Use of Spanish Validated Patient Reported Outcome Measures in Urogynecology

Objectives: US Latina women, one third of whom are monolingual Spanish speakers, are disproportionately affected by pelvic floor disorders yet underrepresented in urogynecologic research. The objective of this study was to investigate the use of patient reported outcome measures (PROMs) that have been validated in Spanish and their relationship to Latina inclusion in research.

Methods: We reviewed Original Research and AUGS Research articles published in the journal “Urogynecology” from April 2020 to March 2024. Articles were included in the analysis if they used at least one validated PROM and were conducted within the United States. Study design, demographics, and PROM usage and characteristics were collected. Our primary outcome was the percent of Latina women included in studies that used exclusively bilingually (Spanish and English) validated PROMs compared to studies that used non-Spanish validated PROMs. Secondary outcomes included characterizing utilization of Spanish-validated PROMs by symptom category and study type. Chi-square, student's t- and Mann Whitney U tests were used to test for significance where appropriate.

Results: We reviewed 124 publications that met inclusion criteria. Seventy-five studies reported Hispanic/Latina ethnicity. Twenty-four (32%) required that the patients be English speaking; of those, 15 (63%) exclusively used bilingually validated PROMs. Of the remaining 51 (68%) publications, those that exclusively used bilingually validated PROMs were associated with Latina inclusion at or above 18.5% (the demographic proportion of Latina women living within the US), whereas studies that used non-Spanish validated PROMs were not (p < 0.05). Studies that exclusively used bilingually validated PROMs reported 22.9% Latina inclusion, compared to 9.4% in studies that used non-Spanish validated PROMs. Among all 124 publications, 96 unique PROMs were used, 63 (66%) of which were validated in Spanish. PROMs validated in Spanish were used in 85% (105/124) of included studies, though only 56% (70/124) exclusively used PROMs validated in Spanish. Commonly used PROMs (used more than five times within the dataset) were validated in Spanish more often than not (83% vs 60%, p < 0.05).

Conclusions: The majority of PROMs being used in Urogynecology research currently are validated for use in a Spanish-speaking population. However, just over half of publications exclusively used bilingually validated PROMs, representing an unnecessary barrier to Hispanic/Latina participation in research. Further, a large proportion of studies that excluded Spanish-speaking women exclusively used bilingually validated PROMs, suggesting that these women may have been excluded unnecessarily. Studies that used bilingually validated PROMs reported Latina participation that reflected or superseded the proportion of Hispanic/Latina women living in the United States, demonstrating that the use of bilingually validated PROMs may increase this population’s representation in research. This work highlights a potential area for improving the diversity and inclusion of a key minority group in urogynecologic research.