241 7 Dutch version of the eHealth Literacy Questionnaire While the items touch upon the maturity of healthcare systems and services, response processes may be country specific and affected by the national advancement in the health technology infrastructure (e.g., access to a national infrastructure for telehealth solutions, use of centralized health databases) (74). Building on the existing literature that explores the link between relatable concepts such as motivation, engagement, trust, activation and health literacy, we propose that future studies should investigate the relationship between eHealth literacy and related concepts (75, 76). In addition we suggest that future research should investigate the role of these constructs in determining health outcomes and how they can be incorporated in the design of health interventions to foster meaningful patient engagement in the digital health landscape. The eHLQ’s large number of items makes the questionnaire less suitable for use in practice. There is a need among healthcare professionals to assess the eHealth literacy needs of their patients (77). To address their needs, the eHealth Literacy Assessment toolkit (eHLA) was developed in parallel to the eHLQ (34). The toolkit employs a combination of existing and newly developed scales to assess individuals’ health literacy and digital literacy across the seven dimensions of the eHLQ (78) . Our findings could inform the development of a Dutch version of the eHLA, which could assist in the implementation and evaluation of digital health technologies and services. Conclusion We systematically performed and combined several procedures to generate comprehensive validity evidence of the eHLQ and conducted informed further refinement of the eHLQ. The objective of this study was to provide initial evidence on the validity and use of the eHLQ as a Dutch person-centred instrument to measure eHealth literacy, rather than to provide a complete picture of all aspects of validity. This study demonstrates that the Dutch version of the eHLQ can be considered a robust instrument which can be used by policy makers, eHealth developers and researchers to understand people’s ability to engage with and use technology so that these systems can be developed, evaluated, and redesigned to meet the eHealth Literacy need of their communities. Ultimately, this is necessary to provide appropriate support and work towards an inclusive, equitable digital healthcare landscape.
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