IAFOR Journal of Education

Volume 7 – Issue 2 – Winter 2019

eHealth Literacy of High School Students in the Philippines
Mark Kenneth S. Camiling
University of the Philippines, Diliman, Philippines

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Abstract
The Internet has become a chief health information source. It is posited that people who use
the Web for health information must possess requisite eHealth literacy to avoid misuse. eHealthliteracy refers to the skills in searching, retrieving, understanding, evaluating, and applying
online health information to alter or maintain well-being. This research employed mixed
methods of data collection, following a three-phase explanatory sequential design: 1) survey
and eHealth literacy test, 2) focus group discussion, and 3) observational study, to describe thestate of eHealth literacy of high school students in terms of their online health information
seeking behaviors, search, retrieval, and evaluation strategies, actual eHealth literacy levels,and perceived eHealth literacy levels. Furthermore, the research aimed at investigating therelationships among school type, actual eHealth literacy levels, and perceived eHealth literacy
levels. Results show that students are adept in searching and retrieving online healthinformation. However, their evaluation strategies are suboptimal as they lack ability to checkfor content accuracy and source credibility. Findings also reveal a significant relationshipbetween school type and perceived eHealth literacy levels, X² (2, N=263) =14.21, p=0.00,
α=0.05. Private school students tend to score their perceived eHealth literacy levels higher.
There is also a significant difference between actual eHealth literacy levels and perceived
eHealth literacy levels, with students rating their perceived eHealth literacy levels (M=32.45,
SD=6.10, N=40) higher than their actual eHealth literacy levels (M=29.13, SD=2.92, N=40),t(40)=4.16, p=0.000, α=0.05. It is concluded that while students are adept in computer andtraditional literacies, they still need to further develop health and information literacies toeffectively evaluate and apply the searched and retrieved online health information.
Keywords: eHealth, eHealth literacy, high school students

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According to Internet Live Statistics (2016), about 50% of the world population is connectedto the Internet. In the local setting, the Philippines registered an Internet Penetration Rate (IPR)of 43.5%. Furthermore, according to Cruz (as cited in Bristol, Caro, Mangaliman, & Bernarte,2016), 60% of Filipino Internet users belong to the youth category of 15-19 years old, thelargest representation in national figures. In the report of Bayani (2014, para. 8), global
information and measurement company, Nielsen, found that a few of the top online activities
of Filipinos are logging on to social networking sites, participating in online discussions andchatrooms, and conducting academic research.
“The Internet, with its capacity to provide information that transcends time and space barriers,
continues to transform how people find and apply information to their own lives” (Seckin,
Yeatts, Hughes, Hudson, & Bell, 2016, p. e161). Hence, the emergence of the Internet has
rapidly changed the paradigm of information consumerism, particularly in the health sector.
Fox and Duggan (2013) found that 72% of Internet users in the United States searched foronline health information. Tracing the early years of the 20th century, one in three adolescentsused the Internet as a reference for health information (Lenhart, Madden, & Hitlin, 2005). Fox
and Duggan (2013) further found that the majority of Internet users sought information about
a specific condition or disease to medically diagnose themselves. Moreover, 28% of these users
did not follow up further with a medical professional. According to Atienza, Hesse, Gustafson,
and Croyle (as cited in Seckin et al., 2016), they generally consult the Internet first before their
physician. These reports imply a strong, apparent influence of the Internet in the way people
manage their health and well-being.
Though access to online health information may develop the consumer to become empowered
and reflexive, Im (as cited in Seckin et al., 2016) strongly declares that regardless of one’s levelof reflexivity and empowerment, a person must still possess a requisite high level of healthliteracy to avoid information misuse. Health literacy has blended in and evolved with theadvancement of technology and onset of Internet access. Hence the emerging concept ofeHealth literacy is coined and explored.
eHealth literacy is defined as “the ability to read, use computers, search for information,
understand health information, and put it into context” (Norman & Skinner, 2006a, p. e27).
Simple as it may seem, eHealth literacy is a multi-skill competency. The ability to navigate thecomputer and access health information requires complex processes. Understanding healthknowledge involves critical evaluation of the acquired information. Lastly, putting theinformation into real-life context entails careful reflection while being faced with various
decision-making mediators.
There have been numerous studies that have attempted to provide descriptions of, indicatorsof, and/or baseline data on eHealth literacy of various populations such as adolescents(Ghaddar, Valerio, Garcia, & Hansen, 2012), adults (Marazienè, Klumbienè, Tomkevičiūtè, &Misevičienè, 2012), and health information and services consumers in general (AlGhamdi &Moussa, 2012). However, these studies were conducted by foreign researchers. Hence, there isa wide gap between the global research development on the emerging concept of eHealthliteracy and the findings from within the Philippines.
Apart from the studies previously mentioned, it is imperative to initiate research on thisemerging field because the advent of technology has prompted schools to revitalize theircurricula in order to respond to the needs of the learners. To contextualize, competencies on
digital literacy and consumer health have been incorporated into the Enhanced K-12 Basic
Education Curriculum of the Philippines since its implementation in 2012. Though there is no71

