Validity and reliability of the Norwegian version of the eHealth Literacy Scale (eHEALS) among patients after percutaneous coronary intervention
Authors: Brors G , Wentzel-Larsen T , Dalen H , Hansen TB , Norman CD , Wahl A , Norekvaal TM 
Published: July 2021

Abstract

Funding Acknowledgements
The Western Norway Health Authority.

OnBehalf
The CONCARD-PCI Investigators

Background
In recent years an internet-based technology has become an important source for providing health information to patients after an acute cardiac event. Therefore, consideration of patients’ perceived eHealth literacy skills, is crucial for improving patient-centred health information after percutaneous coronary intervention (PCI).

Purpose
The aim of this study was to translate and adapt the eHealth literacy Scale (eHEALS) to conditions in Norway, and to determine the psychometric properties of the eHEALS in self-report format administered to patients after PCI.

Methods
The original English version of the eHEALS was translated into Norwegian, following a cross-cultural adaptation process. Further, we set out to determine the reliability (internal consistency, test-retest) and construct validity (structural validity, hypotheses testing and cross-cultural validity). Internal consistency was calculated using Cronbach alpha. Intra-class correlation (ICC) was used to assess test-retest reliability. A confirmatory factor analysis (CFA) was performed for a priori hypotheses 1-, 2- and 3-factor model. Demographic information, health-related internet use, health literacy and health status were collected to correlate with eHEALS scores.

Results
For the validation, 1695 patients were included after PCI. Mean age was 66 years. Most of the patients were male (78%). Cronbach’s alpha for the eHEALS was &gt;0.999. The corresponding Cronbach’s alpha for the 2-week retest was &gt;0.937. The ICC for eHEALS was 0.605 (95% CI 0.419-0.743, P &lt; 0.001). CFA showed a modest model fit of the 1- and 2-factor model. After modifications in the 3-factor model, all the goodness-of-fit indices indicated a good fit. A weak correlation with age (r=-0.206) was found. Employed and higher educated patients scored higher on the eHEALS: There was a higher eHEALS score for the patients with higher education level compared with those with lower education level (mean difference between 2.24 (P = 0.002) and 4.61 (P &lt; 0.001)), and for the patients who were employed compared to those who were retired (mean difference 2.31, P &lt; 0.001). The eHEALS score was higher among the patients who reported to use the internet to find health information (95% CI -21.40, -17.21 (P &lt; 0.001)). There was a moderate correlation with perceived usefulness (r = 0.587) and importance (r = 0.574) of using the internet for health information. There was a moderate correlation with the health literacy dimensions for appraisal of health information (r= 0.380) and ability to find good health information (r = 0.561).

Conclusions
The study provides additional information on the psychometric properties of the eHEALS for patients after PCI, suggesting a multidimensional construct rather than unidimensional. The high internal consistency indicated a redundancy of items. Therefore, further validation studies of the eHEALS is required.