237 7 Dutch version of the eHealth Literacy Questionnaire Table 6. Recommendations for future eHLQ use, score interpretation and reporting by researchers and others Recommendations 1. Collect contextual information such as prior eHealth experience, and current diagnosis, depending on purpose of use and use in score interpretation. 2. Perform validity analysis in new contexts to build further validity arguments for use of the Dutch eHLQ 3. Perform cognitive interviews when used in a new context to test if intended interpretation of data is valid for the new context and reason for testing 4. Include description of local or national digital healthcare context, depending on context and purpose of use. Discussion This paper reported on the systematic translation of the eHLQ into Dutch and initial validity evidence. We used evidence on test content, response process and internal structure to further refine and culturally adapt the Dutch eHLQ. This validity-driven approach created an in-depth understanding on content, response process and internal structure of the Dutch eHLQ. Our study builds on a well-established line of research and strengthens the continuous strand on validity evidence of the eHLQ as 3. Internal structure 3.1 The items of each construct reflect a spectrum of the relevant construct such that the resulting score is a good indicator of the construct Only item 26 showed strong residual correlation with seven other items, indicating that the item relates strongly to other items and the underlying latent factor. 3.2 The eHLQ is a multidimensional tool consisting of seven independent constructs with 4 to 6 relevant items for each construct and such items are related only to the designated construct CFA confirmed adequate model fit for the seven-factor model. Model and fit indices were acceptable. Standardized factor loadings were 0.51 or higher (range 0.51 to 0.84). No significant cross-loadings were identified. 3.3. The eHLQ demonstrates measurement equivalence across subgroups and settings eHLQ is partially invariant for subgroups age, gender, educational level and current diagnosis. Items displaying potential noninvariance were revised, triangulated with cognitive interview data and resulted in amendment of four items. 3.4 The eHLQ produces stable and consistent results Cronbach alpha levels were acceptable. Pretesting was not performed a validity argument adopted from Cheng et al (40). Table 5. Summary of the three sources of validity evidence for the eHealth Literacy Questionnaire (continued)
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