Digital Health Literacy: The Serbian Version of the eHealth Literacy Questionnaire (Preprint)

BACKGROUND The increasing digitization of the health system requires the users of health services to have sufficient competence in the use of digital health (DH) technologies. As DH services are increasingly developing and becoming more interactive in Serbia and everywhere in the world, a comprehensive instrument for measuring digital health literacy (DHL) is needed. OBJECTIVE The aim of this study was to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ), to evaluate DHL in the population of primary healthcare (PHC) users in Serbia, and to explore factors associated with their DHL. METHODS The validation study was conducted in eight PHC centers in the territory of the Macva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. Translation Integrity Procedure was followed to adapt the questionnaire to the Serbian language. The psychometric properties of the Serbian version of the eHLQ were analyzed through the examination of factorial structure, internal consistency, and test-retest reliability.. Descriptive statistics were calculated to determine participant characteristics. Differences between groups were tested by the students’ t-test and analysis of variance. Univariable and multivariable linear regression analyses were used to determine factors related to eHealth literacy. RESULTS A total of 475 PHC users were enrolled. The mean age was 51.0 ± 17.3 years (range 19–94 years), and most participants were female (69.1%).. Confirmatory factor analysis validated the seven-factor structure of the questionnaire. Values for fit indices IFI (0.955) and CFI (0.954) were above the cut-off of ≥ 0.95. The RMSEA value of 0.051 (0.047–0.055) was below the suggested value of ≤ 0.06. Cronbach’s α of the entire scale was 0.95, indicating excellent scale reliability., with the Cronbach α ranging from 0.81 to 0.90 for domains. The ICC ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest eHealth literacy mean scores were obtained for the understanding of health concepts and language (2.86 ± 0.32) and feel safe and in control domains (2.89 ± 0.33), The statistically significant differences for all seven eHLQ scores were observed for age, education, perceived material status, perceived health status, information and communication technology use, and occupation (except Domain 4). In multivariable regression models, ICT use and age under 65 years old were associated with higher values of all domain scores except the domain feel safe and in control for variable age. CONCLUSIONS This study demonstrates that the Serbian version of the eHLQ can be a useful tool in the measurement of DHL and in the planning of DH interventions at the population and individual level due to its strong psychometric properties in the Serbian context.