eHEALS: The eHealth Literacy Scale

Presenter: Asta Y.Z. Lord

Professor: Ming-Puu Chen

Date: November 10, 2008

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Norman, C.D., & Skinner, H.A.(2006). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4):e27. Retrieved November 8, 2008, from the World Wide Web:

http://www.jmir.org/2006/4/e27/HTML

Introduction

Keywords: literacy, psychometrics Motivation and Importance:

How do we determine whether individuals have the capacity to engage with eHealth programs and interventions?

Health practitioners in clinical and public health settings require an understanding of what abilities their patients/clients have before recommending eHealth resources.

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Cameron Norman

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Assistant Professor, Department of Public Health Sciences, University of Toronto.

Research focuses Public engagement and community development for health using information

technology. Literacy assessment and training of consumers in using the Internet for health. The use of communities of practice to promote collaborative learning and

knowledge translation and how systems thinking can inform that process to lead to better health outcomes.

Harvey A. Skinner

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The inaugural Dean of the new Faculty of Health at York University, beginning September 1, 2006. [1]

Professor and Chair of the Department of Public Health Sciences, Faculty of Medicine, University of Toronto.[2]

Research focus : behavior change, organizational improvement and

information technology (e-health), which are summarized in his book, "Promoting Health Through Organizational Change." [3]

He has been a pioneer in the use of computer technology for health assessment and behavior change, and was one of the first to initiate a major program of research, [4] using the Internet for engaging youth in health promotion. TeenNet has created innovative websites for smoking prevention and cessation, [5] gambling education, [6] and youth action. [7]

http://en.wikipedia.org/wiki/Harvey_Skinner

Introduction

Purposes: To design an instrument (ehealth literacy

scale) to assess consumers’ perceived skills at using information technology for health.

This study’s objective is to develop and test a functional method of assessing perceived eHealth literacy skills to aid consumers and health practitioners alike in assessing a fit with eHealth to support clinical care and promote population health.

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Literature Review

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Over 40% of US and Canadian adults having basic (or prose) literacy levels below what is considered necessary to optimally participate in civil society.

National Assessment of Adult Literacy (NAAL), 2005

Building on our competencies: Canadian results of the International Adult Literacy and Skills Survey, 2003

Health literacy need to look at the different contexts where health information is obtained and used as part of a strategy of addressing health literacy.

Health literacy: a prescription to end confusion. Institute of Medicine. 2004

Literature Review

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In Canada, 99% of adolescents have access to the Internet, and the majority of Canadian teens report using the Internet for health in some capacity.

Young Canadians in a wired world, 2004 This group (adolescents) is most likely to be

familiar with information technology tools and is more likely to use eHealth than most other populations(Skinner, Biscope & Poland , 2003).

Many teens experienced difficulty engaging with eHealth and understanding or using health information online, despite frequently using information technologies (Gray, Klein, Noyce, Sesselberg & Cantrill, 2005).

Health and Literacy in an Electronic Context

6 Core skills (Norman and Skinner’s eHealth Literacy Model):

Traditional literacy, Health literacy, Information literacy, Scientific literacy, Media literacy, Computer literacy.

Foundations of concept: Social cognitive theory Self-efficacy theory

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Conceptual Models Norman and Skinner’s eHealth Literacy Model

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Designing Principles

Self-report tool (assess consumers’ perceived skills)

Based on an individual’s perception of her/his own skills and knowledge with each measured domain.

Provide a general estimate of consumer eHealth-related skills.

Can be administered by health professional.

Can be used to inform clinical decision making and health promotion planning.

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Pilot Testing

Participants: 89, aged 14~24. Complete the instrument in paper form. Provide comments on the readability and

item wording. 8 items based on the qualitative and

response feedback.

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Methods

Participants: 664 (grades 9, 10, 11)……….p6 Gender: 370 boys, 294 girls. Age: 13~21, Mean:14.95; SD=1.24 Grades: grade 9 (N=260), grade 10 (N=193), grade 11

(N=211) Ethno-cultural groups (N=394):

Eastern European ( N=107), East Asian(N=103)Central Asian origin( N=78), Not identified (N=106)

Technology Use – baseline data: Using email: 71% > 1/wk, 37% daily Using web: 79%, > 1/wk, 35% daily Text messaging: 71% weekly, 42% daily Primary access: 81% at home, 42% at school; secondarily at friends’ home 34%

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Methods

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( I )

immediatelyprior After3 month

After6 month

Results—eHEALS scale reliability and factor

analysis

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Comrey and Lee’s (1992) guidelines whereby factor loadings :excess of .71

(50% overlapping variance) were considered excellent

.63 (40% overlapping variance) very good

.55 (30% overlapping variance) good.

lower than .55 were considered fitting if items or scales correlated on only a single factor.

Results—eHEALS test-retest reliability

correlations

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Results—

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Baseline levels of eHealth literacy were higher among males (t726 = 2.236, P = .026);

No statistically significant differences were detected in scores at post-intervention and 3 and 6 month follow-up administrations of the eHEALS.

Age did not predict eHealth literacy scores at any time point.

No significant relationship was found between eHealth literacy and use of information technology.

eHealth literacy levels were not related to overall self-evaluations of health. not a significant predictor of perceived health status

over time in this sample.

Conclusion

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The potential applicability of the eHEALS as a standard assessment tool for gauging eHealth literacy in health care is high.

Assessing consumers’ comfort in using eHealth allows for the identification of skill gaps and can better assist those with low comfort levels in taking advantage of the potential benefits that eHealth can afford.

Doing so may foster development of tools that can meet these needs and aid in creating appropriate strategies for bridging the digital divide in consumer health care quality.

Only by increasing the understanding of the disparities between available eHealth tools and consumers’ abilities to use them can the necessary steps towards eliminating them be taken.

Comments

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The eHealth literacy model includes six types of literacy, and thus each skill would require independent measurement, such as: rigorous usability tests of standard computer

equipment for computer literacy. reading aloud text passages to assess basic

prose literacy. Further research needs to consider the

eHEALS’ application to other populations as well as groups with highly variable levels of technology familiarity.