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competency specifically targeting the development of eHealth literacy, its components aretaught separately across subjects and grade levels.
The rationale for this research is the need for immediacy to address the absence or lack ofcontextualized studies on eHealth literacy. This research aimed to consolidate the theoreticalunderpinnings of the concept in an attempt to quantify the eHealth literacy of the most ideal
sample, adolescents, particularly those who are transitioning from secondary to tertiary
education, where the level of independence and reflexivity is increased. This study focuses on
Filipino high school students and specifically investigated the following research questions:
1. What is the state of eHealth literacy of high school students in the Philippines in termsof online health information-seeking behavior, strategies for search and retrieval of
online health information, criteria for evaluating online health information, andperceived and actual eHealth literacy levels?
2. What relationship exists among school type, perceived eHealth literacy level, and actual
eHealth literacy level?
3. Is there a significant difference between the perceived and actual eHealth literacy levelsof high school students in the Philippines?
Literature Review
Defining eHealth Literacy
eHealth literacy is a combination of different literacies simultaneously applied in eHealthconditions such as facing online health information and availing of Internet health services.
Norman and Skinner (2006b) developed the Lily Model (Figure 1) to illustrate the facets ofvarious literacies incorporated in eHealth literacy: traditional literacy and numeracy, andcomputer, media, science, information, and health literacies. The researchers explain that theseare further categorized into two central types or models – analytic and content-specific.
Analytic literacies are a set of skills that are practiced regardless of the content or situation.
Content-specific literacies apply to particular situations.

Figure 1: The eHealth Literacy Lily Model (Norman & Skinner, 2006b,
eHealth Literacy Model, para. 1)

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The lily metaphor used by the researchers seamlessly represents how eHealth literacy operates
in the minds of individuals. In its practice, each of the literacy components is applied
independently, whether simultaneously or consecutively. However, efficacy in the applicationof eHealth literacy greatly relies on the interdependence of all its components. The eHealthliteracy as the pistil, as used by Norman and Skinner (2006b), encapsulates thisinterrelationship – the central concept holding its components [petals] which have theirrespective characteristics.
Online Health Information Search, Retrieval, and Evaluation
Online health information-seeking behaviors, patterns, and skills have become an emerging
field in health research over the past two decades. For example, in the study of Eysenbach andKohler (2002), it was uncovered that people find it “easier to access the quality of informationon the [Inter]net than elsewhere because they could verify and cross check the information ondifferent sites” (p. 575). However, it also discovered that their search techniques of the online
users are suboptimal. It means that they are not utilizing effective strategies to retrieve accurate,complete, and reliable information. The researchers further reported that this state is due toreasons such as inability to utilize medical portals or sites of medical societies or libraries as astarting point and usually choosing the first results displayed by the search engine without
exploring the succeeding pages. The participants were also asked about what they consider inchecking the website reliability. They mentioned criteria such as professional layout andwriting, indication of official authority, and citation of scientific references.
Measuring eHealth Literacy
Little is known about how to quantitatively measure eHealth literacy. Pleasant (2009) argues
that while existing tests are comprehensive, they are merely screening tools. He explains that“the goal of screening is to divide people into healthy and sick categories and it does not tellwhat is actually wrong with the patient” (p. 18). In the same light, Baker (2006) posits that themeasurement of literacy must also involve the individual’s reading ability and vocabulary, notonly their health status. Considering that literacy operates through interactive relationshipamong individuals and the healthcare system, he further stressed that measuring thecommunication capacities of the person is also necessary.
As the instruments evolve to cater to the changing profiles of the population, contexts at which
the individuals are assessed adjust as well. According to the Institute of Medicine (as cited inNorman & Skinner, 2006a), there is “a need to look at the different contexts where healthinformation is obtained and used as part of a strategy of addressing health literacy”(Introduction section, para. 4). These contexts include electronic sources. This has been theinspiration of Norman and Skinner (2006a) in developing the eHealth Literacy Scale(eHEALS) which is “a self-report tool that can be administered by a health professional and isbased on an individual’s perception of her or his own skills and knowledge within eachmeasured domain” (p. e27). It is crafted to measure individual’s estimated literacy level, used
to make clinical decisions. Contextualizing the aims of this present study, it may be inferredthat the instrument most appropriate to use is the eHEALS as it is the only instrument thatprovides if not actual – at the very least perceived – a quantitative measure to describe theeHealth literacy profile of an individual.
eHealth Literacy and Adolescents
It is ideal to identify the youth as a focus for eHealth literacy studies for many reasons. First,
adolescents are about to enter college life, which is “a transitional time for taking charge of
their own health and maintaining a healthy lifestyle, which is essential to their academic
achievement and their overall adult health outcomes” (Ma & Latham, 2013, p. 793). Second,73

