Validating the eHealth Literacy Scale in Rural Adolescents

Jarod T. Giger, Sheila Barnhart, Fran Feltner, Melissa Slone, Michael J. Lawler, Leah Windsor, Alistair Windsor

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Purpose: Given that the recent eHealth literacy literature supports the properties of the 3-factor eHealth literacy scale (eHEALS) model in samples with millennials, adults, and older adults, the appropriate next step is to establish whether the model can be reproduced in a rural adolescent sample. The purpose of this study was to evaluate the recent 3-factor model by Paige and associates with a sample of seventh-grade students. Methods: This cross-sectional study included a subsample of students (n = 146) from 3 school districts in Appalachian Kentucky. We used confirmatory factor analysis (CFA) procedures and small sample model fit guidelines to evaluate our model, and the 1-sample bootstrap algorithm with bias-corrected and accelerated 95% confidence intervals to estimate associations among eHEALS and health and technology variables. Findings: A total of 137 students, or 61% of enrolled seventh-grade students, completed the study. CFA results showed eHEALS 3-factor loadings—information awareness, information seeking, and information engagement—were high (≥0.63) and statistically significant. We observed evidence of a good model fit (root mean square error of approximation [RMSEA] = 0.07, standardized root mean square residual [SRMR] = 0.03, comparative fit index [CFI] = 0.99) and results are comparable with Paige and associates’ model fit (RMSEA = 0.06, SRMR = 0.08, CFI = 0.98). Correlations showed that students with more access to technology were associated with higher information seeking (r = 0.31) and higher information engagement (r = 0.23). eHealth literacy scores did not differ by level of rurality or gender. Conclusions: The 3-factor eHEALS is a reliable and valid instrument in assessing eHealth literacy in a group of rural seventh graders from Appalachian Kentucky.

Original languageEnglish
Pages (from-to)504-516
Number of pages13
JournalJournal of Rural Health
Issue number3
StatePublished - Jun 1 2021

Bibliographical note

Publisher Copyright:
© 2020 National Rural Health Association


  • confirmatory factor analysis
  • eHEALS
  • eHealth literacy scale
  • rural adolescents
  • technology use

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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