eHEALS - Assessing eHealth Literacy Skills

1. eHEALS: The eHealth Literacy Scale 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 Presenter: Asta Y.Z. Lord Professor: Ming-Puu Chen Date: November 10, 2008

2. Introduction • Keywords: literacy, psychometrics • Motivationand 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.

3. Cameron Norman 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.

4. Harvey A. Skinner • 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

5. 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.

6. Literature Review • 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

7. Literature Review • 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).

8. 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

9. Conceptual ModelsNorman and Skinner’s eHealth Literacy Model

10. 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.

11. 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.

12. 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%

13. Methods • Procedure: • Combined randomized trial evaluation: • eHealth literacy promotion intervention ( I ) and a web-based smoking cessation program ( P) (P) ( I ) eHEALS eHEALS eHEALS eHEALS After 3 month After 6 month prior immediately

14. Results—eHEALS scale reliability and factor analysis • 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.

15. Results—eHEALS test-retest reliability correlations

16. Results— • 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.

17. Conclusion • 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.

18. Comments • 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.