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they are highly familiar with technology as evidenced by their high IPR (Cruz, as cited in
Bristol et al., 2016). This is further supported by Norman and Skinner (2006a) when theysampled youth in their research because of the age group’s high level of eHealth use. Third,
adolescents are found to experience difficulty “engaging with eHealth and understanding or
using health information online” (Gray, Klein, Noyce, Sesselberg, & Cantrill, 2005 in Norman& Skinner, 2006a, Introduction, para. 7). In addition, Ivanitskaya, Boyle and Casey (2006)
concluded in their study that adolescents do not possess the ability to “conduct advanced
information searches, judge the trustworthiness of health-related websites and articles, anddifferentiate between various information sources” (Conclusions, para. 1). The authors further
stated that even if adolescents reported high confidence in perceived eHealth literacy, theirskills are still not an accurate predictor of their health information competencies. It ishypothesized by Norman and Skinner (2006a) that the longer the exposure of an individual totechnology, the more likely s/he to use it as a tool to aid in health management.
Therefore, as adolescents grow in technology-rich environments, they will continue to seek
health information from these digital sources. With this inference, it is of high importance that
continuous research be conducted in order to appropriately and adequately address theadolescents’ eHealth literacy needs through intervention provisions.
eHealth Literacy in the Philippine National Curriculum
As of this writing, there is no competency in the Philippine national health education
curriculum that deliberately and specifically covers the development of eHealth literacy acrosselementary and high school. However, the components of eHealth literacy are taken
independently. For example, sources of reliable information are initially discussed in Grade 3.
It is the terminal lesson in the 3rd Quarter wherein at the end, the students are expected to“[identify] reliable sources of health information” (Department of Education, 2016, p. 36). The
following are the sources of health information explicitly mentioned in the document: a)government agencies, b) health professionals, and c) printed materials produced by healthprofessionals or legitimate health institutions. On the other hand, it is in the health curriculumof Grade 10 when evaluation of health information is tackled. The learning competencies
required of the students after they study consumer health in the 1st Quarter (p.87) are:differentiates reliable from unreliable health information, products, and services; explains theguidelines and criteria in the selection and evaluation of health information, products, andservices; explains the nature and dangers of quackery; and reports fraudulent health services.
Although these topics are not “online” in nature, it must be posited that high school students
are equipped with skills needed in the practice of eHealth literacy.
Methodology
Research Design and Methods
The study employed a three-phase explanatory sequential mixed methods design (Cresswell &Plano Clark, 2007): survey and eHealth Literacy Test (eHLT), focus group discussion (FGD),
and observational study (OS). The first phase aimed at eliciting the respondents’ demographic
profile and online health information-seeking behavior. It was followed by FGD to gather
qualitative data on factors that influence the state of eHealth literacy of the high school students
and their retrieval and evaluation strategies. Finally, the last phase elicited observations on the
personal search and retrieval processes of the high school students given a specific task.
The research was conducted within the school year when it commenced. Furthermore, the data
gathering procedures were carried out consecutively with short intervals. This is due to factors
such as time, experience, exposure to technology, and learning of new concept and skills in74

