Readability of Patient Reported Outcomes in Urogynecology

Objectives: Over half of adults between age 16 and 74 lack reading proficiency, defined as below the equivalent of a 6th grade reading level. Patient-reported outcome measures (PROMs) are invaluable in assessing pelvic floor symptoms, impacts on health-related quality of life, and are essential to comparing outcomes in clinical trials and guiding clinical care. Patient comprehension of the tool is vital for providing accurate assessment of patient symptoms and treatment outcomes. The objective of the present study was to assess the readability of a large range of validated PROMs for POP and UI symptoms and condition-specific quality of life using 3 validated measures of readability.

Methods: Existing English-language PROMs assessing symptoms and condition-specific quality of life POP and UI were identified via a literature search. All previously validated, publicly available questionnaires were included. Questionnaires utilizing shapes or figures were excluded. Questionnaires were analyzed using the Readability Studio software using three formulas: Flesh-Kincaid Grade Level, FORCAST, and Gunning-Fog Index.

Results: Forty-three questionnaires met study criteria and were evaluated for readability. The readability scores for POP questionnaires ranged from 5.6 to 18.4, indicating that up to a 12th grade reading level is required to comprehend the questionnaire. The Sheffield Prolapse Symptom questionnaire and the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire - Revised (PISQ-IR) required the lowest reading grade level. Readability scores for urinary incontinence ranged from 4.0 to 19+, with the Incontinence Severity Index and the American Urological Association Symptom Index having the lowest overall readability scores, indicating easier readability. Overall, 19% (8) of all PROMs evaluated met the American Medical Association’s (AMA) recommended reading level according to at least one of the 3 analyzed metrics.

Conclusions: Most existing validated PROMs assessing UI and POP were not written at or below the AMA recommended reading level. Higher than recommended reading levels for PROMs may be a result of the populations used for development and validation of the PROM. Given the essential role of literacy in health outcomes, consideration could be given to reassessing present PROMs to improve their readability amongst educationally diverse patient populations.