Development of an online awareness assessment for adults with neurological conditions: a Delphi study

Online awareness, or the ability to detect errors and monitor performance during activities, is a component of functional cognition essential for safety and independence within everyday activities. There is a lack of assessment methods that target online awareness for individuals with neurological conditions. This study aimed to make recommendations for a clinically useful method for assessing online awareness in rehabilitation. The methods included a conceptual analysis to define online awareness and identify existing assessment approaches; three rounds of Delphi surveys involving an international expert panel to develop an online awareness assessment; and pilot testing of the assessment with consumers. The conceptual analysis generated an online awareness definition framework that included four key elements: appraisal, anticipation/prediction, monitoring, and self-evaluation. This framework guided survey questions posed to the expert panel. The Delphi process supported development of the ‘Online Awareness Behaviours Scale’, an assessment that can be used in clinical practice and research. Consumer feedback indicated high levels of usability and acceptability of the assessment. The Online Awareness Behaviours Scale is a new, clinically acceptable tool for rehabilitation clinicians that assesses online awareness of individuals with neurological conditions. Self-awareness assessment should include both measures of general awareness and online awareness of performance within the context of an activityOnline awareness assessment provides important insights into a person’s perspective of their activity performance and the need to apply strategiesThe ‘Online Awareness Behaviours Scale’ is a recommended approach to assessing online awareness of performance that can be applied across a range of activities and contexts, with outcomes used to guide treatment for individuals with neurological conditions Self-awareness assessment should include both measures of general awareness and online awareness of performance within the context of an activity Online awareness assessment provides important insights into a person’s perspective of their activity performance and the need to apply strategies The ‘Online Awareness Behaviours Scale’ is a recommended approach to assessing online awareness of performance that can be applied across a range of activities and contexts, with outcomes used to guide treatment for individuals with neurological conditions