From Digital Operation to Evaluative Agency: Developing a Cognitively Calibrated eHealth Literacy Scale for Urban Older Adults

As digital health becomes embedded in later-life care, eHealth literacy is essential for safe health-information use among older adults. Existing measures conflate digital operation, general health literacy, and evaluative judgment. This study developed the Seeking-Evaluation-Application eHealth Literacy Scale (SEA-21) for urban older adults through deductive item development, Bloom-based difficulty classification, and a modified Delphi process with 19 experts. The 34-item pool was refined to 21 items across seeking, evaluation, and application. SEA-21 clarifies construct boundaries and reflects graded cognitive demands, with evaluative tasks requiring the greatest complexity, providing a preliminary framework for gerontological social work assessment and intervention.