Psychometric Properties of the Choosing Wisely Questions in a Large Psychiatric Sample

IF 3.4 3区医学 Q2 PSYCHIATRY International Journal of Methods in Psychiatric Research Pub Date : 2026-10-26 DOI:10.1002/mpr.70116

Johan Bengtsson, Alma Andersson, Natalie Forss Lilja, Isabella Hultgren Farsani, Ellen Lissbrant, Björn Wettermark, Ida Blomqvist

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Abstract

Objectives

The Choosing Wisely Questions (CWQ) support shared decision-making and aim to reduce low-value care, but their psychometric properties remain unclear. This study evaluated the structural validity, reliability, and item characteristics of the Swedish CWQ in a psychiatric sample.

Methods

In this cross-sectional study, adult patients at a Swedish university psychiatric clinic (early 2025) completed four CWQ items on perceived information about their medication (benefits, risks, alternatives, and no treatment). Structural validity was assessed using exploratory and confirmatory factor analyses. Internal consistency was measured with Cronbach's alpha, and item characteristics were examined using a graded response model.

Results

A total of 666 patients (57.2% women; median age 35.0 years) were included. The majority had multiple ICD F-diagnoses. EFA supported a one-factor solution explaining 53.8% of the variance. CFA demonstrated excellent model fit (CFI = 0.998, TLI = 0.995, RMSEA = 0.032, SRMR = 0.015). Internal consistency was good (α = 0.81, 95% CI 0.79–0.83). In the item response analysis, all items showed high discrimination (a = 1.94–2.72) and ordered thresholds. Patients reported more information on benefits than on risks, alternatives, or no treatment (p < 0.001).

Conclusion

The Swedish CWQ show good validity, reliability, and item performance, supporting their use as a unidimensional measure of perceived information in psychiatric shared decision-making.

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大型精神病样本中明智选择问题的心理测量特性

目的明智选择问题（CWQ）支持共同决策，旨在减少低价值护理，但其心理测量特性尚不清楚。本研究评估了瑞典CWQ在精神病学样本中的结构效度、信度和项目特征。方法：在这项横断面研究中，瑞典一所大学精神病诊所的成年患者（2025年初）完成了四项CWQ项目，内容涉及他们对药物的感知信息（益处、风险、替代方案和无治疗）。结构效度评估采用探索性和验证性因素分析。内部一致性采用Cronbach’s alpha测量，项目特征采用分级反应模型检验。结果共纳入666例患者，其中女性57.2%，中位年龄35.0岁。大多数患者有多个ICD诊断。EFA支持单因素解决方案，解释53.8%的方差。CFA模型拟合良好（CFI = 0.998, TLI = 0.995, RMSEA = 0.032, SRMR = 0.015）。内部一致性良好（α = 0.81, 95% CI 0.79 ~ 0.83）。在项目反应分析中，所有项目都表现出高判别性（a = 1.94 ~ 2.72）和有序阈值。患者报告的获益信息多于风险、替代方案或无治疗信息（p < 0.001）。结论瑞典CWQ量表具有良好的效度、信度和项目性能，支持其作为精神科共同决策感知信息的单维测量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Journal of Methods in Psychiatric Research 医学-精神病学

CiteScore

5.20

自引率

6.50%

发文量

审稿时长

>12 weeks

期刊介绍： The International Journal of Methods in Psychiatric Research (MPR) publishes high-standard original research of a technical, methodological, experimental and clinical nature, contributing to the theory, methodology, practice and evaluation of mental and behavioural disorders. The journal targets in particular detailed methodological and design papers from major national and international multicentre studies. There is a close working relationship with the US National Institute of Mental Health, the World Health Organisation (WHO) Diagnostic Instruments Committees, as well as several other European and international organisations. MPR aims to publish rapidly articles of highest methodological quality in such areas as epidemiology, biostatistics, generics, psychopharmacology, psychology and the neurosciences. Articles informing about innovative and critical methodological, statistical and clinical issues, including nosology, can be submitted as regular papers and brief reports. Reviews are only occasionally accepted. MPR seeks to monitor, discuss, influence and improve the standards of mental health and behavioral neuroscience research by providing a platform for rapid publication of outstanding contributions. As a quarterly journal MPR is a major source of information and ideas and is an important medium for students, clinicians and researchers in psychiatry, clinical psychology, epidemiology and the allied disciplines in the mental health field.