Translation and Psychometric Validation of the Amharic eHealth Literacy Questionnaire: Cross-Sectional Study.

Abstract

eHealth interventions have demonstrated potential to address challenges related to health and the health care system in low- and middle-income countries. To effectively leverage eHealth in supporting health care in Ethiopia, the assessment and development of the eHealth literacy of patients are essential. This study aimed to translate the eHealth Literacy Questionnaire (eHLQ) to Amharic and assess its psychometric properties. A systematic process of translation, including forward and backward translation, expert review, and cognitive interviews, was applied. Then, a cross-sectional questionnaire-based study using a convenience sample (N=300) of patients with internet access in the primary health care level between January and March 2025 in the capital and a larger city of Ethiopia was conducted. Internal consistency was assessed using Cronbach α and McDonald ω. The factor structure was assessed using confirmatory factor analysis. Convergent and discriminant validity were examined by calculating Spearman correlations between each eHLQ scale and the total score of the eHealth Literacy Scale (eHEALS). A total of 300 participants were included in the analysis. The mean age was 30.4 (SD 6.8, range 18-55) years, and 69.7% (209/300) were women. Internal consistency was acceptable for all scales (Cronbach α=0.72-0.91; McDonald ω=0.79-0.96), except for Scale 4 (α=0.62; ω=0.70). The 7-factor model showed a satisfactory fit, with a comparative fit index of 0.97, Tucker-Lewis index of 0.97, and standardized root mean square residual of 0.07. Factor loadings exceeded 0.40 for all items except one. Strong correlations between Scales 1 to 3 and eHEALS (range r=0.69-0.74) supported convergent validity, whereas moderate correlations between Scales 5 to 7 and eHEALS (range r=0.66-0.67) indicated limited discriminant validity. The Amharic eHLQ demonstrated generally satisfying psychometric properties and can be considered a valid tool for assessing eHealth literacy among patients with internet access in Ethiopia, marking the first validation of the eHLQ in sub-Saharan Africa. Future studies could provide additional evidence to substantiate the psychometric robustness of Scale 4 ("feeling safe and in control"). Overall, the Amharic eHLQ can support the development of tailored eHealth interventions in Ethiopia.