Readability of patient-reported outcome measures for chronic rhinosinusitis and skull base diseases

Readability Analysis of Spanish Language Patient-Reported Outcome Measures in Laryngology

BACKGROUND

Laryngologists use patient-reported outcome measures (PROM) to determine the efficacy of an intervention or to evaluate a patient's symptomatology. PROMs should be developed for a diverse target audience, including patients of all literacy levels. The American Medical Association (AMA) recommends that PROMs are written at or below the sixth- grade level. In recent studies, readability scores for otolaryngology PROMs in English were above the recommended reading level. To date, there is limited data regarding the readability of Spanish PROMs. Thus, this study aims to report the readability of Spanish language PROMs in laryngology.

METHODS

This study analyzed nine Spanish language laryngology PROMs. The authors queried PROMs from PubMed and Google scholar based upon English language laryngology PROM systematic reviews. Common categories included voice, airway, dysphagia, and other laryngology PROMs. Only nine laryngology PROMs were translated and validated in the Spanish language and publicly available. The readability of Spanish PROMs was determined using a multi-lingual readability software by two readability indices: Fernández Huerta and INFLESZ.

RESULTS

The mean and standard deviation (SD) Fernández-Huerta was 75.25 (27.12) and INFLESZ was 71.25 (26.98). The average readability score per PROM in Spanish was: DI (84.19), EAT-10 (11.54), MDADI (64.92), RSI (57.22), SWAL-QoL (70.98), TVQ (87.64), VFI (99.46), VHI-10 (95.04), and VRQoL (88.28).

CONCLUSION

The mean readability of Spanish language laryngology PROMs was above the recommended reading level. Patient readability should be considered when developing laryngology PROMs translations and validations. Robust development and testing of novel PROMs are important to address the persistent, pervasive risks for Spanish speaking patients.

Relationship between health literacy and disease-specific quality of life in patients with sinonasal disease

Background:

Patients with limited health literacy tend to have worse medical outcomes, often due to decreased medication compliance or reduced capacity to self-manage disease. Health literacy can be assessed using validated tools such as the Brief health literacy screening tool (BRIEF). This study theorizes that lower health literacy is associated with worse sinonasal disease quality of life (QOL).

Methods:

A cohort of 187 patients at our clinic were routinely screened for health literacy and rhinosinusitis disability index (RSDI) scores. Health literacy is categorized into “Limited,” “Marginal,” and “Adequate.” The higher the RSDI, the worse the patient’s QOL. Patients were stratified into “New” and “Established” groups. Their demographic data and sinonasal disease-specific QOL were recorded. Statistical analysis was performed to assess the relationship between health literacy and Sinonasal Disease-specific QOL.

Results:

The cohort mean age was 50 years, and 56% were females. In “New” patients, “Limited” health literacy was associated with an increase in RSDI scores (p<0.0001).

Conclusion:

This study demonstrates that patients with limited health literacy have a worse sinonasal disease-specific QOL. Therefore, rhinologists must be aware of this discrepancy and tailor their care appropriately to help patients with limited health literacy.

Availability of Readable Online Spanish Rhinosinusitis Outcome Measures

BACKGROUND

Patient-reported outcome measures (PROMs) are useful instruments that give providers insight into patients' experiences with disease by quantifying the symptoms that matter most to patients. Results of these questionnaires can help guide management in chronic rhinosinusitis. However, these tools are often developed for native English speakers, which disadvantages others, who already have a language barrier to care. The aim of this study is to evaluate accessibility and readability of Spanish PROMs used to evaluate rhinosinusitis.

METHODS

Three Spanish readability measures, Gilliam, Peña & Mountain; SOL; and Fernandez-Huerta were used to evaluate PROMs utilized for rhinosinusitis. PROMs with sixth-grade readability level or easier were considered to meet health literacy recommendations.

RESULTS

Four Spanish PROMs utilized in assessment of rhinosinusitis were identified and evaluated. Cuestionario Español de Calidad de Vida en Rinitis (ESPRINT-15) was the most readable PROM and met readability recommendations in two of three measures. Nasal Obstruction Symptom Evaluation met suggested levels in one measure. The remainder of readability scores were more difficult than recommended.