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regular class that may affect the perceived and actual levels of eHealth literacy of the highschool students.
Sample and Sampling Procedures
The research was conducted in Quezon City, Metro Manila to ensure variation in student
characteristics. It has also the highest student population in the country. In addition, Metro
Manila registered the highest IPR of 19% in the country (Social Weather Stations, 2013; ascited in Labucay, 2014).
Grade 10 students from four private and four public schools were purposively chosen because
at the time this study has been conducted, they have completed the core competencies of thenational health curriculum, particularly on consumer health.
There were two sampling procedures employed. The first determined the survey and eHLT
participants. The eight schools were chosen through criterion sampling. Medium and large
schools, as categorized by the Department of Education, were considered to ensure maximum
variation. Excluding homogenous classes, the section in each school was selected throughrandom sampling. The number of respondents in each school varied as intact class sampling
was employed. Tables 1 and 2 describe the demographic information of the participants.
Table 1: Population of schools
SchoolSchoolPopulation*

Grade 10
Population

SampleSurveyed

Invalidated
Surveys**

ActualSample
Size

A
B
C
D
E
F
G
H
Total

368
975
297
***
2748
3314
3126
1978

71
168
92
224
622
607
658
510

29
43
39
29
39
40
36
48
303

3
4
3
2
7
4
4
2
29

26
39
36
27
32
36
32
46
274

*both Junior and Senior High Schools**incomplete and incorrectly answered***did not disclose

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ActualSampleSize by
SchoolType
Private= 128

Public =146

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Table 2: Demographic information of survey and eHLT respondents
SchoolSex:
Male
Female
Age:
15
16
17
18
19
20

A

B

C

D

E

F

G

H

Total

16
10

14
25

22
14

14
13

14
18

13
23

14
18

21
25

128
146

13
11
2
-

11
26
1
1
-

14
16
5
1
-

9
14
3
1
-

15
13
2
1
1

8
20
6
1
1
-

4
16
9
3
-

17
20
7
2
-

91
136
35
7
4
1

The second sampling procedure was carried out to identify the FGD and OS participants.
Through purposive sampling, four schools (a pair from each school type) with the highest andlowest means of perceived eHealth literacy level were considered. Table 3 shows the results ofthe eHLT. Ten students from Schools A, B, E, and H participated in the FGD and OS. Thesestudents were composed of the five respondents who scored the lowest and five who scoredthe highest perceived eHealth literacy levels. Table 4 details their demographic information.
Table 3: eHLT results
Type
SchoolPrivateA
B
CD
Public
E
F
G
H

Mean
31.77
35.21
33.00
32.67
28.44
29.31
30.06
32.47

Table 4: Demographic information of FGD and OS participants
SchoolSex:
Male
Female
Age:
15
16
17
18

A

B

E

H

Total

6
4

2
8

6
4

5
5

19
21

5
4
1
-

1
8
1

4
4
1
1

5
2
3
-

15
18
5
2

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Research Instruments
The research instruments utilized in the study are the survey, eHLT, and eHealth Literacy
Rubric (eHLR), which are supplemented with guides for the conduct of the FGD and OS.
a. Survey
The survey is based on the instrument developed by TNS Political & Social (2014) as
published in their research on digital health literacy of European citizens. The first of
two parts collected demographic information. The second part is composed of openand close-ended questions that elicited information on the students’ online healthinformation-seeking behaviors.
b. eHLT
Administered simultaneously with the survey, the eHLT was utilized to investigate therespondents’ perceived eHealth literacy level. It was developed by the researcher as a
derivation of Norman and Skinner’s eHEALS (2006a). It measured the respondents’
perceived level of effectiveness in the completion of tasks related to the application ofeHealth literacy. The respondents assigned a perceived level of effectiveness inaccomplishing each task. The ratings and their corresponding descriptions are listed inTable 5.
Table 5: eHLT rating of task effectivenessRating4
3
2
1

Description
I can do the task alone confidently and effectively.
I can do the task effectively but with minimal assistance from anotherperson.
I can do the task when fully assisted by another person.
I cannot do the task alone or even with assistance from another person.

In the context of online health information search and retrieval to address a healthconcern or problem, Table 6 presents the tasks in the sequence of accomplishment andthe literacies being practiced.
Table 6: eHLT tasks

1.
2.
3.
4.
5.
6.

