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

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.

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.

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).

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.