Hypothesis / aims of study
Approximately one-third of the U.S. population has basic or below basic health literacy skills and only 12% of the population possess proficient health literacy.(1) Lower health literacy has been associated with poor health outcomes and poor compliance with care plans.(2) Pelvic floor disorder questionnaires are commonly administered in clinical care and clinical research, but little is known about how health literacy status impacts the utilization of these forms. Our aim was to evaluate the performance of two commonly used measures, Pelvic Floor Distress Inventory–Short Form 20 (PFDI-20) and Pelvic Floor Impact Questionnaire–Short Form 7 (PFIQ-7) in a low health literacy population.
Study design, materials and methods
Readability assessment was performed using Flesch-Kincaid grade level calculator, SMOG readability calculator, Fry graph readability calculator, and FORCAST readability formula. Scores from readability assessments reflected the average U.S. reading level required to comprehend the content. Two health literacy experts performed independent assessment using Patient Education Materials Assessment Tool for Printable Materials (PEMAT) to rate ease of understanding and Evaluative Linguistic Framework for Questionnaires (ELF-Q) to evaluate questionnaire quality, then arrived at consensus. A single focus group was conducted to obtain information on the domains of actionability, readability, and organization of questionnaires using facilitator prompts and Stop Light Coding (3), a validated method for eliciting qualitative assessment of print materials from low health literacy participants. The focus group was designed to include female participants with low health literacy across a broad age range. Demographic data and health literacy status were collected on focus group participants.
Interpretation of results
Higher reading level is needed to interpret PFIQ-7 compared to PFDI-20, though focus group participants preferred the structure of the PFIQ-7 to that of the PFDI-20. Focus group participants and trained expert consensus reviews revealed concerns regarding formatting, organization, and language for both questionnaires.