Digital Health Readiness Questionnaire (DHRQ)

Abstract

The Digital Health Readiness Questionnaire (DHRQ), developed by Scherrenberg et al. (2023), is a specialized psychometric instrument designed to evaluate patients’ preparedness for adopting and engaging with digital health interventions within routine clinical settings. The development of the DHRQ was informed by existing literature (Karnoe et al., 2018; Kayer et al., 2018) and a formal definition of digital readiness established by medical doctors experienced in digital health research.

The questionnaire comprises 20 items, developed simultaneously in Dutch and English, covering core dimensions essential for successful digital engagement: digital skills, digital technology usage, digital literacy, and digital health literacy. It specifically integrates readiness factors relevant to modern digital tools such as smartphone applications, wearables, and internet-based programs. The internal validation study, conducted among adult cardiology patients in Belgium, supported the scale’s structure and reliability.

The DHRQ yields two primary output scores: a comprehensive general DHRQ score reflecting overall readiness, and a specific subscore assessing participant digital learnability. Psychometric analysis confirmed strong internal reliability, with Cronbach’s alpha values exceeding 0.70 across all domains, and Confirmatory Factor Analysis indicating a reasonably good model fit. The authors recommend subsequent research for external validation of the instrument.

Keywords

Digital Access, Digital Health, Digital Health Literacy, Digital Health Readiness, Digital Learnability, Digital Literacy, Digital Skills, Digital Usage, Face Validity, Health Literacy, Telemedicine

Authors

Scherrenberg, Martijn, Falter, Maarten, Kaihara, Toshiki, van Leunen, Mayke, Kemps, Hareld, Kindermans, Hanne, Dendale, Paul

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Purpose

The primary purpose of the Digital Health Readiness Questionnaire (DHRQ) is to provide a standardized, efficient method for measuring a patient’s digital preparedness within a clinical healthcare environment. This measurement is crucial for identifying patients who may benefit most from, or require additional support for, digital health interventions.

Specifically, the scale measures two core aspects: the patient’s current level of digital competence and usage, and their digital learnability, which captures the motivation and confidence necessary to acquire new digital skills required for successful remote health management.

Construct

The DHRQ measures the multidimensional construct of Digital Health Readiness. This construct encompasses the capability, confidence, and motivation of an individual to access, understand, and apply digital technology and information for the management of their own health and well-being.

The 20 items of the DHRQ are organized into five distinct factor domains that collectively define the patient’s readiness profile:

• Digital Access: Availability and frequency of use of basic digital devices (e.g., internet, smartphones, wearables).
• Digital Usage and Skills: Practical ability to perform common tasks such as emailing, video calling, and using health-tracking features.
• Digital Literacy: General competence in navigating the digital world, including finding reliable information and feeling secure online.
• Digital Health Literacy: The specialized ability to locate, evaluate, and utilize health-specific data from digital sources.
• Digital Learnability: Reflects the patient’s intrinsic motivation and self-efficacy regarding the adoption of new technologies for health purposes.

Validity

The initial validation of the DHRQ focused on establishing both content and face validity.

Content Validity: An expert panel, consisting of medical professionals highly experienced in digital health research, was consulted during the development phase. Their expertise ensured that the items comprehensively covered the key dimensions of digital readiness relevant to clinical settings and digital health interventions. Suggestions from this panel were integrated to optimize the questionnaire content.

Face Validity: Testing confirmed that the language and format of all questions were clear, straightforward, and easily understood by the target population of adult patients, maximizing the instrument’s utility in routine clinical practice.

Reliability

Internal consistency, a key measure of reliability, was assessed using Cronbach’s alpha for all subscales of the DHRQ. The coefficients demonstrated good to excellent internal consistency across all measured domains, confirming that the items within each subscale are highly correlated and reliably measure the intended underlying construct.

The Cronbach’s alpha coefficients varied across the subscales, ranging from a minimum of 0.735 (for the Digital Usage factor) up to 0.937 (for the Digital Literacy factor). All coefficients were well above the acceptable standard of 0.70, validating the scale’s sensitivity and reliability.

Factor Analysis

The factor structure of the DHRQ was investigated using Confirmatory Factor Analysis (CFA) to confirm the hypothesized organization of the 20 items into distinct domains.

