Evaluation of eHealth applications

Evaluation of eHealth applications

The eHealth Impact Questionnaire (eHIQ) provides a standardized method to measure attitudes of eHealth users towards eHealth. It has previously been validated in a population of eHealth users in the United Kingdom, and consists of two parts and five subscales. Part 1 measures attitudes towards eHealth in general and consists of the subscales “Attitudes towards online health information” (5 items), and “Attitudes towards sharing health experiences online” (6 items). Part 2 measures the attitude towards a particular eHealth application and consists of the subscales “Confidence and identification” (9 items), “Information and presentation” (8 items), and “Understand and motivation” (9 items).

The objective of this project is to translate and validate the eHealth Impact Questionnaire in a Dutch population of eHealth users.

The eHIQ was translated and validated in accordance with the COnsensusbased Standards for the selection of health status Measurement INstruments (COSMIN) criteria. The validation comprised three study samples of in total 1287 participants.

Structural validity was assessed using Confirmatory and Exploratory Factor

Analyses (all 3 samples). Internal consistency was assessed using hierarchical Omega (all 3 samples). Test-retest reliability was assessed after two weeks, using two-way Intraclass Correlation Coefficients (sample 1). Measurement error was assessed by calculating the Smallest Detectable Change (sample 1). Convergent and divergent validity were assessed using correlations with the remaining measures (all 3 samples). A Graded Response Model was fit and Item Information Curves were plotted to describe the information provided by items across item trait levels (all 3 samples).

Results: The original factor structure showed a bad fit in all 3 study samples. Exploratory Factor Analyses showed a good fit for a modified factor structure in the first study sample. This factor structure was subsequently tested in sample 2 and 3, and showed acceptable to good fits. Internal consistency, test-retest reliability, convergent validity, and divergent validity were acceptable to good for both the original as the modified factor structure, except for test-retest reliability of one of the original subscales, and the two derivative subscales in the modified factor structure. The Graded Response Model showed that some items underperformed in both the original and modified factor structure.

The conclusion is that the Dutch version of the eHIQ (eHIQ-NL) shows a different factor structure compared to the original English version. Part 1 of the eHIQ-NL consists of three subscales: “Attitudes towards online health information” (5 items), “Comfort with sharing health experiences online” (3 items), and “Usefulness of sharing health experiences online” (3 items). Part 2 of the eHIQ-NL consists of three subscales: “Motivation and confidence to act” (10 items), “Information and presentation” (13 items), and “Identification” (3 items).

This project is financed through the Citrienfund via the eHealth programme of the Dutch Federation of UMC’s (NFU).


  • Neijenhuijs KI, van der Hout A, Veldhuijzen E, Scholten-Peeters GGM, van Uden-Kraan CF, Cuijpers P, Verdonck-de Leeuw IM. Translation of the eHealth Impact Questionnaire for a Population of Dutch Electronic Health Users: Validation Study. J Med Internet Res. 2019 Aug 26;21(8):e13408.

For questions, please contact: K. Neijenhuijs, MSc, prof dr IM Verdonck-de Leeuw via [email protected]