Serbian Version of the eHealth Literacy Questionnaire (eHLQ): Translation, Cultural Adaptation, and Validation Study Among Primary Health Care Users

• Published in: Journal of medical Internet research 2024-05, Vol.26 (1), p.e57963-e57963
• Main Authors: Vujkovic, Branko, Brkovic, Voin, Pajičić, Ana, Pavlovic, Vedrana, Stanisavljevic, Dejana, Krajnović, Dušanka, Jovic Vranes, Aleksandra
• Format: Article
• Language: English
• Subjects: Adult; Aged; Digitization; Female; Health Literacy - statistics & numerical data; Humans; Literacy; Male; Medical personnel; Middle Aged; Primary health care; Primary Health Care - methods; Primary Health Care - statistics & numerical data; Psychometrics - methods; Reproducibility of Results; Serbia; Surveys and Questionnaires - standards; Telemedicine - methods; Telemedicine - statistics & numerical data; Translations; United Kingdom; Young Adult
• ISSN: 1438-8871; 1439-4456; 1438-8871
• DOI: 10.2196/57963

As digital health services are increasingly developing and becoming more interactive in Serbia, a comprehensive instrument for measuring eHealth literacy (EHL) is needed. This study aimed to translate, culturally adapt, and investigate the psychometric properties of the Serbian version of the eHealth Literacy Questionnaire (eHLQ); to evaluate EHL in the population of primary health care (PHC) users in Serbia; and to explore factors associated with their EHL. The validation study was conducted in 8 PHC centers in the territory of the Mačva district in Western Serbia. A stratified sampling method was used to obtain a representative sample. The 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 2-tailed Students t test and ANOVA. Univariable and multivariable linear regression analyses were used to determine factors related to EHL. A total of 475 PHC users were enrolled. The mean age was 51.0 (SD 17.3; range 19-94) years, and most participants were female (328/475, 69.1%). Confirmatory factor analysis validated the 7-factor structure of the questionnaire. Values for incremental fit index (0.96) and comparative fit index (0.95) were above the cutoff of ≥0.95. The root mean square error of approximation value of 0.05 was below the suggested value of ≤0.06. Cronbach α of the entire scale was 0.95, indicating excellent scale reliability, with Cronbach α ranging from 0.81 to 0.90 for domains. The intraclass correlation coefficient ranged from 0.63 to 0.82, indicating moderate to good test-retest reliability. The highest EHL mean scores were obtained for the understanding of health concepts and language (mean 2.86, SD 0.32) and feel safe and in control (mean 2.89, SD 0.33) domains. Statistically significant differences (all P