The Adult Inpatient eHealth Literacy Scale (AIPeHLS): Development and Validation Study

Background: The rapid evolution of digital health technologies, particularly within the Web 3.0 framework, has underscored eHealth literacy (eHL) as a critical competency for patients engaging with digital health care platforms. Patients in sustained hospital stays, often in vulnerable conditions, face unique challenges in using eHealth tools effectively. However, existing eHL assessment tools are insufficient to address the intricate and dynamic demands of contemporary health care systems, especially for individuals under continuous hospital care. Objective: This study aimed to develop the Adult Inpatient eHealth Literacy Scale (AIPeHLS), a comprehensive, multidimensional tool grounded in the Lily Model, to evaluate eHL among adult inpatients within the context of digital health care innovations. Methods: The development of the AIPeHLS followed a systematic, multiphase process. Initial item pool generation was informed by a literature review and then refined using the Delphi method, resulting in a preliminary set of 53 items spanning 6 dimensions of the Lily Model. The scale was refined through a pilot survey among 100 individuals requiring inpatient care, followed by item analysis and exploratory factor analysis (EFA). Validation was achieved via a cross-sectional study with 532 participants, using confirmatory factor analysis (CFA) to verify the scale structure, alongside evaluations of convergent, discriminant, criterion-related, and content validity. Reliability was assessed using Cronbach α, Omega, and split-half reliability. Results: The finalized AIPeHLS comprised 44 items across 6 dimensions: traditional literacy, information literacy, media literacy, health literacy, computer literacy, and scientific literacy, reflecting the skills necessary in the Web 3.0 context. Both EFA and CFA confirmed the 6-factor structure, demonstrating acceptable model fit indices (χ²=1974.654 (df=887), root mean square error of approximation=0.048, comparative fit index=0.957, normed fit index=0.925, and incremental fit index=0.957). The scale exhibited robust content validity, convergent and discriminant validity, criterion-related validity, and high internal consistency, with a Cronbach α of .965, Omega coefficient of 0.962, and a split-half reliability of 0.791 for the entire scale. Conclusions: The 44-item AIPeHLS was found to be a reliable and valid instrument for assessing eHL in adult inpatients in the evolving Web 3.0 context. Its comprehensive framework and strong psychometric properties make it an effective tool for health care providers to understand patients' digital health competencies and tailor interventions accordingly. For researchers, our findings provided opportunities to explore the relationship between eHL and health outcomes, while offering valuable insights into the development of more effective eHealth interventions and policies.