Assessment of the eHealth Literacy Questionnaire (eHLQ) in US Cancer Patients: eHealth Literacy, Cancer Literacy, Information Processing Style, and its Impact on Patient Anxiety

Abstract

Cancer patients have significant healthcare needs and are likely to encounter complex health information along the course of their treatment, making it important for that information to be accessible and understandable. Online health resources strive to improve existing gaps in access to health services and information. Nevertheless, basic digital and health literacy skills are necessary for using and understanding these services and information. eHealth literacy, defined as the “ability to seek, find, understand, and appraise health information from electronic sources and apply the knowledge gained to addressing or solving a health problem,” is crucial for the successful uptake of online-based health tools. Research shows that individuals with high eHealth literacy display greater health information-seeking practices and better quality of life. Low adoption and use of online health interventions, however, has resulted in efforts to develop a more comprehensive assessment of eHealth literacy. The eHealth Literacy Questionnaire (eHLQ) is a measure of eHealth literacy not yet tested in US cancer patients, who have complex, time-sensitive healthcare needs. Furthermore, no studies have yet examined the relationships between eHealth literacy, cancer literacy, information processing styles, and its impact on mental health outcomes, such as patient anxiety. Using these factors, the current study surveyed a sample of cancer patients (n= 153) actively receiving treatment or follow-up in the oncology department at Temple University Hospital in Philadelphia, PA. The survey was used to assess patient characteristics, eHealth literacy (eHLQ), cancer health literacy (CHLT-6), information processing style (MBSS-Monitoring) and patient anxiety (HADS-A). This data was then used to examine the fitness of a unidimensional latent factor model for the eHLQ. Results were also used to assess correlations between eHealth literacy, cancer literacy, information processing, and patient anxiety. Finally, moderation tests were performed to determine the effects of eHealth and/or cancer health literacy on the relationship between information processing style and anxiety level. The results indicate the eHLQ adequately fits a one-factor model, which incorporates its seven underlying domains under one construct. Also, engagement with digital services and cancer health literacy appears to be significantly associated with information processing. Through these findings, our study provides initial steps towards the application of a comprehensive eHealth literacy measure in the web 2.0 world, and how this variable correlates to cognitive-behavioral processes and affective outcomes in an underserved group of US cancer patients.