Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure

Background: Digital health literacy is a critical skill for heart failure self-care, which should be assessed through valid and reliable instruments. Objective: To evaluate the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument in individuals with heart failur...

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Main Authors: Daniele Cristina Bosco Aprile, Karina Aparecida Lopes da Costa, Renata Eloah de Lucena Ferretti-Rebustini, Vinicius Batista Santos, Mirian Ueda Yamaguchi, Camila Takáo Lopes
Format: Article
Language:English
Published: Elsevier 2025-12-01
Series:International Journal of Nursing Studies Advances
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Online Access:http://www.sciencedirect.com/science/article/pii/S2666142X25000967
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author Daniele Cristina Bosco Aprile
Karina Aparecida Lopes da Costa
Renata Eloah de Lucena Ferretti-Rebustini
Vinicius Batista Santos
Mirian Ueda Yamaguchi
Camila Takáo Lopes
author_facet Daniele Cristina Bosco Aprile
Karina Aparecida Lopes da Costa
Renata Eloah de Lucena Ferretti-Rebustini
Vinicius Batista Santos
Mirian Ueda Yamaguchi
Camila Takáo Lopes
author_sort Daniele Cristina Bosco Aprile
collection DOAJ
description Background: Digital health literacy is a critical skill for heart failure self-care, which should be assessed through valid and reliable instruments. Objective: To evaluate the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument in individuals with heart failure. Design: A psychometric study analyzing internal structure validity and reliability. Settings: The participants were recruited at the cardiomyopathy outpatient clinic of a public hospital in São Paulo, Brazil. Participants: Outpatients with heart failure who used the internet. Methods: The instrument was administered to 127 individuals, with bootstrapping to 500. Internal structure validity and reliability were assessed through Exploratory and Confirmatory Factor Analyses. Dimensionality was determined via Parallel Analysis, and data extraction employed Robust MORGANA factor analysis. Measure of Sampling Adequacy and Kaiser-Meyer-Olkin were expected to be close to 1 and Bartlett’s test should have p < 0.05. Target explained variance was approximately 60 %, with factor loadings >0.3 and communalities >0.4. Fit indices (Comparative Fit Index, Tucker-Lewis Index and Goodness of Fit Index) should be approximately 1 and Root Mean Square Error of Approximation should be 0.05–0.08. Reliability was measured using ordinal alpha and McDonald’s omega (>0.9). Results: A unidimensional model emerged. Five items were removed due to factor loadings <0.2, Heywood case, excessive residuals, and double saturation. The final 16-item model had Kaiser-Meyer-Olkin = 0.86, Measure of Sampling Adequacy >0.75, explained variance = 59 %, factor loadings 0.53–0.86, and communalities 0.28–0.74. Reliability was high (alpha= 0.94, omega= 0.95). The adjusted model showed Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99 and Goodness of Fit Index = 0.98 and Root Mean Square Error of Approximation = 0.07. Conclusions: The Brazilian version of the Digital Health Literacy Instrument demonstrated strong internal structure validity and reliability for individuals with heart failure, supporting its use in research and clinical practice.