Task
Understand the information needed to search
for when asked to address a health concern
or problem
Tell whether the technological tool isconnected to the Internet or not
Identify appropriate software applications to
use to search for online health information
Navigate the software application used tosearch for online health information
Identify websites that are credible sources ofhealth information
Check if an unfamiliar website is a credible
source of health information

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Literacy/ies
Traditional literacy andnumeracy
ComputerComputerComputer
Health and information
Health and information

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7. Understand the language used in the Traditional literacy andinformation presented
numeracy
8. Identify helpful information from a text Health, information, media,
presented
and science literacies
9. Tell whether the online health information is Health, information, andaccurate or notscience10. Explain the answer to a health concern after Traditional literacy andsearching and retrieving online health numeracy
informationc. eHLRThe eHLR is a researcher-developed rubric used to score the respondents’ actual
performance of eHLT tasks during the simulation activity in the OS.
Prior to data gathering, an expert validation and a pilot study were administered to ensure thevalidity and reliability of the research instruments. Four content professionals and one language
expert participated in the expert validation. The pilot study was conducted in two secondary
schools: one public and one private.
Having an expert validation rating of Exceeds expectation (Survey: M=3.75/4.00; eHLT:
M=3.91/4.00; eHLR: M=3.81/4.00), Good Cronbach’s alpha (α) of 0.82 from the pilot study,
and no major recommendations for language revision, the results of the instrument validationand pilot study indicated that the research tools are valid and reliable.
Data Analysis
The resulting data from the various methods of collection were rendered and analyzed throughdifferent means. The data analysis procedure is subdivided into three phases.
Phase one. Descriptive statistics were employed to organize survey data which include thedemographic profile and the prevalence and patterns of online health information-seeking
behaviors.
The eHLT was scored accordingly, with minimum score of 10 and maximum of 40. This
determined the perceived eHealth literacy level. As the score adds, the level increases. Table 7
indicates the range of scores and corresponding proficiency levels. This is based on the studyof Cutilli and Benett (2009, Results of the NAAL section), where adult health literacy in the
United States was evaluated through a series of tasks. Proficient eHealth literacy refers to theability to perform complex tasks such as knowing how to properly use online healthinformation and evaluate content validity and source credibility. Intermediate eHealth literacy
refers to skills that allow the person to perform moderately complex tasks such as knowing
where to find helpful health information on the Internet. Basic eHealth literacy refers to theability to perform simple tasks such as accessing the Internet. Below basic eHealth literacy
describes the skill level below simple and concrete tasks, which include the inability to use
technology to access online health information.

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Table 7: eHLT proficiency levels
Score
29 – 40
24 – 28
19 – 23
10 – 18

Level
ProficientIntermediate
Basic
Below Basic

Phase two. The results of the FGD were rendered through thematic analysis. On the other hand,each respondent’s effectiveness in the performance of eHealth literacy-related tasks during the
OS was scored accordingly using the eHLR. The same scoring and assignment of literacy levels
used in the eHLT evaluation were utilized. The results from the eHLR yielded eachparticipant’s actual eHealth literacy level.
Phase three. Using IBM SPSS Statistics version 20 for Windows, inferential statistics were
employed to answer Research Questions 2 and 3. A chi-square test was administered todescribe the relationship that exists among school type, perceived eHealth literacy level, andactual eHealth literacy level. In addition, a paired samples t-test was administered to determine
if there is a significant difference between the means of perceived and actual eHealth literacy
levels of the high school students.
Ethical Considerations
Several ethical guidelines were upheld in the conduct of the study. The well-being of the
respondents was protected at all times, with their identities kept confidential. Necessary permits
were also secured from appropriate channels prior to administration of any data gathering
procedure. Informed consent, verbal assent, and written consent were also secured whereverimperative to do so. No individual was forced to participate in the study and all were given
freedom to leave the study any time they feel the need to do so.
Results and Discussion
Access to the Internet and Online Health Information
It is not surprising that 100% of the respondents in this study reported access to the Internet,
with personal gadgets used most frequently (at 92.0%). The age group of the respondents
makes up the biggest populace of Filipino Internet users. According to On Device Research(2014), 53% of Filipino Internet users are under the age of 24. In terms of frequency of use,
89.8% of the respondents reported daily access to the Internet. This percentage even surpasses
the finding of Labucay (2014) that three-fifths of Filipino Internet users are “frequent tomoderate users” (p. 39), accessing the Web a few times or at least once daily.
Of those who access the Internet, 96% reported searching for online health information, withpersonal gadgets remaining to be the top choice for use (at 89.4%). Of this percentage, 47.5%
conveyed that they do so weekly, while 41.4% reported monthly access. The high percentageof reported access to online health information even exceeds the range of 40%-73.4% describedin existing literature on adolescents (Jimenez-Pernett, de Labry-Lima, Bermudez-Tamayo,
Garcia-Gutierrez, & Salcedo-Sanchez, 2010). These also support the findings of Labucay(2014) as she reported that health, dieting, and fitness information-seeking and -learning are
one of the major online activities of Internet users.

