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Accuracy, Usefulness of Patient eHealth Literacy Assessments

Patient eHealth literacy assessments have proven useful for providers targeting different health IT interventions to patients.

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Source: Thinkstock

By Sara Heath

- With the increasing mHealth and other health IT use to support patient engagement, healthcare professionals are focused on assessing the ability for patients to access, use, and apply knowledge from these tools — otherwise known as patient electronic health literacy (eHealth).

However, questions have cropped up surrounding the efficacy of eHealth literacy assessments, particularly the eHealth Literacy Scale (eHEALS). According to one recent study published in the Journal of Medical Internet Research, eHEALS is an effective measure of patient eHealth literacy, and it can help providers better target health IT initiatives to improve patient engagement.

According to the research team, eHEALS is the most frequently-used eHealth literacy assessment around the globe. Designed in 2006, eHEALS leverages social cognitive theories and self-efficacy theories to test a patient’s “knowledge, comfort, and perceived skills at finding, evaluating, and applying electronic health information to health problems,” the researchers explained.

As use of the assessment tool has grown, health IT experts have questioned the ability for eHEALS to accurately measure eHealth literacy and to do so consistently among different test groups.

To assess those two factors, the research team issued eHEALS to a group of 996 Baby Boomers in the US, Great Britain, and New Zealand.

The researchers selected Baby Boomers because this patient population increasingly needs better health self-management and comprises variable health IT users. The researchers issued the test in three countries to gain a wide perspective in what eHEALS is indeed testing.

Ultimately, the research team found that eHEALS did test three important eHealth literacy factors.

“The first factor comprises items relating to knowledge about health resources and information that are available on the Internet,” the researchers said. “The second factor relates to the skills needed to access and use the health resources and information. Finally, the third factor relates to levels of self-belief in the ability to use this information effectively.”

According to the team, eHEALS did have factorial validity and could be used to accurately assess patient eHealth literacy.

Additionally, the researchers found that eHEALS had measurement invariance, the ability to test eHealth literacy consistently from study to study.

“Despite it being often difficult to achieve, metric invariance was established. This result suggests that eHEALS is measured in the same way across these nations,” the researchers explained.

“The results of a configural invariance test suggest that the respondents under study employ the same conceptual framework when answering eHEALS, despite their different cultural experiences and indeed very different experiences of health care provision.”

These findings have important implications, not only for health researchers but also for healthcare providers looking to prescribe to patients health IT and mHealth tools.

“eHEALS can now be used to segment health consumers into distinct groups based on their scores on the scale, with corresponding intervention and training provision designed around meeting the needs of these segments,” the researchers explained.

For example, if a patient has low scores on questions regarding health literacy, providers can point patients toward more instructional or educational apps. Providers can prescribe patients who test low on the technology literacy scale tools that are simple to use and more navigable.

As mHealth and other health IT become more popular in healthcare, the ability to target interventions based off patient needs will be critical, the researchers concluded. Knowing that eHEALS is a valid test of patient eHealth literacy and being able to apply eHEALS scores to patient interactions will help providers better target patients based off their unique needs.

“As more and more of the world’s population gains Internet access, and as patients increasingly expect to be active rather than passive consumers of health care services, the concept of eHealth will continue to grow in importance,” the research team concluded.

“Health care providers and researchers need a valid, reliable, and easy-to-use measurement tool with which to assess levels of perceived eHealth literacy among different groups of patients.”

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