The prostate cancer electronic health (eHealth) literacy instrument: a tool for eHealth design and patient...

To describe the development and validation of the Prostate Cancer Electronic Health (eHealth) Literacy Instrument (P-CeHLI). This is in response to: (i) a lack of clear and validated eHealth literacy measurement for men with prostate cancer; (ii) the unique information processing, decision making, and digital communication experience of men with prostate cancer as a single sex, older age, cancer cohort; and (iii) modern eHealth literacy theory and research, which now greatly considers the transactional nature of web technologies and digital communicative practice.

A total of 349 men with prostate cancer participated in a three-phase, longitudinal instrument development study. This was undertaken with end-user participation, and a multidisciplinary and international collaboration of prostate cancer, psycho-oncology, communication, and biostatistics experts. Exploratory and confirmatory factor analysis evaluated construct validity. The P-CeHLI was compared to respondents' eHealth literacy measured with the Transactional eHealth Literacy Instrument (TeHLI), as well as respondent eHealth utilisation and sociodemographic characteristics.

A four-factor model was demonstrated with acceptable fit properties (root mean square error of approximation = 0.074; comparative fit index = 0.931; Tucker-Lewis index = 0.924; standardised root mean square residual = 0.051) and excellent reliability (subscale alphas of 0.85-0.96). Domains of the P-CeHLI included cancer-specific functional, communicative, critical and translational eHealth literacy. Association between the scores of the scales and respondents' characteristics were similar; however, for all four subdomains, the P-CeHLI added significant predictive value when assessing eHealth use in men with prostate cancer whilst controlling for respective TeHLI scores.

The P-CeHLI establishes a novel cancer-specific multidomain eHealth literacy instrument, validated in men with prostate cancer, and positioned to respond to their needs in the digital cancer care era. The P-CeHLI provides a new opportunity for clinicians and researchers to accurately identify and enhance the eHealth literacy skills of patients with prostate cancer, which may improve future clinical outcomes through digital intervention and improved communicative practice.