Corvo, E.

De Caro, W.

Sansoni, J.

English

Canterbury Research and Theses Environment

eHealth Literacy Scale: online version validation initalianValidazione italiana della eHealth Literacy ScaleWalter De Caro1 Elisabetta Corvo2 Julita Sansoni31 Ph.D, RN, Research Fellow - Sapienza University of Rome 2 Ph.D, MPH, JD, Lecturer - Canterbury Christ Church - Canterbury UK3 Professor of Nursing Science, Sapienza University of ROmeSTUDI E RICERCHE© 2017Professioni Infermieristiche - Volume 70 - 2017 Special Issue - Health Literacy: Clear Communication better HealthCNAI 21INTRODUCTIONThe high number of health information that the webcan provide together with the easy access and anonymi-ty in the access encourages health researcher to try tounderstand the phenomenon. According to Norman &Skinner, 2006 health information on the web may havenegative effect on individuals’ health, for instancewrong and incomplete health information on the webcan lead to false reassurance or on the contrary todiscomfort as result from incorrect diagnosis. Thisissues is particularly serious for young people who accessthe web quite easily but who did not have yet the abili-ty to correctly evaluate health information and theirquality level. This study was aimed to validate in Italian the eHealthLiteracy Scale (eHEALS) developed by Norman eSkinner  in 2006. The scale is made up of 10 items hasbeen validated in several different languages and accor-ding to Karnoe, A., & Kayser, L., 2015  is  widely used. METHODA cross sectional study has been carried out. Data weregathered using the questionnaire translated in Italian,with a convenience sample of individuals of differentfacebook groups, excluding groups of health professio-nals. The study followed Gorsuch’s recommendationstating as minimum sample to properly carry out a fac-torial analysis in 200 individuals.InstrumentThe original English version of eHEALS was developedas a scale for measuring perceived levels of ability ofconsumers to use technology to gather informationabout health. The eHEALS is a tool of 10 items (2+8) the first twoadditional items measure the perception of informationon the internet in general while the other 8 measurecombined the knowledge, consumer comfort and per-ceived ability to find, evaluate, and implement electro-nic health information. Individuals can assess theiragreement/disagreement through a five point Likertscale ranging from "strongly disagree" to "stronglyagree", with a score from 1 to 5 for each item for the 8items thus, the scores could range from a minimum of8 to a maximum of 40, with higher scores representinghigher levels of eHealth Literacy. For the first two itemthe Likert scale ranging from “Not useful at all” to“Very Useful” (item 1) and “Not important at all” and“Very important” (Item 2). Psychometric assessment for eHEALS had a Cronbach'salpha of 0.86, while a single factor solution with value4.48 (56% of variance explained) was obtained fromanalysis of the main components. The test-retest reliabi-lity made by Norman & Skinner showed limited stabi-lity over time from baseline to 3 months of follow-up,with a Pearson correlation coefficient of 0.467.Translation processThe original version of the questionnaire, available forfree, was translated having as main focus to get a con-ceptual translation rather than a linguistic one. Forward-translations and back-translations were used(WHO, 2015) this is made up of 4 main phases:a. Forward translationb. Expert panel Back-translationc. Pre-testing d. Final versionPhase a) carried out by a nurse who was familiar withthe topic, phase b) carried out by a panel of two expertswho know both language Italian and English to sort outany kind of issues connected with different expressionin the two languages, a comparison with the Spanishversion (Paramio Gema Perez, 2015) was also carriedout, this process produced the final version of the que-stionnaire, a back translation with an independent tran-slator was also carried out, a number of discrepancieswere sorted out. As far as Phase c) is concerned a pre-test was carried out, the questionnaire was filled in by asample of 10 individuals above 18 years old, female andmale and with a range of different education level, thesample was asked to identify issues or problems in fil-ling in and a statistical analysis was carried