220 7 Chapter 7 care (47) and secondary care (48, 49). Despite eHealth gaining ground, a comprehensive Dutch person-centred instrument to measure eHealth literacy is lacking. Hence, the aim of this study was to translate and culturally adapt the original eHLQ into a Dutch version, and to examine validity of the translated instrument. Method Overall study design In this paper we report on the translation of the original eHLQ, and two studies performed to assess the initial validity evidence that was used to inform the final translation and cultural adaption. Our research was guided by the Standards to assess validity evidence. Figure 1 provides a schematic outline of the study design and the relation between the two studies. In Study 1, evidence on 1) content validity and 2) response process was collected using cognitive interviewing. In Study 2, the initial eHLQ was tested in a large sample and evidence on 3) internal structure validity was collected. Studies in cross-cultural adaptation of instruments often first perform cognitive interviews, then change wordings or phrasings, and subsequently evaluate psychometric properties of the final instrument (50, 51). We instead performed Study 1 and 2 simultaneously, which allowed us to use results from both studies in the decision on item revision and final translation, instead of changing items based on cognitive interview data only. In the final consensus stage, more weight was given to the cognitive interview data over psychometric data, considering the richness of qualitative data. As such, this study had a nested mixed-method design (52, 53). We formulated validity evidence arguments per source of validity evidence (see Table 5). The Dutch and other translations of the eHLQ are available upon request from the original developers and authors (LK, RHO)(54). Figure 1. Schematic overview study design: a concurrent mixed-method design
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