The overall chi-square test for model fit was significant (χ²₁₆₀=5590, P<.001). However, a review of standard fit indices demonstrated a reasonably good fit for the proposed model, suggesting that the underlying factor structure accurately represents the data collected:

• Standardized Root-Mean-Square Residual (SRMR): 0.065
• Root-Mean-Square Error of Approximation (RMSEA): 0.098 (95% CI 0.09-0.106)
• Tucker-Lewis Fit Index (TLI): 0.895
• Comparative Fit Index (CFI): 0.912

Instrument

Test Type: Original psychometric scale

Format: This is a 20-item measure. Items are rated on a 5-point Likert scale. Responses are scored from 1 (“strongly disagree”) to 5 (“strongly agree”), though specific items related to digital access use a frequency scale (1=”Never” to 5=”Daily”). A higher score indicates better digital readiness. The scale was administered via paper-based format.

Language Available: Dutch; English

Population Group: Human (Male; Female; Outpatient)

Age Group: Adulthood (18 yrs & older), including Young Adulthood (18-29 yrs), Thirties (30-39 yrs), Middle Age (40-64 yrs), Aged (65 yrs & older), and Very Old (85 yrs & older)

Population Details: The initial validation sample consisted of adult Cardiology Patients (aged 21–97 years) located in Belgium.

Test Methodology: Test Validity; Content Validity; Test Reliability; Internal Consistency; Factor Analysis; Confirmatory Factor Analysis

Keywords

Digital Access, Digital Health, Digital Health Literacy, Digital Health Readiness, Digital Learnability, Digital Literacy, Digital Skills, Digital Usage, Face Validity, Health Literacy, Telemedicine

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Authors

Author ORCID Identifier (Scherrenberg, Martijn): http://orcid.org/0000-0001-9483-3828

Affiliation Email addresses: [email protected] (for Martijn Scherrenberg)

Correspondence Address: Jessa Hospital, Heart Centre Hasselt, Stadsomvaart 11, Hasselt, Belgium, 3500

Permissions & Fee and Test Year

Permissions: May use for Research/Teaching.

Commercial: No

Fee: No

Test Year: 2023

Web Site (License): creativecommons.org/licenses/by/4.0/

Reference’s

Scherrenberg, M., Falter, M., Kaihara, T., Xu, L., van Leunen, M., Kemps, H., Kindermans, H., & Dendale, P. (2023). Development and internal validation of the Digital Health Readiness Questionnaire: Prospective single-center survey study. Journal of Medical Internet Research, 25, Article e41615. DOI: https://doi.org/10.2196/41615

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Items of the Digital Health Readiness Questionnaire (DHRQ)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Test Items Available: Yes, located in the Supplemental Material, Pages 1-5 (Source: 2023-88383-001).

Number of items: This is a 20-item measure.

Factors and Subscales:

• Digital usage

• Digital skills

• Digital literacy

• Digital health literacy

• Digital learnability

A) Digital access

1. I use the internet
   (1 = Never / I don’t have access to the internet; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Daily)

2. I use a computer and/or laptop
   (1 = Never / I don’t have a computer and/or laptop; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Daily)

3. I use a smartphone and/or tablet
   (1 = Never / I don’t have a smartphone and/or tablet; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Daily)

4. I use a wearable (fitness tracker, smartwatch, other)
   (1 = Never / I don’t have any wearable; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Daily)

B) Usage of digital technology

1. I am able to write and send an email independently.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

2. I use social media such as Facebook, Instagram, other.
   (1 = No; 2 = Rarely; 3 = Sometimes; 4 = Often; 5 = Daily)

3. I am able to perform videocalling.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

4. I am able to take a picture and to send it to another person.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

5. I am able to register and review my daily step count.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

C) Digital Literacy
Being able to use digital technology to reach information.

1. I know how to find helpful and reliable information on the internet.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

2. I feel safe when looking up information on the internet.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

3. I feel in control when looking up information on the internet.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

D) Digital Health Literacy
Being able to use digital technology to look up, use and work with health information.

1. I use the internet to find more information about my symptoms, health status and/or medication.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

2. I use health-related applications to follow up my health status.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

3. I am able to identify trustworthy, reliable health information on the internet.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

E) Learnability
Motivation and interest to engage with new technology.

1. I am motivated to learn more about digital technology and how to use it myself.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

2. I feel confident that I can learn more about digital technology and how to use it myself.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

3. I believe that I will learn quickly when offered written information about digital technology.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

4. I believe that I will learn quickly when offered personal guidance about digital technology.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)

5. I expect that learning digital skills can positively impact my health.
   (1 = Strongly disagree; 2 = Disagree; 3 = Neither agree nor disagree; 4 = Agree; 5 = Strongly agree)