out. WitheHealth Literacy Scale: online version validation in italian22Professioni Infermieristicherespect to phase d) the final version of the Italian que-stionnaire was administered on line.Data was gathered by both sending an email to indivi-duals with internet mobile phone and to a number offacebook groups from September to November 2015,for test online validity of eHealsThe statistical analysis used for the development of thefirst  eHEALS was used to properly compare the twoquestionnaire. Alpha di Cronbach was calculated andthe SPSS software were also used, factorial analysis wascarried out using Kaiser Meyer-Olkin test (KMO) aswell as that of Bartlett.RESULTSThe sample is made up of 737 individuals, of these451 were female (61.2%) (table 1). The medium age is41.4 years.The majority of the sample has an high school diplo-ma (Table 2)Alpha di Cronbach is 0,862 which is aligned to litera-ture on the topic, total items are positively correlatedwith high value (Table 3).Kayser Meyer Olkin test for sampling adequacy is0.776,  which is higher to the value of 0,6015, Bartletttest is statistically significant (p <0,001) therefore datacan used to a factorial analysis.Frequency Percent Valid percent ComulativepercentFemale 451 61.2 61.2 61.2Male 286 38.8 38.8 100Total 737 100 100Table 1 - GenderFrequency Percent Valid percent CumulativepercentOther 99 13.4 13.4 13.4PhD 10 1.4 1.4 14.8Registered inthe university 36 4.9 4.9 19.7Bachelordegree 57 7.7 7.7 27.4MSc/MA 159 21.6 21.6 49Junior HighSchool 72 9.8 9.8 58.8High School 304 41.2 41.2 100Total 737 100 100Alfa di Cronbach Alfa di Cronbach's onstandardized value Items0.862 0.865 10Table 2 - Sample education carateristhicTable 3 – Statistical reliabilityTable 4 - Total Statistics for itemScalemean  ifitemdeletedScalavarianceif itemdeletedCorrecteditem –Total cor-relationAlpha diCronbachif itemdeletedHow useful do you feel theInternet is in helping you inmaking decisions about yourhealth?30.98 29.19 0.711 0.836How important is it for you tobe able to access healthresources on the Internet?30.65 32.314 0.577 0.848I know what health resourcesare available on the Internet 31.08 33.508 0.487 0.855I know where to find helpfulhealth resources on theInternet31.03 33.009 0.573 0.849I know how to find helpfulhealth resources on theInternet30.92 31.453 0.731 0.837I know how to use theInternet to answer my que-stions about health30.88 31.079 0.729 0.836I know how to use the healthinformation I find on theInternet to help me30.89 31.239 0.64 0.843I have the skills I need to eva-luate the health resources Ifind on the Internet31.05 33.873 0.344 0.869I can tell high quality healthresources from low qualityhealth resources on theInternet31.14 33.535 0.404 0.863I feel confident in using infor-mation from the Internet tomake health decisions31.63 30.93 0.591 0.847Sampling adequacy KMO (Keiser Meyer Olkin) 0.776Bartlett's Test ofSphericityChi-square appross. 4229.421df 45Sig. 0.001Table 5 - KMO and Bartlett’s testCommunalities are high (the proposed modelexplains a good proportion of variance), all items canbe used to carry out a factorial analysis (higher to 0.5).These results indicated that the data was appropriatefor the exploratory factor analysis.With respect to the components of the totalvariance, using the principal component analysis, asingle solution with an eigenvalue of 4.66 represents46,69% of the total variance.The first column are the various possible solutions,eigenvalues with a value higher than one are three,therefore three principal components are extracted,together with the 75.29% of the variance (table 7)All variables under consideration were positivelycorrelated with the first principal component and thevariables related to the use, evaluation and distinctionof the main components are linked to the secondcomponent (table 8).23eHealth Literacy Scale: online version validation in italianTable  6 - CommunalitiesInitial ExtractionI know what health resources are available onthe Internet 1 0.582I know where to find helpful health resourceson the Internet 1 0.884I know how to find helpful health resources onthe Internet 1 0.803I know how to use the Internet to answer myquestions about health 1 0.697I know how to use the health information Ifind on the Internet to help me 1 0.705I have the skills I need to evaluate the healthresources I find on the Internet 1 0.853I can tell high quality health resources fromlow quality health resources on the Internet 1 0.82I feel confident in using information from theInternet to make health decisions 1 0.727How useful do you feel the Internet is in hel-ping you in making decisions about yourhealth?1 0.761How important is it for you to be able toaccess health resources on the Internet? 