CONCLUSION

PROMs are powerful clinical tools that help patients communicate their symptoms and self-advocate. For providers to gain accurate and useful information, these measures should be written at appropriate readability levels. Most Spanish PROMs used for assessment of rhinosinusitis were above recommended readability. Development of future PROMs should ensure appropriate readability levels to provide good patient-centered care for our primarily Spanish speaking patients.

Readability analysis of Spanish language patient-reported outcome measures in pediatric otolaryngology

BACKGROUND

Pediatric otolaryngology encompasses interactions with a young patient, parent and/or guardian, and the provider. As healthcare transitions toward patient-centered care, clinicians are using direct tools of measurement such as patient-reported outcome measures (PROM) as a modality of communication between the patient and healthcare provider. Therefore, literacy levels of both the patient and their parent or guardian must be considered. Moreover, PROMs administered in pediatric audiology and otolaryngology in Spanish were found to be above the recommended reading level. Assessing the readability of Spanish translated PROMs is vital in providing safe, accurate, and quality care. The goal of this study is to analyze the readability of PROMs in pediatric otolaryngology and assess their compliance with readability recommendations.

METHODS

Pediatric otolaryngology PROMs were identified from Powell's systematic review on pediatric otolaryngology PROMs. Spanish pediatric otolaryngology PROMs were selected from a literature search through PubMed (pubmed.ncbi.nlm.nih.gov) and Google scholar databases (scholar.google.com). After completion of the literature search, seven PROMs were identified. Only four PROMs Spanish validations included the translation of the PROM in their publication. The authors of the remaining PROMs were contacted via email. Ultimately, eight pediatric otolaryngology PROMs were included in this study. The PROMs included were assessed by a Latin Spanish translator for grammar, syntax, and comprehension ease.

RESULTS

Four out of eight PROMs (50%) included in our study had readabilities above the recommended sixth-grade level. The following PROMs were noted with readabilities above the recommended level: tonsil & adenoid health status instrument (TAHSI), the nasal quality of life survey (SN-5), Spanish pediatric voice handicap index (P-VHI), and velopharyngeal insufficiency effects on life outcome (VELO).

CONCLUSIONS

Currently, some Spanish translated pediatric PROMs are written at a reading level above the recommended range for patients and their families.

Readability of Commonly Used Patient-Reported Outcome Measures in Laryngology

OBJECTIVES

Patient-reported outcome measures (PROMs) are used to evaluate patients' symptoms and clinical improvement after an intervention. Advocacy efforts and increased provider awareness regarding health literacy have helped to improve the readability of PROMs. Recent studies in otolaryngology in rhinology, pediatric otolaryngology, and head and neck reported PROM readability scores above the sixth-grade level. However, there is limited data regarding the readability of laryngology PROMs. Thus, this study aims to report the readability levels of PROMs in laryngology by assessing different readability indices and describing the relationship of readability levels to equitable healthcare.

METHODS

This is a bibliometric study that received approval from institutional review board (IRB) review as a nonhuman subject research study. Recent and widely utilized laryngology PROMs were selected from a publicly available literature search by reviewing laryngology systematic reviews, PubMed, and Google Scholar. Laryngology PROMs were selected from voice, dysphagia, airway, and other PROMs including voice questionnaires administered to patients seeking gender affirming voice care from systematic reviews and expert opinion. There were 37 PROMs included in this study. PROMs were analyzed via Gunning Fog, Simple Measure of Gobbledygook (SMOG), FORCAST, and Flesch Reading Ease Score.

RESULTS

All laryngology PROMs had readabilities above the recommended sixth-grade level. The mean and standard deviation (SD) of Gunning Fog was 7.30 (2.59), SMOG was 8.70 (1.51), FORCAST was 10.05 (1.51), and Flesch Reading Ease Score was 8.08 (2.76).

CONCLUSION

Laryngology PROMs are above the recommended middle school reading level. To further promote health equity, readability should be considered when developing future PROMs.

LEVEL OF EVIDENCE

N/A Laryngoscope, 2021.