The tool is useful in the current context of rapid digitalization of the health system
The COVID-19 epidemic was a catalyst for the digitalization of the healthcare system: online appointments and test results were quickly introduced and adopted. Spain now has a highly developed digital health infrastructure; however, neither the health system nor its users are yet fully ready for digital services.
Given this scenario, it is essential to have tools to assess digital health literacy among users of the healthcare system, as this enables the design of services adapted to their needs and abilities. "There are no instruments that assess these aspects in the languages that we speak – Catalan and Spanish. The tool currently being used is completely inadequate, because it only assesses how citizens search for information on the internet, and digital health goes far beyond that today," explained Eulàlia Hernández, who is an expert with a wealth of experience in the field of health literacy and a researcher in the Behavioural Design Lab (BDLab), which is part of the eHealth Center at the Universitat Oberta de Catalunya (UOC).
Hernández, who is also a member of the Faculty of Psychology and Education Sciences at the UOC, led the project and the article Spanish and Catalan Versions of the eHealth Literacy Questionnaire: Translation, Cross-Cultural Adaptation, and Validation Study has been published as open access in the Journal of Medical Internet Research, one of the leading international publications covering digital health.
In the study, Hernández and other BDLab researchers translated, adapted and scientifically validated an instrument to assess the profile of health system users in terms of digital health. The questionnaire is based on the eHealth Literacy Questionnaire (eHLQ), a model that is backed by the World Health Organization (WHO), and is now available in Catalan and Spanish, and adapted to the country's cultural and social setting.
"The Catalan and Spanish versions of the eHLQ are valid psychometric questionnaires for assessing and describing the digital health literacy of people in our country. Both can be useful tools for researchers, policymakers, and health service managers to explore the population's needs, skills and competencies. It is a tool for action, not for obtaining a score that is devoid of meaning," explained Hernández.
Using technology to care for health
The researchers analysed data from 800 adults (400 Catalan speakers and 400 Spanish speakers) to culturally adapt and scientifically validate the questionnaire. The participants were a sample from Spain, stratified by gender, age and geographical area. Variables such as their socioeconomic circumstances and level of education, their use of technology and their self-reported state of health were taken into account.
A large nnumber of the questions that the users had to answer in order to define their digital health literacy focused on how they use technology in their healthcare: for example, if they use technology to help them decide which healthcare is best for them, if they use test results to understand their health, if they learn to use innovations in health technology quickly, if technology makes them feel that they are actively involved in taking care of their health, if they believe that digital health services are adapted to their needs, etc.
According to Hernández, "in addition to allowing us to define the user's profile in terms of the population's digital health literacy, this instrument can provide us with interesting data on interactions and experiences with digital health services, especially in a context of increased digitalization of health services in Spain and Catalonia."
Hernández is the coordinator of the Spanish Health Literacy Network, a network of professionals with a shared interest in contributing to improving the health system based on one of its cornerstones: health literacy. She said that "literacy has been proven to be related to better health. Indeed, health literacy shouldn't focus on the citizen, but instead on the citizen's relationship with the healthcare system, which needs to enable the individual to promote their health and that of those around them, prevent disease and have a good quality of life. In fact, I see health literacy as a dynamic balance between relinquishing and assuming responsibility."
The BDLab team is currently analysing the users' profiles. The next step will be to disseminate the tool and examine how it can be implemented in partnership with the healthcare system.
Article: Hernández Encuentra, E.; Robles, N.; Angulo-Brunet A.; Cullen, D.; del Arco, I. Spanish and Catalan Versions of the eHealth Literacy Questionnaire: Translation, Cross-Cultural Adaptation, and Validation Study. Journal of Medical Internet Research, 2024(26), e49227. DOI: 10.2196/49227.
This research contributes to the Sustainable Development Goals (SDGs) 3 (Good Health and Well-being), 9 (Industry, Innovation and Infrastructure) and 10 (Reduced Inequalities).