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Type of Health Information Searched Online
The types of health information searched for by the respondents vary. In general, most of theinformation gathered by the students is about personal health (60.8%), nutrition (58.2%), andinjury prevention, safety, and first aid (52.5%). This finding supported the study of FernandoCallo (2009) on high school students’ expressed health interests. She reported that the top threehealth interest topics are about mental health, nutrition, and safety education and first aid.
These concerns are linked to health risk behaviors reported by Peltzer and Pengpid (2015) intheir cross-sectional study on the results of the 2003, 2007, and 2011 Global School-based
Health Survey to investigate the trends in the health risk behaviors of adolescents aged 10-19.
These behaviors include improper dieting, lack of physical activity, increased sedentary habits,
injury and violence involvement, and practices that contribute to poor mental health. According
to Miguel-Baquilod (as cited in Peltzer & Pengpid, 2015, p. 1), risk behaviors relative to theaforementioned list are correlated with the leading causes of death among the youth in thePhilippines.
Peltzer and Pengpid (2015) reported that there were significant improvements in malnutrition
and mental health over the nine-year coverage of the study. However, it has been found that
there is an increase of health risk behaviors that pertain to bullying, injury, and loneliness. Thisparticular finding of their research is indicative of this study’s results on the specific healthconcerns being searched for online by the respondents.
The high percentage of information search about mental health also supports the results of the2015 National Youth Assessment Study reported by Cendeña (2017). Cendeña mentioned that
20% of the 2,762 respondents “have experienced extreme emotional distress” (p. 20), while
about a third “thought at least once that life was not worth living” (p.20). This may be anunderlying reason why this study’s participants reported the highest frequency of online
information search for mental health concerns.
Sources and Consumers of Online Health Information
Results show that 63.5% of the respondents use Google Chrome, Mozilla Firefox, Bing, Yahoo,
Safari, and Internet Explorer for health information search. These bridge the Internet users tovarious websites that offer health content. Boyer & Geissbuhler (2006, in Jimenez-Pernett etal., 2010) posit that these mechanisms are most frequently used “because they are very easy,
accessible, fast, and contain a great deal of information” (p.5).
At 42.6%, the second most frequently visited source of online health information are social
media sites. Official websites of government and non-government health organizations ranked
fourth at 14.4%. Online newspapers and magazines are reported to be the least common sourceof online health information at 12.5%.
Jacobs, Amuta, and Kwon (2017) mentioned that the motivations behind the healthinformation-seeking behavior are the individual’s perception of health, health status, andfamily health history. This is consistent with the results of this study’s survey. When asked forwhom the health information search is for, 72.6% of all respondents reported that they are themere consumers of the information. Only 25.1% searches online health information for theirfamily members and a low of 2.3% for their friends.
The survey also prompted the respondents to identify all possible reasons for online healthinformation search. A high percentage of 65% stated that they wanted to gain additional
knowledge on the topics searched. It is interesting to note that private and public schools differ
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on the second most common reason for searching online health information. Among students
from public schools, 13.0% reported that they seek clarification in the Internet regarding theopinion they gathered from a medical check-up. In the private school setting, 8.0% of thestudents indicated that they search for online health information to guide them in buying ahealth product or availing of a health service.

