eHealth Literacy Instruments: a Systematic Review of Measurement Properties (Preprint)

BACKGROUND The internet is now a major source of health information. With the growth of internet users, electronic health literacy (eHealth literacy) has emerged as a new concept for digital health care. Health professionals need to consider the eHealth literacy of consumers when providing care utilizing digital health technologies. OBJECTIVE The objectives of this study were to identify currently available eHealth literacy instruments and evaluate their measurement properties with the intention of providing robust evidence to researchers and clinicians who are selecting an eHealth literacy instrument. METHODS A systematic review and meta-analysis was conducted of self-reported eHealth literacy instruments by applying the updated COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. RESULTS This study included 7 instruments from 41 articles describing 57 psychometric studies, as identified in 4 databases (PubMed, CINAHL, Embase, and PsycInfo). No eHealth literacy instrument provided evidence for all measurement properties. The eHealth Literacy Scale (eHEALS) was originally developed with a single-factor structure under the definition of eHealth literacy before the rise of social media and the mobile Web. That instrument was evaluated in 18 different languages in 26 countries involving diverse populations. However, a variety of other factor structures were exhibited: seven types of two-factor structure, three types of three-factor structure, and one-bifactor structure. The Transactional eHealth Literacy Instrument (TeHLI) was developed to reflect broader concept of eHealth literacy, and was demonstrated to have a sufficient low- and very-low-quality evidence for content validity (relevance, comprehensiveness, and comprehensibility), and sufficient high-quality evidence for structural validity and internal consistency; however, that instrument has rarely been evaluated. CONCLUSIONS The eHEALS was the most frequently investigated instrument. However, it is strongly recommended that the content of the instrument be updated to reflect recent advancements in digital health technologies. The TeHLI needs improvements in content validity and further psychometric studies to increase the credibility of its synthesized evidence. CLINICALTRIAL Not applicable.