Development and Validation of DHL Questionnaire for stroke survivors（DHLQ-SS）: Rasch analysis (Preprint)

Abstract

Stroke is a major cause of mortality and disability among adults. Current evaluation tools lack specificity for stroke survivors, hindering precise assessment of their digital health literacy (DHL). This gap underscores the need for a tailored DHL scale to accurately reflect the unique needs of this population.

With the digitization of health care and the wide availability of Web-based applications, a broad set of skills is essential to properly use such facilities; these skills are called digital health literacy (DHL). To describe the development and validation of a patient-reported outcome measure for DHL from stroke, the DHL Questionnaire for survivors（DHLQ-SS）.

Design Multiphase, prospective mixed methods study. Setting Face-to-face data collection and social media channels in China, September 15, 2023, to April 28, 2024. Participants 15 stroke survivors (aged ≥18 years) with self-reported stroke and 20 experts evaluated the content validity. 418 stroke survivors tested the draff questionnaire. Main outcome measures Published systematic reviews informed the development of the DHLQ-SS conceptual framework and initial item pool. Thematic analysis of transcripts from cognitive debriefing interviews and online expert surveys established content validity. Rasch analysis of field test data guided item and scale refinement and provided initial evidence of the DHLQ-SS’s measurement properties.

DHLQ-SS (version 1.0) is a modular instrument measuring stroke survivors’ DHL. Respondents rate their DHL during the past seven days using a 5-point scale. Including DHL acquisition ability, evaluation ability, and application ability, it returns a summed raw score that can be transformed into a linear (0-75) score. Higher scores represent higher levels of DHL. The factor model showed good fit with χ2/df = 1.669, GFI = 0.926, CFI = 0.977, IFI = 0.977, and RMSEA =0.047. The correlation coefficient between the DHLQ-SS and eHEALS is 0.853 (P<0.001). The coefficient of test-retest reliability was 0.941, indicating a high degree of consistency in the measurements over time. After rating scale refinement and item reduction, the scale satisfied the Rasch model requirements for unidimensionality (the measurement dimension be 50% and item fit (outfit mean square values within 0.5-1.5 logits). The assessment tool demonstrated strong reliability and consistency, with a person reliability of 0.89, item reliability of 0.94, a person separation was 2.91, an item separation was 3.81, and internal consistency (Cronbach’s alpha) scores ranging from 0.858 to 0.937.

DHLQ-SS (version 1.0) is a patient-reported outcome instrument developed using modern psychometric methods. It measures the DHL of stroke survivors. It can facilitate personalized medical interventions, enhancing survivors' self-management capabilities and overall health outcomes.