Number of Students

Perceived eHealth Literacy
The results of the eHLT revealed that the respondents perceive their eHealth literacy level as
proficient at M=31.75 (n=263). The mean eHLT scores of students from private and publicschools are 33.30 (n=125) and 30.30 (n=138) respectively. These results indicate that generally,
the students’ eHealth literacy level is proficient. Figure 2 indicates the complete eHLT results.
120
110
100
90
80
70
60
50
40
30
20
10
0

PublicPrivateBelow Basic

Basic
Intermediate ProficientProficiency Level

Figure 2: Perceived eHealth literacy levels
The eHLT also indicated that the participants are most confident in efficiently performing tasks
that practice their computer and traditional literacies. These include the ability to understandthe information needed to retrieve to address the health concern (M=3.21), to tell whether the
tool is connected to the Internet or not (M=3.35), to identify the software application needed toretrieve online health information (M=3.22), to navigate the software application (M=3.16),
and to understand the language used in the presentation of information (M=3.30). Different
factors may explain this trend. First, it has been established that today’s youth are tech-savvy.
Second, this is supported by the high basic and functional literacy rates of the country. In thePhilippine in Figures 2017 Report of the Philippine Statistics Authority (2017), the basic
literacy rate of Filipinos in 2013 is 96.5% while the functional literacy rate is 90.3%.
On the other hand, they scored their lowest efficiency in tasks that apply health and information
literacies. The majority of the respondents reported difficulty and need of full assistance fromanother person in explaining the answer to a health concern after an information search(M=3.15), identifying credible websites (M=3.10), checking the credibility of an unfamiliar
website (M=3.01), and proving the accuracy of the online health information (M=2.98).

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Focus Group Discussion
FGD results revealed that the participants preferred Google Chrome as their starting point insearching and retrieving online health information due to its speed and variety of references.
The participants also reported the use of both English and Filipino in accessing online healthinformation. There are more participants from private schools who type keywords on the searchengine because for them, it will provide more varied scope. The sentence or question form ismore preferred by participants from public schools as they think it provides them exact
information they need to address their concern or question. When asked which from the Google
results list is first chosen, the majority of the respondents reported that they select the firstwebsite because they think it is the most rated and reliable.
Upon analyzing the emerging themes, there are only three main criteria used by the respondents
to evaluate the credibility of the online health information: user rating and review, commonalityof content across websites, and authority of source. It may be deduced that the criteria aresomewhat ineffective. For one, user rating and review may not necessarily guarantee theaccuracy of content. The anonymity of the source is already a cause of doubt and worry.
Moreover, the commonality of content across websites is neither a reliable criterion because
information can easily be disseminated online by anyone. It is only the authority of source thathas high reliability in terms of discerning the trustworthiness of the source. In terms of action
taken after information retrieval, the majority of the respondents reported that they immediately
applied the information to address their concerns through self-medication, which has no
guarantee of effectiveness and may pose great harm.
Observational Study
The search and retrieval process was simulated during the OS. The 40 respondents visited a
total of 113 webpages from 35 unique websites. The average time in finishing the search andretrieval process is 7 minutes 20 seconds. All participants used Google Chrome as a starting
point and Google Search as the engine for information retrieval. With relatively fast durationof search and familiarity with online navigation, it was observed that the students are adept interms of their computer literacy.
The majority of the health concerns searched were phrased in English. In analyzing the qualityof search, it is imperative to validate whether the phrase or sentence searched is accurate to theconcern being addressed. Although the majority of the participants scored high in their ability
to understand the information needed to search (M=3.55), which is a skill practiced in
traditional literacy, there is disparity in terms of phrasing the information. There were instances
when the information typed in the search bar included unnecessary details. In addition, none ofthe participants utilized Boolean operators for a more efficient search.
About 60% of the participants clicked the first website in the results list. 90% of the respondents
reported lack of familiarity with the websites they visited. When asked to check for credibility,
almost half admitted to having no idea. When probed by the researcher, the students mentionedthat they tend to consider the physical layout or attractiveness of the website as the primarybasis to determine its credibility.
Identifying helpful information in the article is not considered a challenge for the respondents.
With the mean score of 3.40, it may be analyzed that the participants’ facility in the English
and Filipino languages aided them in the understanding of information that will answer thehealth concern. However, checking the information’s accuracy seems to be a challenge for theparticipants. A low mean score of 1.43 in the particular task only dictates that the participantscannot verify the information even if assistance and cuing are given. From the abovementioned
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observations, it is inferred that the students need further development of their health,information, media, and scientific literacies.
At the end of the OS, the participants were required to explain to the researcher the information
gathered to address the health concern. With a mean score of 3.05, it is inferred that they are
equipped in terms of comprehension and summarizing skills.
Actual eHealth Literacy
The results of the OS complement the reported perceived inefficiency of the respondents inapplying their health and information skills. The general mean score of students in the OS is29.13 (n=40), which translates to borderline intermediate to proficient eHealth literacy level.
Unpacking the results further, students from private schools scored lower in the search andretrieval experiment (M=28.85, intermediate eHealth literacy) than those from public schools(M=29.40, proficient eHealth literacy). Figure 3 indicates the participants’ actual eHealthliteracy scores.

