227 7 Dutch version of the eHealth Literacy Questionnaire From a measurement perspective, the use of multiple-item composite scales for group comparisons depends on the demonstration that: (a) the same factor structure underlies the item responses in all groups of interest (configural invariance); (b) the factor loadings are equivalent across groups (metric invariance); and (c) item intercepts (thresholds in the case of ordered categorical variables) are also equivalent across the groups (scalar invariance) (67, 68). We performed a series of nested model comparisons with increasingly stringent equality constraints each time. The fit of each model was compared with the fit of the previous (less restricted) model. When invariance could be obtained, we moved on to the next, more restricted model. We adhered to the rule of thumb to interpret differences in CFI of >0.01 as significant differences (69) and maintained a significance level of p<0.05. For items with insufficient endorsement (≤2) of the response category “completely disagree”, this category was collapsed with the “disagree” category. We performed exploratory analyses to identify patterns of eHLQ scale scores (i.e., total observed scores for each domain) across a range of sociodemographic variables. We performed post-hoc tests for differences between groups based on gender, age, education and having a current diagnosis using independent t-tests and ANOVAs. Effect sizes were calculated using Cohen’s d with the interpretation of effect size as: small < 0.20 to 0.50; medium between 0.50 and 0.80 and large > 0.80. Ethical considerations The cognitive interview study and the FitKnip study were cleared for ethics by the Medical Ethical Review Committee of the Leiden University Medical Centre (No. 19 – 078 and P20.001, respectively). Written informed consent was obtained from each participant prior to study activities. Results study 2 Participants Demographics Participant characteristics are depicted in Table 1. The majority was female (71%) and between 35 and 54 years old (mean (SD); 45.05 (13.28). 1556 (94.3%) of the participants had a Dutch Nationality. The large majority (78.2%) reported having finished a high education, was employed full-time (43,8%) and lived with a partner and children (35.1%) or only with a partner (33.1 %). About one third (30.1%) of the participants had a BMI above 25, indicative of overweight and 18% had a BMI above 30, indicative of obesity. In total 592 (35.9%) reported having a current medical, physical or psychological diagnosis, and over one third (38.4%) had used a form of healthcare the past month. Details concerning the study design and data collection are provided elsewhere (70). Preparatory analyses For each eHLQ item, the distribution of responses, the mean and standard deviation, and Cronbach’s alpha are reported in Additional file 2. Alpha values show acceptable to good internal consistency for all seven scales (range 0.66 to 0.80).
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