Translation, Cross-Cultural Adaptation, and Psychometric Validation of the Health Information Technology Usability Evaluation Scale in China: Instrument Validation Study

Abstract

Background: The dramatic growth of digital health apps highlights an urgent need for rigorous usability evaluation tools. While the Health Information Technology Usability Evaluation Scale (Health-ITUES) has gained validation, a Chinese version has not yet been developed and validated. Objective: This study aimed to translate and culturally adapt the Health-ITUES into Chinese, customize it for both service consumers and professional health care providers, and evaluate its reliability and validity in the Chinese context. Methods: Following the Guidelines for the Process of Cross-Cultural Adaptation of Self-report measures, the Health-ITUES was meticulously translated and culturally adapted into Chinese version following 2 rounds of expert consultation. Subsequently, based on the SMART system, an intelligent and integrated older adult care model, the Chinese version of the Health-ITUES was customized into the care receiver version (Health-ITUES-R) and professional health care provider version (Health-ITUES-P). Older individuals and nurses participated in the validation testing conducted between December 2020 and February 2021, facilitated by the improvement of the COVID-19 pandemic and the timing preceding the Spring Festival, which ensured feasible recruitment and a sufficient sample size. In addition, the pandemic-driven increase in digital health app usage allowed us to assess usability in a relevant real-world health care setting. Content validity, internal consistency reliability, construct validity, convergent validity, discriminant validity, and criterion validity were used to evaluate the psychometric attributes of the Health-ITUES-R and Health-ITUES-P. Results: A Chinese version of the Health-ITUES comprising 20 items across 4 dimensions was formulated, informing the customization of the Health-ITUES-R and Health-ITUES-P. In total, 110 and 124 eligible older adults and nurses validated the customized Health-ITUES-R and Health-ITUES-P, respectively. Both versions exhibited satisfactory content validity (content validity index of items=0.83-1.00; content validity index of scale=0.99) and adequate internal consistency reliability (Cronbach α and McDonald ω>0.80 for the overall scale; >0.75 for individual items). Confirmatory factor analysis confirmed a 4D structure with acceptable construct validity, as indicated by model fit indices. Both the Health-ITUES-R and Health-ITUES-P showed satisfactory convergent validity (average variance extracted [AVE] value>0.5, composite reliability value>0.7), except for a slightly lower AVE value (0.478) for the second dimension of the Health-ITUES-R. Discriminant validity was supported, with the square root of AVE values exceeding correlation coefficients and the Hetereotrait-Monotrait ratio below 0.85. Furthermore, Pearson correlation coefficients for the perceived usefulness dimension, perceived ease of use dimension, and overall scale of the Health-ITUES-R and patient acceptance questionnaire for mobile health application were 0.587, 0.647, and 0.743 (all P