Readability of Patient-Reported Outcome Questionnaires for Use with Persons with Swallowing Disorders
- 508 Downloads
The purposes of this study were to examine the readability of published patient-related outcome (PRO) questionnaires for persons with swallowing problems, and to compare the readability results to existing data about average reading levels of English-speaking adults living in the United States. A search was conducted to identify published PRO questionnaires related to swallowing problems that traditionally are completed by patients in a self-administered format. Reading grade levels were analyzed separately for four different swallowing-related PRO questionnaires using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. Descriptive statistics were also computed across the questionnaires. The results of this study demonstrate that all four PRO questionnaires exceeded the fifth- to sixth-grade reading levels recommended by health literacy experts regardless of the formula applied. In the demand for standardization of swallowing-related quality-of-life assessment tools, developers should consider readability as another testable construct, since poor readability may affect validity, reliability, and sensitivity. The swallowing clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or his or her proxy. Developers of PRO questionnaires should consider the reading level of respondents and include information about this when reporting psychometric data.
KeywordsReadability Patient-reported outcome measures Swallowing Dysphagia deglutition Questionnaires Swallowing-related quality of life Dysphagia-related quality of life Health literacy Deglutition disorders
- 1.Lawton M. A multidimensional view of quality of life in frail elders. In: Birren J, editor. The concept and measurement of quality of life in frail elders. San Diego: Academic Press; 1991. p. 61.Google Scholar
- 2.U.S. Food and Drug Administration. Guidance for industry - patient-reported outcome measures: use in medical product development to support labeling claims, 2009. Retrieved September 19, 2011 from www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/default.htm.
- 4.Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M.D. Anderson Dysphagia Inventory. Arch Otolaryngol Head Neck Surg. 2001;127:870–6.PubMedGoogle Scholar
- 6.Kutner M, Greenberg E, Jin Y, Paulsen C. The Health Literacy of America’s Adults: results from the 2003 national assessment of adult literacy (NCES 2006–483). U.S. Department of Education. Washington, DC: National Center for Education Statistics; 2006.Google Scholar
- 7.Doak CC, Doak LG, Root JH. Teaching patients with low literacy skills. Philadelphia: J.B. Lippincott; 1996.Google Scholar
- 10.Dubay WH. The principles of readability. Costa Mesa: Impact Information; 2004.Google Scholar
- 11.U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion (n.d.). Healthy People 2010. Available at www.health.gov/healthypeople. Accessed 19 Sep 2010.
- 12.American Speech-Language-Hearing Association. Health literacy. Available at www.asha.org/members/slp/healthliteracy. Accessed 19 Sep 2010.
- 14.Kahn A, Pannbacker M. Readability of educational materials for clients with cleft lip/cleft palate and their families. Am J Speech Lang Pathol. 2000;9:3–9.Google Scholar
- 15.Harris J, Fleming V, McDougall J. Effects of text and reader variables on understanding health information. Presented at the Annual Convention of the American Speech-Language-Hearing Association, Chicago, IL, November 2003.Google Scholar
- 20.Belafsky PC, Mouadeb DA, Rees CJ, Pryor GC, Postma JN, Allen J, Leonard RJ. Validity and reliability of the Eating Assessment Tool (EAT-10). Ann Otol Rhinol Laryngol. 2008;12:919–92.Google Scholar
- 21.Chen AY, Frankowski R, Bishop-Leone J, Hebert T, Leyk S, Lewin J, Goepfert H. The development and validation of a dysphagia-specific quality-of-life questionnaire for patients with head and neck cancer: the M.D. Anderson dysphagia inventory. Arch Otolaryngol Head Neck Surg. 2001;7:870–6.Google Scholar
- 24.Caylor JS, Sticht TG, Fox LC, Ford JP. Methodologies for determining reading requirements of military occupational specialties [Tech. Report No. 73–5]. Alexandria: Human Resources Research Organization; 1973.Google Scholar
- 26.Gunning R. The technique of clear writing. New York: McGraw-Hill; 1952.Google Scholar
- 29.McCall WA, Crabbs LM. Standard test lessons in reading. New York: Teachers College; 1961.Google Scholar
- 32.Zraick RI, Atcherson SR. Readability of patient-reported outcome questionnaires for use with persons with dysphonia. J Voice. doi: 10.1016/j.jvoice.2011.01.009.