Below are sample measures used by ODPHP to evaluate users' level of engagement with online prevention content and their level of self-efficacy. Also included are sample measures for the acceptability and applicability of Web content as well as a proxy measure for health literacy.

Engagement

The eHealth Engagement Scale* was adapted from commercial advertising research. The scale includes rating 10 descriptors (α = 0.90), including absorbing, attention-grabbing, stimulating, surprising, suspenseful, thought-provoking, convincing, believable, not dull, and clever (1 = Strongly Agree; 5 = Strongly Disagree). Internal reliability of each of the two multi-item subscales of the eHealth Engagement Scale was 0.878 for "Involving" and 0.805 for "Credible."

Self-Efficacy

The self-efficacy scale was adapted from the Guide for Constructing Self-Efficacy Scales, where Bandura^† proposes measuring self-efficacy by having participants rate their level of confidence in taking an action. The scale used by ODPHP includes the following three items: "This information made me feel more confident that I can do something"; "This information made me feel more prepared to do something"; and "This information made me feel more prepared to do something in the next month" (1 = Strongly Agree; 5 = Strongly Disagree).

Acceptability

Acceptability is the extent to which the intended users like the tool/content and find it easy to use. ODPHP operationalized acceptability (based on the 2006 report, Expanding the Reach and Impact of Consumer E-Health Tools^‡) with two items. They include "This information was easy to use" and "This information was presented in ways that I could easily understand" (1 = Strongly Agree; 5 = Strongly Disagree).

Applicability

Applicability is the extent to which the tool/content is relevant to the needs of the intended user; in other words, does it help him or her in his or her everyday life? ODPHP operationalized applicability (based on the 2006 report, Expanding the Reach and Impact of Consumer E-Health Tools) with two items. They include "This information was useful to me" and "This information gave me some specific ideas about what to do" (1 = Strongly Agree; 5 = Strongly Disagree).

Limited Health Literacy

ODPHP used proxy measures to identify a limited health literacy sample based on statistics from the health literacy component of the 2003 National Assessment of Adult Literacy. Individuals included in the limited health literacy sample met the following criteria: have a high school education or below, have an annual household income below the poverty threshold (under $40,000), and have not searched for health information online in the past year.

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* Lefebvre, R. C., Tada, Y., Hilfiker, S., & Baur, C. (in press). The assessment of user engagement with ehealth content: The eHealth Engagement Scale. Journal of Computer-Mediated Communication.
† Bandura, A. (2006). Guide for creating self-efficacy scales. In T. Urdan & F. Pajares (Eds.), Self-efficacy beliefs of adolescents (pp. 307–337). Charlotte, NC: Information Age Publishing.
‡ Office of Disease Prevention and Health Promotion. (2006). Expanding the reach and impact of consumer e-health tools. Rockville, MD: Author. Retrieved from http://www.health.gov/communication/ehealth/ehealthtools/default.htm