The eHealth literacy scale (eHEALS) adaptation for use among the Bulgarian population: Language and cultural aspects

Digitalization and eHealth literacy are closely interconnected, as digital transformation in healthcare changes the way people access, understand, evaluate, and use online health information. In recent years, a validated instrument has been widely used to assess and measure these changes: the eHealth Literacy Scale (eHEALS). The aim of this study was to culturally and linguistically adapt the eHEALS questionnaire for use in the Bulgarian population. The study sample included 157 women (53%) and 140 men (47%). Most had completed higher education (68%), were employed (83%), and reported no chronic conditions (72%). The internal consistency of the Bulgarian version of the eHealth Literacy Scale (eHEALS) instrument was evaluated using Cronbach’s alpha. The 8-item version showed an alpha of 0.955, while the 10-item version achieved 0.938, demonstrating excellent reliability for both versions. In line with commonly accepted standards, alpha coefficients exceeding 0.90 indicate outstanding internal consistency, confirming that both scale formats are reliable tools for use in the Bulgarian population.