eHealth Literacy Scale (eHEALS)
Also known as: eHEALS
The eHealth Literacy Scale measures individuals' ability to seek, find, understand, and appraise health information from electronic sources and apply that knowledge to health decision-making. Developed by Norman and Skinner in 2006, it assesses functional, communicative, and critical digital health literacy competencies essential for navigating modern health technologies and online medical information.
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When to use it
Ideal for identifying individuals who may struggle with digital health tools, telehealth platforms, patient portals, or self-directed online health research. Use in clinical settings to screen for patients who need enhanced health coaching or simplified educational materials. Valuable in public health campaigns targeting older adults, populations with lower education, or those new to digital health technologies. Essential for evaluating digital health interventions or assessing readiness for technology-based chronic disease management programs.
Strengths & limitations
- Brevity and parsimony: 8 items capture the core construct efficiently, enabling rapid administration in busy clinical workflows.
- Strong psychometric foundation: Cronbach's alpha typically 0.90+; demonstrates good internal consistency and factor validity across diverse populations.
- Cross-cultural validation: Translated and validated in multiple languages (German, Spanish, Arabic, Mandarin); shows invariant structure across cultures.
- Predictive validity: eHealth literacy scores predict adoption of patient portals, telehealth use, and online health information-seeking behavior.
- Self-report bias: Respondents may overestimate their digital health skills, particularly older adults or those unfamiliar with technology.
- Limited assessment of critical appraisal: Focuses more on perceived ability than actual skill in evaluating information quality or detecting misinformation.
- Ceiling effects in tech-savvy populations: May show reduced discrimination among younger, highly educated respondents with strong general digital literacy.
- Context-dependent: Scores may not generalize across different health topics or technologies (e.g., wearable devices vs. medical databases).
Frequently asked
Does eHEALS measure actual digital skills or just perceived ability?
eHEALS measures self-perceived eHealth literacy, not objective performance. Research shows moderate to strong correlation between eHEALS scores and actual behavior (e.g., patient portal use, health information-seeking); however, self-report does not guarantee demonstrated competence. Consider pairing eHEALS with performance-based tests for high-stakes applications.
What is the minimum score to consider someone 'eHealth literate'?
No consensus clinical cutoff exists. Studies suggest scores ≥32 associate with effective telehealth engagement and online health information appraisal, but thresholds vary by population and context. Many researchers treat eHEALS as a continuous measure rather than categorical.
Can eHEALS be administered to people with limited education or low literacy?
eHEALS uses straightforward language (5th–6th grade reading level) suitable for most adults. However, for individuals with low general literacy or cognitive impairment, consider cognitive interviewing or assisted administration (read-aloud). Items may need simplification in some populations.
How often should eHealth literacy be reassessed?
No standard interval exists. For tracking individual progress in digital health training, reassess every 3–6 months. For population surveillance or baseline screening, annual assessment is typical. Rapid changes in technology may warrant more frequent measurement.
Sources
- Norman, G. R., & Skinner, H. A. (2006). eHEALS: The eHealth Literacy Scale. Journal of Medical Internet Research, 8(4), e27. DOI: 10.2196/jmir.8.4.e27 ↗
How to cite this page
ScholarGate. (2026, June 3). eHealth Literacy Scale (eHEALS). ScholarGate. https://scholargate.app/en/health-informatics/ehealth-literacy-scale
Which method?
Set this method beside its closest kin and read them side by side — the library lays the books on the table; the choice is yours.
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