229 7 Dutch version of the eHealth Literacy Questionnaire Table 1. Characteristics of participants in study 2 (n = 1650) (continued) n (%) Other 91 (5.5) Self-reported diagnosis Yes 592 (35.9) No 1058 (64.1) Utilisation healthcare past month Yes 365 (38.4) Construct validity A seven factor CFA model was fitted to the 35 eHLQ items, allowing correlation between latent factors. Standardized factor loadings were 0.51 or higher (range 0.51 to 0.84). The CFI and TLI indicated acceptable model fit (0.936 and 0.930, respectively). The RMSEA and SRMR (0.088 and 0.085, respectively) indicated that the model fit was not acceptable. However, it is not uncommon for fit indexes to show less than optimal values with large numbers of observed variables, like in the current study. Similar values for fit indices have also been reported for the closely related Health Literacy Questionnaire (71). Closer inspection of correlation matrices indicated substantial residual correlations between items 4, 6, 7, 20 and 26. We inspected whether goodness of fit improved when allowing correlation between these items. Goodness of fit indices improved for the CFI and SRMR, exceeding the cut-off value for good fit. Considering that item 26 (‘I use measurements about my body to help me understand my health’) showed strong residual correlation with seven other items and goodness-of fit improved, item 26 was flagged for discussion (see Table 2). Correlation matrices are provided in Additional file 2. Table 2. Model fit indices for the seven-factor confirmatory factor analysis of the Dutch version of eHealth Literacy Questionnaire Chi square DF CFI TLI RMSEA (95% CI) SRMR Goodness of fit Seven factor model 7429.201 539 0.936 0.930 0.088 (0.086 -0.09) 0.085 Acceptable fit Seven factor model – improved model 5960.518 527 0.950 0.943 0.079 (0.0770.081) 0.077 Good fit DF, degrees of freedom; CFI, Comparative Fit Index; TLI, Tucker-Lewis index ; RMSEA, Root Mean Square Measure of Approximation; SRMR, Standard Root Mean Square Residual
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