Validation and cross-cultural adaptation of the Transactional eHealth Literacy Scale (TeHLI) for European Portuguese

Background : Digital health literacy (DHL) is crucial for navigating the increasingly digital healthcare landscape. This study aimed to validate the Portuguese adaptation of the TeHLI (Transactional eHealth Literacy Instrument), a scale measuring four key dimensions of DHL: functional, communicative, critical, and translational. Methods : A rigorous translation and cross-cultural adaptation process was conducted. The adapted TeHLI was applied to a cross-sectional sample of 961 participants residing in Portugal. Construct validity was assessed using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Internal consistency was evaluated using Cronbach’s alpha. Results : Cognitive debriefing revealed good comprehension of the items with minor suggestions for refinement. EFA confirmed the four-factor structure, with a slight shift in one item’s loading. CFA demonstrated excellent model fit (CFI = 0.971, TLI = 0.964, RMSEA = 0.055). High Cronbach’s alpha values indicated excellent internal consistency for the overall scale (0.95) and its subscales (0.86-0.90). Conclusions : The Portuguese adaptation of the TeHLI is a valid and reliable instrument for assessing digital health literacy in Portugal. This tool can be used to identify populations in need of support and to evaluate interventions aimed at improving digital health literacy skills, ultimately contributing to better health outcomes.