Number of Students

15129Public6

Private30Below Basic

Basic
Intermediate ProficientProficency Level

Figure 3: Actual eHealth literacy levels
Relationships among Variables Affecting eHealth Literacy
The chi-square test of independence also indicated that the actual eHealth literacy level does
not depend on the school type, X²(2, N=40)=0.99 with p-value of 0.61 at 95% confidence.
However the results of the same test indicate that school type affects the perceived eHealthliteracy level, X²(2, N=263)= 14.21with p-value of 0.00 at 95% confidence. Students fromprivate schools tend to score their perceived eHealth literacy level higher than theircounterparts in public schools.
Lastly, a paired samples t-test was administered to investigate if there is a significant difference
between the perceived and actual eHealth literacy levels of the high school students. Results
show that there is a significant difference between the two variables. The high school students
rated their perceived eHealth literacy (M=32.45, SD=6.10, N=40) higher than their actual
eHealth literacy (M=29.13, SD=2.92, N=40), t(40)=4.16, p=0.000 at 95% confidence.

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Summary and Conclusion
This study aimed at describing the state of eHealth literacy of high school students in terms of
their online health information-seeking behavior, strategies for search and retrieval of online
health information, and criteria for evaluating online health information. It also intended toprovide a quantitative description of the perceived and actual eHealth literacy of the students
along with identifying their relationship with school type.
The high school students indicate high frequency of use of personal gadgets to search for online
health information to maintain or improve their well-being. They prefer to use search engines
as a starting point. They generally search for information about personal health, nutrition, andinjury prevention, safety and first aid. Personal consumption was the main motivation for the
online search. When asked for the general satisfaction, almost all participants provided anaffirmative response.
The high school students’ ability to evaluate the credibility of online sources of healthinformation and the accuracy of health information in general is suboptimal. They tend to
consider the layout of the website rather than its content. It may be concluded that the
respondents have not mastered the curricular competencies covering these skills. It is in thenational health curriculum of Grade 10 (p. 87) when evaluation of health information is tackled.
It is essential to point that the participants of the study are Grade 10 students and the research
was conducted during the 4th Quarter; this means that these competencies should have beenlearned by the students already.
The high school students perceive their eHealth literacy level higher than their actual ability.
This finding implies that they may not have been given enough opportunities to practice theirlearning competencies on evaluation of health information and health information sources.
Knowledge may have been imparted, but its actual application may be missing.
In summary, the high school students, though adept in terms of traditional and computer
literacies, still need to further develop their scientific, media, information, and health literacy
in order to effectively consume and apply online health information to maintain and/or improvetheir well-being.
Recommendations
It is recommended to conduct further research to investigate other influencing factors to
eHealth literacy. A study on the impact of educators and other stakeholders in the development
and enhancement of eHealth literacy is imperative to expounding on the emerging skill. It isalso essential to develop and validate eHealth literacy measurement tools in the local language.
Since the findings of the study indicate absence/lack of the skill integration in the curriculum,
reviews by program and curriculum planners must be initiated to incorporate the emerging
concept especially in consumer health learning competencies. It is also necessary to reinforce
consumer health instruction in schools through the educational policy-makers, administrators,
and educators in order to strengthen the foundational skills of the students in terms ofevaluating source credibility and content accuracy of health information gathered whether
online or through other emerging forms of media. In terms of classroom assessment, review
and enhancement of methods to evaluate consumer health skills must be proposed so that actual
practice of such among students shall be evident and successful. If curricular inclusion may not

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Volume 7 – Issue 2 – Winter 2019be possible, it can be recommended that school administration devises an eHealth literacy
development program or module as supplementary instruction in regular classes.
Extending the utilization of the research results to the healthcare setting, medical personnel
may use the data to enhance patient-professional relationship as the services are being rendered.
Furthermore, the findings may also be key in the improvement of user interface of online sitesthat provide health information, products, and services.

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Corresponding author: Mark Kenneth S. CamilingContact email: mark.camiling@gmail.com
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