Psychometric Evaluation of a Chinese Version of the eHealth Literacy Scale (eHEALS) in School Age Children

Introduction with the widespread use of the Internet as a medium for health information, it is imperative to understand the impact that such technology has on decision-making among non-health professionals is high. The interactive nature of the technology, including ease of access and potential anonymity, make it an attractive source of information for the young health consumer. (1) However, the substantial variations in the quality of the health information available on the Internet have raised concerns about the potential negative health effects related to eHealth use. (2) For example, inaccurate and incomplete health information on the Internet may lead to false reassurance or needless distress arise from incorrect self-diagnosis. (3) Biased information and misleading promotional material can also lure patients to try unproven treatments and potentially deflect them from making optimal treatment decisions for their health conditions. (4) The potential for risk is exacerbated in young people who may not have the experience or skill to properly evaluate its quality or potential consequences of use. (5) Skinner and colleagues found that adolescents who use the Internet for health information felt that high-quality information did exist, but that they were insufficiently skilled to find it. (6) For public health, the challenge is assessing the level of skills that consumers have and finding the means to improve them if necessary. To assess consumers' perceived skills at finding, evaluating and applying electronic health information to health problems, Norman and Skinner developed the eHealth Literacy Scale (eHEALS). (7) The scale was based on a theoretical model comprised of six key eHealth core skills including (1) traditional literacy, (2) health literacy, (3) information literacy, (4) scientific literacy, (5) media literacy, and (6) computer literacy. (8) The eHEALS is a simple eight-item self-reported scale with five-point Likert response format and has been successfully applied to different contexts. (9-11) The need for skills in seeking and appraising eHealth resources is common across ages, sex, and cultural groups, even if the specific health conditions may vary between them. We sought to translate and apply the eHEALS to Chinese school children to assess the applicability of the instrument and eHealth literacy model in a different cultural context. The present study was designed to assess the psychometric properties of the Chinese version of eHEALS (CeHEALS) for use in Mandarin-speaking school children. Methods Design, Participants and Setting A single group, cross-sectional study design was used. Data for the present study were collected as part of a larger study examining the association between health literacy and computer competencies in school children. Participants in the study were sixth-grade school children in two elementary schools located in Minhsiung and Meishan townships of Chiayi county in south Taiwan. The written form of Chinese language in Taiwan is in Traditional Chinese characters. The two schools were established within ten years and both had a classroom with computers for every student in the class. In addition, both schools provided no formal classes on Internet use. Informed consent was obtained from the parents of the participating students. The sample size of the study was based on the recommendation by Gorsuch that a sample of 200 is preferred in factor analysis. (12) Instruments The original English version of the eHEALS was developed as a scale to quantify the levels of consumers' perceived skills at using information technology for health. The eHEALS is an eight-item measure of eHealth literacy developed to measure consumers' combined knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems. A psychometric evaluation of the eHEALS on 664 adolescents revealed a Cronbach's alpha of 0. …