Journal of Health Literacy

Journal of Health Literacy

Digital Health Literacy: Comparing Factor Structures of the Portuguese eHEALS Using Confirmatory Factor Analysis

Document Type : Original Article

Authors
Cláudia Ribeiro Silva
António Alves Lopes
Vitor Hugo Azevedo
Francisco Felix Lopes
Leonardo Vieira Ribeiro
Tomás Manuel Machado Dias
Department of Physiotherapy, Escola Superior de Saúde do Alcoitão / Alcoitão School of Health Sciences, Alcoitão, Portugal.
10.22038/jhl.2025.84915.1688
Abstract
Background and Objectives: Digital health literacy is essential for navigating digital health environments safely, particularly for future health professionals. Validated assessment tools are crucial for understanding competency levels and guiding educational interventions. This study evaluated the construct validity and internal consistency of the Portuguese version of the eHealth Literacy Scale (eHEALS) among health sciences students. Two models were tested using Confirmatory Factor Analysis (CFA): a unidimensional model and a second-order bidimensional model.

Materials and Methods: A total of 375 undergraduate and postgraduate health sciences students (75.2% female, 23.2% male, 1.6% undisclosed) participated. CFA was performed to assess model fit using Chi-square divided by degrees of freedom (CMIN/DF), Root Mean Square Error of Approximation (RMSEA), Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Goodness-of-Fit Index (GFI), Root Mean Square Residual (RMR), and Akaike Information Criterion (AIC). Internal consistency was assessed via Cronbach’s alpha.

Results: Both models demonstrated very good fit. The bidimensional model showed slightly better fit (CMIN/DF=1.704, RMSEA=0.043, CFI=0.991, TLI=0.985, RMR=0.015, GFI=0.983, AIC=67.261) than the unidimensional model (CMIN/DF=1.767, RMSEA=0.045, CFI=0.990, TLI=0.983, RMR=0.017, GFI=0.980, AIC=68.047). The chi-square difference test (Δχ²=2.786, Δdf =1, p=0.095) indicated that both models were statistically comparable. Internal consistency was high (α=0.868 total, 0.850 Factor 1, 0.743 Factor 2).

Conclusion: The Portuguese version of eHEALS demonstrates good construct validity and internal consistency for assessing digital health literacy in higher education students. The bidimensional model, distinguishing between "Ability to Search for Online Health Information" and "Ability to Evaluate and Apply Health Information," provides a more detailed understanding of competency areas, helping to identify specific aspects for improvement and inform targeted educational interventions.
Keywords
Digital Health Literacy
eHEALS
Confirmatory Factor Analysis
Internal Consistency
Health Sciences Students

Acknowledgments: The authors would like to thank the participants and the supporting institution for their collaboration in this study.


Availability of data and materials: The dataset analyzed in this study is available from the corresponding author upon reasonable request.


Conflicts of interest: The authors declare no conflicts of interest related to this manuscript.


Consent for publication: Not applicable.


Ethics approval and consent to participate: The study was approved by the Ethics Committee of the higher education institution where it was conducted, ensuring compliance with applicable ethical and legal principles for scientific research. This study adhered to the ethical principles outlined in the Declaration of Helsinki, ensuring that all participants provided informed consent, understood the study objectives, and were assured of data protection and confidentiality, in full compliance with the General Data Protection Regulation (GDPR).


Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.


Authors’ contribution: AAL, VHA, FFL, LVR, and TMD contributed to the study design, data collection, analysis, and manuscript preparation. CRS was responsible for data processing and manuscript submission. All authors read and approved the final version of the manuscript.

 

Open Access Policy: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/

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