Judgement Skills in Health Literacy: Measurement and Role in Effective Patient Empowerment

Health literacy has been established for the past 15 to 20 years as an important factor in public health and health outcomes of medical treatments. Since the Ottawa Charter of 1986, patient empowerment has increasingly been propagated as a tool to enlarge the part played by the pa-tient, and his or her responsibility, in health care. Both concepts are related, and the relation-ship is being systematically explored in another project, where we also incorporate in our model of empowerment literacy components—specifically declarative and procedural knowledge in the relevant health domain and the judgmental skills to make reasoned choices in that domain. Judgmental skills especially enable patients to manage conditions that appear in their lives and impede their activities, making them more autonomous to deal with a new situation created by acute or chronic conditions. It goes without saying that this often requires practice, time, and also initial support from health professionals. But developing and acquiring performance skills are an integral part of patients’ perceived empowerment.

Marketing research provides the concepts of “psychological empowerment” (employees’ feelings of perceived competence and influence; comprised of volitional components) and “role” or “situ-ational empowerment” (the range of an employee’s factual decision-making authority). With these conceptions in mind, our projected studies seeks to understand how health literacy and empowerment mediate the decisions and behaviors that individuals make in managing their health.

The studies will use the self-management of asthma (Project 1) and insomnia (Project 2) as ex-amples. For asthma, there is ample evidence that education in self-management has an array of beneficial results and that health literacy is linked to better treatment and management out-comes. For insomnia, several issues suggest this as a subject: reluctance to seek medical help, compliance, side-effects of medication. Our communications focus in the planned studies is primarily in the context of a doctor-patient relationship. We seek to examine the relationships among psychological empowerment, health literacy, health outcomes, and situational empo-werment as communicated by physicians. In both projects, two parallel studies will develop and validate a measure of patient judgment skills (Study 1), and examine the impact of patient judgment skills and other elements of health literacy on constructive and destructive self-management activities (Study 2). We will develop, in consultation with physicians, a battery of 10 situational judgment test scenarios with possible action responses for each of the two health conditions. We will test its validity in a Delphi procedure with physicians and a patient survey of groups of 80 patients (Study 1, done twice for each of the two conditions). In Study 2 (also done for both conditions, with 300 patients each), one-on-one computer-aided-interviews will be conducted, administering the literacy and empowerment questionnaires in addition to inquiries about medical history and behavioral measures related to health management and basic demographics. Outcome variables in this study will be degree of self-management activities and appropriateness of use of medication (both as directed by and not as directed by physician). All surveys will be done in Ticino and conducted in Italian.