In the last decades, enormous attention has been paid to health literacy due to its influence on health behaviours and health outcomes and there is a robust body of literature focusing on this relationship.1-4
However, two main aspects are still discussed by the research community for this concept to be fully considered as an effective approach. One concerns its conceptualization, as to date there is not a unique definition for it, and the other one its measurement.5 The most commonly used measures have focused on assessing reading, writing, and numeracy skills.6 Although so far the tools measuring these functional skills have shown a well-established relationship between health literacy and health outcomes,3 these tools fail to capture more advanced health literacy skills needed by individuals to function properly within a health care context,7 including decision-making, analytical thinking, pondering abilities, information use, informatics and communicative skills. These advanced skills among others allow patients to be autonomous in navigating the health care system, participate actively in their own and their families’ health care, make informed decisions, and collaborate efficiently with healthcare professionals. All this points towards the need to develop reliable tools that can assess skills that go beyond these functional abilities. Different attempts have been carried out to develop other measures able to capture more advanced health literacy skills. Chew et al.8 for instance developed a screening tool to assess individuals’ understanding of health material and the use of this; Ishikawa et al.9 went further and developed a screening tool assessing different dimensions of health literacy such as individuals’ capabilities to extract health information, derive meaning from it (communicative literacy), and critically use it (critical literacy). Despite these noticeable efforts to advance health literacy measurement, findings from other studies using these tools are inconclusive regarding their capacity to measure more advanced health literacy dimensions.10,11 Another recent approach that fits into the conceptualization of advanced health literacy skills has been proposed by Schulz and Nakamoto.12 One of the dimensions of the authors’ theoretical framework, known as judgment skills, focuses on the individuals’ abilities to adapt and apply health information according to the health context. These skills allow the individual to subtract and generalize information, to build knowledge that can be applied differently according to the situation.12 Thus, it has been hypothesized that individual with higher judgment skills are able to respond better to a particular health situation. The conceptualization of judgment skills has been recently and successfully operationalized in a scenario based-tool for the context of asthma self-management.13
The tool was developed in the asthma context because this chronic condition poses high demands on patients’ self-care routines. Patients need to follow strict medical regimens, use medicines properly, avoid asthma triggers, and recognize symptoms. However, if asthma health information is not properly understood and integrated by patients, a proper asthma control is difficult to achieve, which is at the end the final purpose for managing this condition. Therefore, the characteristics present in asthma self-management make it an appropriate condition to develop and test the proposed judgment skills. In addition to this, it has been pointed out by other authors that health literacy skills should involve more content-specific skills and health-related knowledge that depends on the health condition.7 Thus it is crucial to develop content-specific tools as the knowledge and skills required vary.
The purpose of the present work is to continue the evaluation of this newly developed tool and find out whether patients with higher judgment skills perform better than patients with low judgment skills in different asthma self-management practices such as medicine usage, trigger control, symptoms recognition, information seeking, doctor-patient communication, and exercise. Furthermore, this study aimed to investigate the associations between patients’ past self-management experiences and their impact on responding to similar situations.
ในทศวรรษที่ผ่านมา ได้จ่ายให้วัดสุขภาพเนื่องจากอิทธิพลของพฤติกรรมสุขภาพและผลลัพธ์สุขภาพความสนใจอย่างมาก และมีร่างกายแข็งแกร่งวรรณกรรมเน้นนี้ relationship.1-4However, two main aspects are still discussed by the research community for this concept to be fully considered as an effective approach. One concerns its conceptualization, as to date there is not a unique definition for it, and the other one its measurement.5 The most commonly used measures have focused on assessing reading, writing, and numeracy skills.6 Although so far the tools measuring these functional skills have shown a well-established relationship between health literacy and health outcomes,3 these tools fail to capture more advanced health literacy skills needed by individuals to function properly within a health care context,7 including decision-making, analytical thinking, pondering abilities, information use, informatics and communicative skills. These advanced skills among others allow patients to be autonomous in navigating the health care system, participate actively in their own and their families’ health care, make informed decisions, and collaborate efficiently with healthcare professionals. All this points towards the need to develop reliable tools that can assess skills that go beyond these functional abilities. Different attempts have been carried out to develop other measures able to capture more advanced health literacy skills. Chew et al.8 for instance developed a screening tool to assess individuals’ understanding of health material and the use of this; Ishikawa et al.9 went further and developed a screening tool assessing different dimensions of health literacy such as individuals’ capabilities to extract health information, derive meaning from it (communicative literacy), and critically use it (critical literacy). Despite these noticeable efforts to advance health literacy measurement, findings from other studies using these tools are inconclusive regarding their capacity to measure more advanced health literacy dimensions.10,11 Another recent approach that fits into the conceptualization of advanced health literacy skills has been proposed by Schulz and Nakamoto.12 One of the dimensions of the authors’ theoretical framework, known as judgment skills, focuses on the individuals’ abilities to adapt and apply health information according to the health context. These skills allow the individual to subtract and generalize information, to build knowledge that can be applied differently according to the situation.12 Thus, it has been hypothesized that individual with higher judgment skills are able to respond better to a particular health situation. The conceptualization of judgment skills has been recently and successfully operationalized in a scenario based-tool for the context of asthma self-management.13เครื่องมือถูกพัฒนาในบริบทโรคหอบหืดเนื่องจากเงื่อนไขนี้เรื้อรังซึ่งทำให้เกิดความต้องการสูงในผู้ป่วยสุขภาพตามปกติ ผู้ป่วยจำเป็นต้องตาม regimens เข้มงวดทางการแพทย์ ใช้ยาอย่างถูกต้อง หลีกเลี่ยงโรคหืดทริกเกอร์ และรับรู้อาการ อย่างไรก็ตาม ถ้าข้อมูลสุขภาพโรคหอบหืดไม่เข้าใจ และบูรณาการ โดยผู้ป่วย ควบคุมโรคหอบหืดที่เหมาะสมได้ยากเพื่อให้บรรลุ ซึ่งเป็นที่สิ้นสุดวัตถุประสงค์สุดท้ายสำหรับการจัดการเงื่อนไขนี้ ดังนั้น ลักษณะในการจัดการตนเองโรคหืดทำให้มีสภาพที่เหมาะสมเพื่อพัฒนา และทดสอบทักษะการนำเสนอคำพิพากษา นอกจากนี้ มันมีได้ชี้ให้เห็น โดยคนที่ สุขภาพสามารถทักษะควรเกี่ยวข้องกับทักษะเฉพาะเนื้อหาเพิ่มเติม และเปลี่ยนแปลงความรู้ที่เกี่ยวข้องกับสุขภาพที่ขึ้นอยู่กับสุขภาพ condition.7 การพัฒนาเครื่องมือเฉพาะเนื้อหาความรู้และทักษะที่จำเป็นดังนี้วัตถุประสงค์ของงานปัจจุบันจะดำเนินการประเมินนี้เพิ่งพัฒนาเครื่องมือ และพบว่าผู้ป่วย มีทักษะพิพากษาสูงทำดีกว่าผู้ป่วยที่มีทักษะต่ำพิพากษาในวิธีบริหารจัดการตนเองโรคแตกต่างกันเช่นการใช้ยา ทริกเกอร์ควบคุม รู้อาการ หาข้อมูล สื่อสารแพทย์ผู้ป่วย และออกกำลังกาย นอกจากนี้ การศึกษานี้มุ่งการตรวจสอบความสัมพันธ์ระหว่างผู้ป่วยผ่านการจัดการตนเองประสบการณ์และผลกระทบต่อการตอบสนองต่อสถานการณ์
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