Development and Validation of a Mobile-Centered Digital HealthReadiness Scale (mDiHERS):Health Literacy and Equity Scale

Background: There has been a rapid expansion of digital health care services, making the need for measuring and improvingdigital health readiness a priority. In response, our study team developed the Mobile-Centered Digital Health Readiness: HealthLiteracy and Equity Scale(mDiHERS) to measure digital health readiness.Objective: We aim to develop and validate a scale that assesses digital health readiness, encompassing literacy and equity, andto ensure the effective use of mobile-centered digital health services.Methods: This study was conducted from October 2021 to October 2022 to develop and validate the mDiHERS. Participantsincluded patients with inflammatory bowel disease, which is a chronic condition requiring continuous management, and expertsin medical and nursing informatics. The scale development involved a literature review, focus group interviews, and contentvalidity evaluations. A total of 440 patients with inflammatory bowel disease were recruited for the validation phase, with 403completing the survey. The scale's validity and reliability were assessed through exploratory factor analysis and Cronbach alpha.The scale was translated into English by translators and bilingual and native researchers, ensuring its applicability in diversesettings.Results: The mDiHERS consists of 36 items across 6 domains, with a 5-point Likert scale for responses. The validation processconfirmed the scale's construct validity, with 4 factors explaining 65.05% of the total variance. The scale's reliability wasestablished with Cronbach alpha values ranging from 0.84 to 0.91. The scale's development considered the technical proficiencynecessary for engaging with health mobile apps and devices, reflecting the importance of subjective confidence and objectiveskills in digital health literacy.Conclusions: The mDiHERS is a validated tool for measuring patients'readiness and ability to use digital health services. ThemDiHERS assesses user characteristics, digital accessibility, literacy, and equity to contribute to the effective use of digital healthservices and improve accessibility. The development and validation of the mDiHERS emphasize the importance of confidenceand competence in managing health digitally. Continuous improvements are necessary to ensure that all patients can benefit fromdigital health care.