Evaluation of the Psychometric Properties of the Digital Health Literacy Instrument (DHLI-BrA) for Use in Brazilian Adolescents

This study evaluated the psychometric properties of the Portuguese version of Digital Health Literacy Instrument for Brazilian Adolescents (DHLI-BrA). Two hundred and sixty Brazilian adolescents answered the DHLI-BrA and the Brazilian version of quality-of-life and health literacy instruments: WHOQOL-Bref, eHEALS-BrA, NVS-BR, and REALMD-20. Then, they answered a questionnaire on sociodemographics, health, Internet access, and digital health aspects. The data collection was conducted between September and December of 2022.The statistical test assessed internal consistency, stability, discriminant and convergent validities, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Item response theory (IRT) analysis using 2PL was applied to performance-based DHLI-BrA. The DHLI-BrA self-reported questions demonstrated almost perfect internal consistency (α and ω = 0.83) and good stability (ICC = 0.906; 95% CI: 0.75-0.95). In EFA and CFA, the best-adjusted model was composed of six factors (χ² = 229.173 (df = 174, <i>p</i> = 0.003), CFI = 0.944, TLI = 0.933, RMSEA = 0.035, and RMSR = 0.047). The performance-based DHLI-BrA demonstrated moderate internal consistency (α = 0.57 and KR20 = 0.56) and good stability (ICC = 0.86, 95% CI: 0.76-0.92). In EFA and CFA, the best-adjusted model was composed of a single factor (χ² = 17.901 (df = 14, <i>p</i> = 0.2113), CFI = 0.952, TLI = 0.927, RMSEA = 0.033, and RMSR = 0.038). IRT analyses revealed item discrimination ranging from -0.71 to 1.83 and difficulty from -1.53 to 1.02. Convergent validity of the self-reported DHLI-BrA was obtained by its correlation with the eHEALS-BrA (r = 0.45) and REALMD-20 (r = 0.19), besides the performance-based DHLI-BrA with its correlation with the NVS (r = 0.47) and REALMD-20 (r = 0.44). The DHLI-BrA demonstrated adequate psychometric properties to measure the self-reported, performance-based digital health literacy of Brazilian typically developing adolescents.