Cross-cultural adaptation of the eHealth Literacy Scale for Brazilian adolescents

BARBOSA, Mariane Carolina Faria; BALDIOTTI, Ana Luiza Peres; DIAS, Maria Luisa Leandro de Souza; GRANVILLE-GARCIA, Ana Flávia; PAIVA, Saul Martins; FERREIRA, Fernanda de Morais

doi:10.1590/1807-3107bor-2024.vol38.0094

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Original research/Community Dental Health • Braz. oral. res. 38 • 2024 • https://doi.org/10.1590/1807-3107bor-2024.vol38.0094 copy

Cross-cultural adaptation of the eHealth Literacy Scale for Brazilian adolescents

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The aim of this study was to undertake a cross-cultural adaptation of the eHealth Literacy Scale (eHEALS) instrument to measure digital health literacy of Brazilian adolescents. eHEALS is a scale consisting of 8 items that measure self-perception related to the consumption of electronic health information. This is a methodological study of cross-cultural adaptation, conducted out from February 2022 to June 2022. The following steps were carried out: a) assessment and adequacy of cultural equivalence by a committee of experts; b) back-translation; c) synthesis of back-translations; d) cognitive testing with 42 Brazilian adolescents, using cognitive interviews with probing questions. All items that were difficult to understand were adapted to the (language) context of Brazilian adolescents. Cronbach’s alpha coefficient for eHEALS-BrA was 0.81 and, if one of the items were excluded from the instrument, it ranged from 0.75-0.81. This version of the eHEALS proved to be culturally well-adapted to the context of Brazilian adolescents, and has the potential to measure digital health literacy in this population after having its validation confirmed through psychometric analyses.

Health Literacy; Cross-Cultural Comparison; Internet Access; Telemedicine; Adolescent

Itens	Original Version	Brazilian Version for Adolescents of the eHealth Literacy Scale (eHEALS-BrA).
Itens	eHealth Literacy Scale items¹¹11.Galhardi CP, Freire NP, Fagundes MC, Minayo MC, Cunha IC. Fake news and vaccine hesitancy in the COVID-19 pandemic in Brazil. Cien Saude Colet. 2022 May;27(5):1849-58. https://doi.org/10.1590/1413-81232022275.24092021en https://doi.org/10.1590/1413-81232022275...
Statement	I would like to ask you for your opinion and about your experience using the Internet for health information. For each statement, tell me which response best reflects your opinion and experience right now.	Para as questões abaixo, eu gostaria de saber sua opinião e sua experiência no uso da Internet para buscar informações sobre saúde. Não existem respostas certas ou erradas. Para cada afirmação, marque a resposta que melhor reflete sua opinião e sua experiência neste momento.
Statement		Considere “Recursos de saúde” como todas as formas de usar a internet relacionada a saúde.
Answer	1) Strongly Disagree	a) Discordo totalmente
	2) Disagree	b) Discordo em parte
	3) Undecided	c) Não tenho certeza
	4) Agree	d) Concordo em parte
	5) Strongly Agree	e) Concordo totalmente
1.	I know how to find helpful health resources on the Internet	Eu sei como encontrar informações/recursos úteis de saúde na Internet.
2.	I know how to use the Internet to answer my questions about health	Eu sei como usar a Internet para responder as minhas dúvidas sobre saúde.
3.	I know what health resources are available on the Internet	Eu sei quais os recursos de saúde que estão disponíveis na Internet.
4.	I know where to find helpful health resources on the Internet	Eu sei onde encontrar informações/recursos úteis de saúde na Internet.
5.	I know how to use the health information I find on the Internet to help me	Eu sei como usar as informações de saúde que encontro na internet para me ajudar.
6.	I have the skills I need to evaluate the health resources I find on the Internet	Eu tenho as habilidades necessárias para avaliar as informações/recursos de saúde que encontro na internet.
7.	I can tell high quality health resources from low quality health resources on the Internet	Eu consigo diferenciar as informações/recursos de saúde de alta qualidade das de baixa qualidade na internet.
8.	I feel confident in using information from the Internet to make health decisions	Eu me sinto confiante em usar as informações da Internet para tomar decisões sobre saúde.

Variable	n (%)	eHEALS-BrA Score
Variable	n (%)	Mean (SD)
Sex
Female	20 (47.6)	24.6 ± 6.1
Male	22 (52.4)	27.0 ± 4.5
Age (years)
≤ 15	19 (45.2)	24.7 ± 5.2
> 16–19	23 (54.8)	26.8 ± 5.4
Adolescents education level (years of study)
< 8	35 (83.3)
≥ 8	7 (16.7)	27.9 ± 6.8
Skin color (self-declared)
Black	13 (31.0)	26.5 ± 6.3
White	13 (31.0)	25.4 ± 4.7
Brown	16 (38.0)	25.7 ± 5.5
Parents/guardians education level (years of study)
< 8	16 (38.1)	27.1 ± 6.0
≥ 8	20 (47.6)	24.7 ± 5.4
Health of the adolescent (self-reported)
Bad/Fair	8 (19.0)	25.9 ± 5.1
Good/Very good	34 (81.0)	25.6 ± 6.7
Oral health of the adolescent (self-reported)
Bad/Fair	13 (31.0)	26.8 ± 5.6
Good/Very good	29 (69.0)	23.7 ± 4.4
Looking for health information on the internet
Yes	24 (57.1)	26.2 ± 5.2
No	18 (42.9)	25.3 ± 5.7
Uses health-related smartphone app
Yes	9 (21.4)	29.7 ± 3.2
No	33 (78.6)	24.8 ± 5.4
Do you have a Computer/Notebook/Tablet?
Yes	18 (42.9)	27.0 ± 5.0
No	24 (57.1)	24.3 ± 5.6
Internet access frequency
Every day	36 (85.7)	25.4 ± 5.4
Almost everyday	6 (14.3)	28.3 ± 4.6
Average time using the internet per day (years)
0–5	16 (38.1)	28.0 ± 6.3
5–10	14 (33.3)	24.9 ± 5.1
≥ 10	12 (28.6)	24.0 ± 3.4
Did you follow guidelines/health tips from bloggers. digital influencers or people you follow on the social network?
Yes	21 (50.0)	26.1 ± 4.9
No	21 (50.0)	25.5 ± 5.9
Do you look for information about a doctor/dentist on social networks before consulting?
Yes	8 (19.0)	24.1 ± 3.1
No	34 (81.0)	26.2 ± 5.7
Performed self-medication based on information available on the internet
Yes	10 (23.8)	27.3 ± 6.2
No	32 (76.2)	25.4 ± 5.1

Itens	Cronbach’s Alpha coefficient if the item was excluded from the instrument
1 - Eu sei como encontrar informações/recursos úteis de saúde na Internet.	0.79
2 - Eu sei como usar a Internet para responder as minhas dúvidas sobre saúde.	0.79
3 - Eu sei quais os recursos de saúde que estão disponíveis na Internet.	0.81
4 - Eu sei onde encontrar informações/recursos úteis de saúde na Internet.	0.76
5 - Eu sei como usar as informações de saúde que encontro na internet para me ajudar.	0.75
6 - Eu tenho as habilidades necessárias para avaliar as informações/recursos de saúde que encontro na internet.	0.78
7 - Eu consigo diferenciar as informações/recursos de saúde de alta qualidade das de baixa qualidade na internet.	0.81
8 - Eu me sinto confiante em usar as informações da Internet para tomar decisões sobre saúde.	0.80

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[1] Corresponding Author
: Mariane Carolina Faria Barbosa E-mail: marianecarolinabarbosa@gmail.com