1 0.699Extraction method: Principal component analysisComponentEigenvalue at start Pesi dei fattori non ruotatiTotal % of variance % cumulated Total % of variance % cumulated1 4.669 46.691 46.691 4.669 46.691 46.6912 1.685 16.85 63.54 1.685 16.85 63.543 1.175 11.755 75.295 1.175 11.755 75.2954 0.657 6.574 81.875 0.465 4.648 86.5186 0.452 4.519 91.0377 0.33 3.302 94.3398 0.269 2.691 97.039 0.179 1.794 98.82410 0.118 1.176 100Extraction method: Principal component analysisComponent1 2 3I know what health resources areavailable on the Internet 0.606 -0.02 -0.463I know where to find helpful healthresources on the Internet 0.675 0.363 -0.545I know how to find helpful healthresources on the Internet 0.81 0.255 -0.285I know how to use the Internet toanswer my questions about health 0.822 -0.143 -0.027I know how to use the health infor-mation I find on the Internet to helpme0.73 -0.209 0.359I have the skills I need to evaluate thehealth resources I find on the Internet 0.384 0.699 0.466I can tell high quality health resourcesfrom low quality health resources onthe Internet0.447 0.742 0.264I feel confident in using informationfrom the Internet to make healthdecisions0.692 -0.338 0.366How useful do you feel the Internet isin helping you in making decisionsabout your health?0.824 -0.284 -0.039How important is it for you to be ableto access health resources on theInternet?0.691 -0.436 0.175Extraction method: Principal component analysisa. Three component extracted Table 8  Component Matrix.© 2017Professioni Infermieristiche - Volume 70 - 2017 Special Issue - Health Literacy: Clear Communication better HealthCNAIeHealth Literacy Scale: online version validation in italian24Professioni InfermieristicheDISCUSSIONThis study was aimed to validate in Italian theeHealth Literacy Scale (eHEALS) developed byNorman e Skinner  in 2006. Results provide supportfor both construct and validity in Italian. The factoranalysis results found that all eight C-eHEALS wereone factor. This is consistent with the original versionof the scale, further support that this scale is able tomeasure a single construct of eHealth literacy. Theconcurrent validity of I-eHEALS has also been satisfac-torily established as was consistent with other question-naire which measure informatics competences, further-more the I-eHEALS also demonstrated good internalconsistency.This study has several limitations, including the factthere is not as yet a gold standard for Health Literacy.In conclusion, the instrument I-eHEALS is a promi-sing questionnaire to evaluate the eHealth Literacy.Considering its brevity, ease of administration and goodpsychometric properties, it is hoped that the results ofthis study will encourage further investigations withthe use of I-eHEALS questionnaire for use among diffe-rent age groups and gender in the Italian population.This tool is essential to facilitate further research onthe development and testing of interventions that couldraise health literacy to promote self-empowerment. BIBLIOGRAFIANorman, C. D., & Skinner, H. A. (2006). eHEALS: the eHealth literacy scale. Journal of medical Internet research,8(4).Karnoe, A., & Kayser, L. (2015). How is eHealth literacy measured and what do the measurements tell us? Asystematic review. Knowledge Management & E-Learning: An International Journal (KM&EL), 7(4), 576-600.Paramio Pérez, G., Almagro, B. J., Hernando Gómez, Á., & Aguaded Gómez, J. I. (2015). Validación de la escalaeHealth Literacy (eHEALS) en población universitaria española. Revista Española de Salud Pública, 89(3), 329-338.World Health Organization (2015). Process of translation and adaptation of instruments, Avaible onhttp://www.who.int/substance_abuse/research_tools/translation/en/

eHealth literacy scale: online version validation in
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eHealth literacy scale: online version validation in Italian

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