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The Swedish version of the eHealth literacy questionnaire: Translation, cultural adaptation, and validation study
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Nursing. Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.ORCID iD: 0000-0003-0661-8269
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0003-1543-6512
Faculty of Nursing, University of Iceland, Reykjavik, Iceland.
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2023 (English)In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 25, article id e43267Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: With the increasing digitalization in health care, an effective instrument is necessary to assess health care consumers' digital competencies-their "eHealth literacy." The 7-scale eHealth Literacy Questionnaire (eHLQ), based on the theoretically robust eHealth Literacy Framework, has shown strong psychometric properties in Denmark and Australia.

OBJECTIVE: The aim of this study was to translate, culturally adapt, and evaluate the psychometric properties of the Swedish version of the eHLQ.

METHODS: We followed the Translation Integrity Procedure guidelines to translate and culturally adapt the questionnaire to Swedish using forward and backward translations, review by an expert panel, and cognitive interviewing. The psychometric properties of the Swedish eHLQ were investigated by evaluating its internal consistency (Cronbach α) and a priori-defined factor structure (confirmatory factor analysis).

RESULTS: A total of 236 primary health care patients and parents of hospitalized children were included in the validation analysis. The mean age was 48.5 years, and 129 (55%) were women. All 7 eHLQ scales showed good internal consistency, with the Cronbach α ranging from .82 to .92. Single-factor and 7-factor confirmatory factor analysis showed satisfactory model-fit values. With one exception, all items demonstrated satisfactory loadings on their respective factors.

CONCLUSIONS: The Swedish eHLQ demonstrated strong psychometric properties. It has the potential as a useful tool for a variety of purposes, including population surveys, intervention evaluations, and eHealth service implementations.

Place, publisher, year, edition, pages
JMIR publications , 2023. Vol. 25, article id e43267
Keywords [en]
cultural adaptation, digital health, eHLQ, eHealth, eHealth literacy, health literacy, validation
National Category
Nursing
Identifiers
URN: urn:nbn:se:umu:diva-206994DOI: 10.2196/43267PubMedID: 37043268Scopus ID: 2-s2.0-85152474327OAI: oai:DiVA.org:umu-206994DiVA, id: diva2:1752711
Funder
Swedish Diabetes AssociationForte, Swedish Research Council for Health, Working Life and WelfareAvailable from: 2023-04-24 Created: 2023-04-24 Last updated: 2024-01-17Bibliographically approved
In thesis
1. eHealth literacy and internet use for health information: a study in Swedish primary healthcare
Open this publication in new window or tab >>eHealth literacy and internet use for health information: a study in Swedish primary healthcare
2023 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
eHälsolitteracitet och internetanvändning för hälsoinformation : en studie inom svensk primärvård
Abstract [en]

Background: Primary healthcare (PHC) is facing significant challenges in Sweden and around the world. One way to address such challenges is through health-related Internet information (HRII) and other eHealth services, which are resources for high-quality, accessible and cost-effective care. Such re­sources have been found to assist in improving individual health, especially for people with chronic conditions such as type 2 diabetes. More specifically, eHealth services may play an important role in increasing patients’ knowledge, engagement and autonomy in health management, as well as enhancing their self-care practices. However, patients must have adequate capabilities – collectively known as eHealth literacy (eHL) – in order to use eHealth services effectively. 

Aim: The overall aim of this thesis was to explore eHL and HRII use in the context of Swedish PHC. 

Methods: Data collection for paper I was conducted through individual interviews with PHNs, which were then analysed using qualitative content analysis. Paper II involved patients with type 2 diabetes who were interviewed individually or responded to open-ended survey questions; the data were analysed using thematic analysis. In paper III, which was a translation and validation study, the data consisted of cognitive interviews and questionnaires predominantly answered by PHC visitors, and employed psychometric analysis methods. The same data from PHC visitors were used in paper IV, in which descriptive and comparative statistics and logistic regression analyses were employed. 

Results: In paper I, the interviewed PHNs expressed mixed feelings regarding consultations with Internet-informed patients. While they recognised benefits such as increased patient engagement and the support of self-care, their responses focused on the challenges they encountered. These challenges included patient confusion and unwarranted anxiety stemming from HRII, as well as conflicted, time-consuming and unnecessary healthcare consultations. In paper II, patients with type 2 diabetes outlined their challenges associated with online COVID-19 information, which encompassed information overload, conflicting content and notable emotional impact. They described employing diverse coping strategies to address these challenges, including restricting their information consumption, relying on authoritative sources, actively evaluating source credibility, engaging in discussions with others and applying common sense. In paper III, the eHealth Literacy Questionnaire (eHLQ) was translated and culturally adapted to assess eHL in a Swedish context. The Swedish version of the eHLQ was found to demonstrate robust psychometric properties. In paper IV, it was determined that older age groups (>60) were assessed with lower eHL in several eHLQ domains, including those regarding motivation and ability to use HRII and digital technology. In addition, older age groups reported that eHealth services did not suit their individual needs. Variables that were found to be independently associated with lower eHL across several domains were advanced age and the perception that HRII was not useful or important. 

Conclusion: Both the patients and PHNs in this thesis encountered challenges related to patients’ acquisition of HRII and utilisation of eHealth services. A collective and important objective for healthcare professionals and authorities should be to facilitate patients’ HRII and eHealth service usage. Therefore, PHNs and other healthcare professionals should actively encourage open discussions with patients about the latter’s HRII findings, recommend credible websites, explore potential barriers to patients’ eHealth usage, motivate patients to use eHealth services and suggest ways for patients to enhance their eHL. Healthcare authorities and eHealth developers are suggested to increasingly involve end-users in the development of eHealth services and provide opportunities for customisation based on individual needs. 

Place, publisher, year, edition, pages
Umeå: Umeå University, 2023. p. 99
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2277
Keywords
eHealth, eHealth literacy, health literacy, nursing, primary healthcare, person-centred card care
National Category
Nursing
Identifiers
urn:nbn:se:umu:diva-217574 (URN)9789180702195 (ISBN)9789180702201 (ISBN)
Public defence
2024-01-12, Aula Biologica, Biologihuset, Linnaeus väg 7, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Funder
Forte, Swedish Research Council for Health, Working Life and WelfareDiabetesfondenThe Kempe Foundations
Available from: 2023-12-15 Created: 2023-12-09 Last updated: 2023-12-11Bibliographically approved

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Sjöström, Anna E.Hajdarevic, SenadaHörnsten, ÅsaIsaksson, Ulf

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