Piloting an Educational Approach to Assess eHealth Literacy and Evidence-Based Medicine in Integrative Health: A Feasibility and Validation Study.

Abstract

Introduction: Low rates of online health literacy put consumers at risk of misinformation, but this could be mitigated through practitioner engagement. Integrative health (IH) crosses health care disciplines, so it is well-positioned to improve health information sharing. IH practitioners require evidence-based medicine (EBM) and electronic health literacy (eHL) competencies to make such impact. Several EBM assessments exist, but none are IH-specific. The Fresno Test of EBM FEBM is a validated, performance-based assessment used in medical education. We sought to assess feasibility of incorporating eHL and EBM assessments into graduate coursework while adapting and validating the FEBM for an IH audience (FEBM-IH). Methods: A pilot observational design was used to adapt, evaluate, administer, and validate the FEBM-IH. Revalidation of the FEBM-IH began with a discipline-focused adaptation, which was reviewed by an expert panel. The FEBM-IH was then administered to IH students and faculty. Independently scored assessments determined inter-rater reliability, internal consistency, item discrimination, and item difficulty. eHL assessments (eHEALS and General Health Numeracy Test-6) were also embedded in the online course. Results: Outcome completion rates suggest the FEBM-IH and eHL assessment tools are feasible to include in online courses, with 68.9% (102/148) eligible participants joining and 76.5% (78/102) completing all questions in all measures. The FEBM-IH demonstrated excellent assessor agreement (kappa = 0.97, p < 0.001), high internal consistency (α = 0.799), and acceptable item discrimination (0.26-0.68). Median self-perceived eHL scores increased from 30/40 to 33/40 points by course's end, suggesting some increase in eHL. Conclusions: Tools were feasible to integrate; FEBM-IH maintains acceptable validity; and further exploration of the relationship between EBM and eHL is warranted.