Doctoral thesis

Judgment skills in health literacy : Measurement and role in effective asthma patient self-management


125 p.

Thèse de doctorat: Università della Svizzera italiana, 2014 (jury note: Magna cum laude)

English This dissertation is a collection of three empirical papers describing three interrelated studies. In addition, an introductory chapter reviews the state of the art of the health literacy field and addresses how judgment skills come into play. Moreover, a general conclusion reports the contribution of this work to the field of health literacy, and states the direction for future research concerning judgment skills, and the role of these skills on the self-management of chronic diseases. The first paper describes the development of a scenario-based tool in the context of asthma self-management. The tool was constructed in different stages that included a revision of scientific literature on asthma self-management, and several consultations with pulmonologists and asthma patients. Moreover, a three-round Delphi study composed of a panel of twelve experts in the field of lung diseases was conducted. This panel helped to validate the content of the tool and to create a ranking score for the responses from a medical perspective. This process resulted in a scenario-based judgment skills tool composed of nineteen scenarios with four response options each. The second paper describes a pilot study. This study used the newly developed judgment skill tool with a sample of 80 asthma patients to explore constructive and destructive self-management practices. Patients were classified according to their level of judgment skills, either on the High or Low judgment groups. Significant associations were found between self-management practices and the level of these skills, including compliance with the use of asthma medicines and consultations with doctors when asthma-related problems arouse. The third paper describes the use of the Health Empowerment Model to explore the influence of the health literacy components, including judgment skills and psychological empowerment on asthma self-management practices. This study was carried out with an independent sample of 236 asthma patients. Findings revealed that judgment skills and empowerment have a significant and positive impact on the use of asthma medicines, appropriate doctor consultation, and trigger controls. However, other elements of health literacy that address communicative and critical skills as a result of health information use appeared to have significant negative effects on self-management practices. Furthermore, results from this study endorse the use of the Health Empowerment Model to explain health-related behaviors. In summary, the results of these three studies support the use of judgment skills as an integral part of the conceptualization of health literacy. These findings also contribute to broaden the range of measurement tools available to assess a more advanced health literacy dimension within the context of chronic diseases.
  • English
Social sciences
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