Medical assessments of patient decisions and health literacy. A scenario-based measure of judgment skills

Objective: To design a measure of judgment skills (a dimension within the wider concept of health literacy) that assesses patient decisions with a scenario-based measure in the context of sleeping disorders; more specifically to provide a basis for the professional medical evaluation of patient decisions to be employed in the measure; and in a wider sense to explore in which way knowledge about insomnia, self-management and autonomous decision-making are affecting insomnia patients and their health outcomes. Methods: A three-round Delphi-study was conducted with an expert panel of three sleep specialists and 26 general practitioners to rate scenarios of patient decision problems and find a consensus in ranking the answer options from a medical perspective. Results: A consensus emerged among the medical experts about the measure, which could be further improved with regard to the scenarios and the answer options. Scenarios were rated as realistic and the answer options ranked with a high agreement. Conclusion: The 16 scenarios with four ranked answer options each provide a valid measure for patients' judgment skills within the wider concept of health literacy. Practical implications: The proposed judgment skills measure is ready to be pre-tested with insomnia patients, and a validation study can be conducted.