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spelling doaj-art-1e1c817fa95c4d6aae62c50578af6fb62025-08-20T05:07:46ZengElsevierInternational Journal of Nursing Studies Advances2666-142X2025-12-01910039110.1016/j.ijnsa.2025.100391Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failureDaniele Cristina Bosco Aprile0Karina Aparecida Lopes da Costa1Renata Eloah de Lucena Ferretti-Rebustini2Vinicius Batista Santos3Mirian Ueda Yamaguchi4Camila Takáo Lopes5Escola Paulista de Enfermagem, Universidade Federal de São Paulo, 754 Napoleão de Barros St, Zip code 04024-002, Vila Clementino, São Paulo-SP, Brazil; Corresponding author at: 754 Napoleão de Barros St, Zip code 04024-002, Vila Clementino, São Paulo, SP, Brazil.Escola Paulista de Enfermagem, Universidade Federal de São Paulo, 754 Napoleão de Barros St, Zip code 04024-002, Vila Clementino, São Paulo-SP, BrazilEscola de Enfermagem da Universidade de São Paulo, 419 Dr. Enéas de Carvalho Aguiar Av, Zip code 05403-000, Cerqueira César, São Paulo-SP, BrazilEscola Paulista de Enfermagem, Universidade Federal de São Paulo, 754 Napoleão de Barros St, Zip code 04024-002, Vila Clementino, São Paulo-SP, BrazilPrograma de Pós-graduação em Promoção da Saúde da UniCesumar, Universidade Cesumar, 833 Guedner Av, Zip code 87050-900, Jardim Aclimação, Maringá-PR, BrazilEscola Paulista de Enfermagem, Universidade Federal de São Paulo, 754 Napoleão de Barros St, Zip code 04024-002, Vila Clementino, São Paulo-SP, BrazilBackground: Digital health literacy is a critical skill for heart failure self-care, which should be assessed through valid and reliable instruments. Objective: To evaluate the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument in individuals with heart failure. Design: A psychometric study analyzing internal structure validity and reliability. Settings: The participants were recruited at the cardiomyopathy outpatient clinic of a public hospital in São Paulo, Brazil. Participants: Outpatients with heart failure who used the internet. Methods: The instrument was administered to 127 individuals, with bootstrapping to 500. Internal structure validity and reliability were assessed through Exploratory and Confirmatory Factor Analyses. Dimensionality was determined via Parallel Analysis, and data extraction employed Robust MORGANA factor analysis. Measure of Sampling Adequacy and Kaiser-Meyer-Olkin were expected to be close to 1 and Bartlett’s test should have p < 0.05. Target explained variance was approximately 60 %, with factor loadings >0.3 and communalities >0.4. Fit indices (Comparative Fit Index, Tucker-Lewis Index and Goodness of Fit Index) should be approximately 1 and Root Mean Square Error of Approximation should be 0.05–0.08. Reliability was measured using ordinal alpha and McDonald’s omega (>0.9). Results: A unidimensional model emerged. Five items were removed due to factor loadings <0.2, Heywood case, excessive residuals, and double saturation. The final 16-item model had Kaiser-Meyer-Olkin = 0.86, Measure of Sampling Adequacy >0.75, explained variance = 59 %, factor loadings 0.53–0.86, and communalities 0.28–0.74. Reliability was high (alpha= 0.94, omega= 0.95). The adjusted model showed Comparative Fit Index = 0.99, Tucker-Lewis Index = 0.99 and Goodness of Fit Index = 0.98 and Root Mean Square Error of Approximation = 0.07. Conclusions: The Brazilian version of the Digital Health Literacy Instrument demonstrated strong internal structure validity and reliability for individuals with heart failure, supporting its use in research and clinical practice.http://www.sciencedirect.com/science/article/pii/S2666142X25000967Digital health literacyHeart failurePsychometricsValidation studies
spellingShingle Daniele Cristina Bosco Aprile
Karina Aparecida Lopes da Costa
Renata Eloah de Lucena Ferretti-Rebustini
Vinicius Batista Santos
Mirian Ueda Yamaguchi
Camila Takáo Lopes
Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure
International Journal of Nursing Studies Advances
Digital health literacy
Heart failure
Psychometrics
Validation studies
title Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure
title_full Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure
title_fullStr Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure
title_full_unstemmed Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure
title_short Evaluation of the psychometric properties of the Brazilian version of the Digital Health Literacy Instrument for individuals with heart failure
title_sort evaluation of the psychometric properties of the brazilian version of the digital health literacy instrument for individuals with heart failure
topic Digital health literacy
Heart failure
Psychometrics
Validation studies
url http://www.sciencedirect.com/science/article/pii/S2666142X25000967
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