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2011 - Does the eHealth Literacy Scale (eHEALS) Measure What it Intends to Measure? Validation of a Dutch version of the eHEALS in Two Adult populations


Vaart, R., van Deursen, A.J.A.M., Drossaert, C.H.C., Taal, E., Van Dijk, J.A.G.M. & Laar, M.A.F.J. (2011). Does the eHealth Literacy Scale (eHEALS) Measure What it Intends to Measure? Validation of a Dutch version of the eHEALS in Two Adult populations. Journal of medical internet research, 13(4), e86-1-11.



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 (2006) developed an 8-item self-report e-health literacy scale to measure these skills: the eHealth Literacy Scale (eHEALS). Up until now, this instrument is only available in English and there is no data on its validity.
Objectives: To assess the internal consistency and the construct and predictive validity of a Dutch translation of the eHEALS in two populations.
Methods: In study 1, the translated scale was examined in a sample of patients with rheumatic diseases (n = 189), in study 2 in a stratified sample of the Dutch population (n = 88). Cronbach’s  coefficients were determined and principal component analysis was performed. Convergent validity was determined by studying correlations with age, education and current (health related) internet use. Furthermore, in study 2 the predictive validity of the instrument was assessed by comparing scores on the eHEALS with an actual performance test.
Results: The internal consistency of the scale was sufficient:  = .93 in study 1 and = .92 in study 2. In both studies the 8 items loaded on one 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). Contrary to expectations, correlations between the eHEALS and successfully completed tasks on a performance test were weak and non-significant: r = 0.18 (P = .09). 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 is assessed as unidimensional in a principal component analysis and the internal consistency of the scale is high, which makes the reliability adequate. However, findings suggest that the validity of the eHEALS is questionable since the relationship with internet use is weak and expected relationships with age, education, and actual performance were not significant. Further research in order to develop a self report instrument with high correlations with people’s actual e-health literacy skills is warranted.