org/0000-0002-1152-3873
authors.initials: E
authors.lastname: Brainin
keywords: eHealth; literacy; performance