Development and Validation of a Revised Multidimensional Digital Health Literacy Scale: Secondary Analysis Using...

Area of Science:

• Digital Health
• Health Literacy Measurement
• Psychometrics

Background:

• Digital technologies are transforming healthcare, making digital health literacy (DHL) essential for navigating online health information.
• The eHealth Literacy Scale (eHEALS) is often treated as unidimensional, but emerging evidence suggests a multidimensional structure.
• Previous studies proposing alternative eHEALS structures have not accounted for the ordinal nature of its response data.

Purpose of the Study:

• To identify and validate an alternative multidimensional structure for the eHEALS.
• To account for the ordinal response scale of the eHEALS in its structural analysis.

Main Methods:

• Utilized data from the 2022 GetCheckedOnline community survey (n=1657) of adults in British Columbia.
• Employed exploratory and confirmatory factor analyses with polychoric correlations to assess the eHEALS structure.
• Evaluated reliability and validity using polychoric ordinal alpha, average variance extracted, and composite reliability.

Main Results:

• A 3-factor solution was supported, explaining 65.7% of the variance: Information Navigation, Resource Appraisal, and Confidence in Use.
• The final model demonstrated excellent internal consistency (polychoric ordinal α=.92) and supported construct validity.
• Confirmatory factor analysis indicated good model fit (RMSEA=0.059, CFI=0.969, TLI=0.948).

Conclusions:

• Confirmed a multidimensional structure of eHEALS, comprising Information Navigation, Resource Appraisal, and Confidence in Use.
• This revised model enhances measurement precision for identifying populations with limited DHL and informs targeted interventions.
• Future research should validate this structure in diverse populations and explore its impact on digital health service access.