Measures
Different validated scales were assembled into a questionnaire to
explore the study variables. The following is a description of the variables
and the scales used to measure them:
Functional health literacy. This was assessed by a validated scale
that included three screening questions:8 How often do you have someone
help you read hospital materials?; How often do you have problems
learning about your medical condition because of difficulty understanding
written information?; How confident are you filling out forms by
yourself?. These were measured on a 5-point scale ranging from always
to never (score 1-5).
Judgment skills. These were evaluated by the scenario-based tool
developed in a previous study.13 It included nineteen scenarios with
four response option each, describing self-management situations
regarding exercise, doctor-patient communication, information seeking,
triggers control, symptoms recognition, and medicine use. Every
response option was transformed into a score ranging from 1-4 (most
inadequate to most adequate). The ranking of the response options and
the validity of the scenarios was determined in a prior study by a Delphi
panel (i.e. panel of experts gathered to achieve consensus about a particular
topic) composed of twelve physicians in the field of lung diseases.13
Past experience. Following each scenario a yes/no question was
asked about prior experience on a similar situation as the one
described in the scenario. The purpose of this was to verify whether the
described scenarios matched the most common situations for asthma
patients and whether past experience has an association with the
response given to the scenario.
Test for asthma control (ACT). This validated and widely use test
included five questions measured in a 5-point scale. They assessed
asthma symptoms and medicine usage in the last four weeks,14 e.g.,
During the past 4 weeks, how often have you had shortness of breath?.
Asthma self-management. A pull of seven questions measured
patients’ care practices; some were drawn from a study on asthma
management,15 and others from asthma guidelines,16 the scale ranged
from always to never (3 and 5 point scales) and included questions
such as I take my rescue medicine as indicated by my doctor. These
questions were used as outcome measures.
Demographics. These were included at the end of the questionnaire
with the aim of describing the study population.
The questionnaire was pre-tested among ten asthma patients who
did not belong to the pilot study, and it was revised by two experts in
questionnaire development before conducting the study.