(PP1401) Evaluation of Readability and Comprehensibility of Tinnitus Patient-Reported Outcome Measures

Introduction:   Using PROMs is common practice in many medical settings and is currently considered best practice for evaluating the success of healthcare interventions (Clerehan, Guillemin, Epstein, & Buchbinder, 2016). With the increasing emphasis on the use of PROMs, it is important that reading comprehension levels be considered, as respondent burden can negatively impact both reliability and validity of the questionnaire (SAC-MOT, 2002). In determining the severity of tinnitus, PROMs take on a diagnostic role as well as an outcome measure. It is therefore imperative that tinnitus PROMs are designed to yield the most accurate responses as they inform what treatment is undertaken primarily, as well as serve as a key patient-centered measure of treatment outcomes. This research aligns with an increasing national effort [Healthy People 2030] to address health literacy (https://health.gov/healthypeople; https://www.nih.gov/institutes-nih/nih-office-director/office-communications-public-liaison/clear-communication/plain-language). 

Purpose:  The purpose of this study is to revisit the work of Atcherson, Zraick, and Brasseux (2011) in readability analysis of tinnitus PROMs and to examine these measures further using the ELF-Q (Evaluative Linguistic Framework for Questionnaires). (Clerehan et al., 2016) Ten years ago, Atcherson et al. analyzed the readability of 15 tinnitus patient-report measures using the Flesch Reading Ease, FOG, and FORCAST formulas and found that all 15 surpassed the 5-6th grade reading level suggested by health literacy experts. The researchers also noted that none of the reading level formulas took human factors or certain non-human factors such as layout or amount of white space, into account. The ELF-Q was developed specifically as a more qualitative measure to determine the readability of medical questionnaires. It considers many of the factors not accounted for by reading grade-level formulas. 

Methods:  For this study, we have expanded the number of questionnaires to be analyzed using both reading grade-level formulas and the ELF-Q. After obtaining the original version of the questionnaires, each will be converted to a Word document while maintaining the layout of the PDF version. These will be run through text analysis software to determine reading level scores using the same formulas as Atcherson, et al. (2011). Each questionnaire will then be analyzed by two authors separately using the ELF-Q, after which the two authors will meet and come to a consensus regarding scoring and recommendations for improvement. As part of the ELF-Q, both lexical density and technicality of vocabulary need to be examined. For lexical density, we will be using a free online text analyzer for computation. The technicality of vocabulary will be determined by comparing the vocabulary used in the questionnaire to the New General Service List published in 2013 (Brezina & Gablasova, 2013).