Critics who lament the sluggish pace at which e-health is being integrated in to the Canadian health care system should consider the low literacy and technology skills of nearly half the adult population, says the dean of York University’s Faculty of Health, Harvey Skinner.
Skinner co-developed an e-health literacy scale to assess people’s ability to understand health information presented in Web sites, interactive behaviour-change tools (such as smoking cessation 
Web portals) and telephone-assisted services.
Right: Harvey Skinner
With more than 40 per cent of Canadian and American adults showing basic literacy levels below what is considered necessary to optimally participate in society, many e-health resources are likely to be inaccessible to large segments of the population, according to two joint studies from York University and the University of Toronto.
"Computers are practically ubiquitous in our society, so it is often assumed that people know how to use them and that they understand the content they find online," said Skinner. "While you would think that older adults and people from non-industrialized countries would report greater difficulty in these areas, we’re finding a real lack of ability and opportunity to use e-health resources among those we would expect to be skilled users."
The studies define e-health literacy as the ability to read, use computers, search for information, understand health information and put it into context. E-health literacy requires that people be able to work with technology, think critically about issues of media and science, and navigate through a vast array of information tools and sources to acquire the information necessary to make decisions about their health.
The e-health literacy scale, developed by Skinner and Professor Cameron Norman of the University of Toronto, is an eight-item measure of e-health literacy designed to assess consumers’ combined knowledge, comfort and perceived skills at finding, evaluating and applying electronic health information to health problems.
For the literacy scale study, the researchers chose to examine youth aged 13 to 20 years, primarily because the demographic has high levels of e-health use and familiarity with information technology tools. A total of 664 participants, 370 boys and 294 girls, completed the literacy scale at four points in time over six months.
The results showed that the e-health literacy scale reliably and consistently captures the literacy of the subject, showing promise as a tool for assessing consumer comfort and skill in using information technology for health.
"This scale has the potential to help clinicians identify those who may or may not benefit from referrals to an e-health resource, such as an online smoking cessation program," Skinner said. "The next step is to see how it works for other demographics and settings while also exploring the relationship between e-health literacy and health care outcomes."
The joint studies’ findings were documented in the paper, titled "eHeals: The eHealth Literacy Scale", which was originally published in the Journal of Medical Internet Research in 2006. The paper recently received the designation of "Best Paper of the Year" by the International Medical Informatics Association (IMIA), based in Edmonton, Alta. The paper ‘eHEALS: The eHealth Literacy Scale’ was originally published in Volume 4, Edition 27 of the Journal of Medical Internet Research and has since been included in the 2008 IMIA Yearbook along with "other notable papers deemed to have had high impact on the field of medical and health informatics over the past year".
The IMIA provides leadership and expertise to the multidisciplinary health focused community and policy makers to enable the transformation of healthcare in accord with the world-wide vision to improve the health of the world population.
A PDF copy of the paper and related information, is available at eHEALS: The eHealth Literacy Scale and eHealth Literacy: Essential Skills for Consumer Health in a Networked World.