Completing the Patient Specific-Complaint Questionnaire in Physical Therapy Practice is Problematic for High and Low Literate Patients: A Qualitative Study

Main Article Content

Marlies Welbie
H Wittink
M J Westerman
W L J M Deville

Abstract

Objective: to get insight into the perspectives of physical therapy patients with different levels of health literacy on ‘ease of use’ and ‘usefulness’ of the most frequently used questionnaire in Dutch physical therapy: the Patient Specific-Complaint questionnaire (PSC). Methods: Cognitive interviews were conducted with twenty-five Dutch and twenty-five Turkish physical therapy patients with variable health literacy levels after they completed the Dutch PSC. A thematic content analysis approach was used to analyze the data.Results: Nineteen respondents did not complete the PSC fully and ten were not able to complete the questionnaire at all. All respondents but one experienced difficulties completing the PSC. Most problems were experienced in understanding and interpreting the instructions and questions. Low educated and low health literate respondents experienced more difficulties than high educated and adequate health literate respondents did. Due to these difficulties in twenty-four cases the PSC generated other information than was intended by its developers. Almost half of the respondents were positive about the usefulness of the PSC in relation to their treatment process. Conclusions: Completing questionnaires is more difficult for patients than care providers might realize. The results of this study confirm the necessity to collaborate with patients in all stages of questionnaire development. The ease of use of questionnaires should be tested and if necessary improved. To stimulate questionnaire developers to take usability and face and content validity into account, it is recommended to incorporate assessment of these criteria in quality evaluation tools like the COSMIN checklist.

Article Details

Section
Regular Articles

References

Black, B. (2013). Patient reported outcome measures could help transform healthcare. British Medical Journal 97(4):8-13.

Wees van der, P.J., Nijhuis van der, Sanden M.W., Ayanian, J.Z., Black, N., Westert, G.P., Schneider, E.C. (2014). Integrating the use of patient-reported outcomes for both clinical practice and performance measurement: views of experts from 3 countries. Milbank Quaterly 92(4):754-775.

U.S. Department of Health and Human Services, Food and Drug Administration (2009). Guidance for industry: Patient-reported outcome measures used in medical product development to support labeling claims. Washington: U.S. Department of Health and Human Services.

Ellwood, P. (1988). Outcomes management – a technology of patient experience. New England Journal of Medicine 318:1549–1556.

Swinkels, R.A.H.M., Meerhoff, G.M., Custers, J.W.H., Peppen van, R.P.S., Beurskens, A.J.H.M., Wittink, H. (2015) Using Outcome Measures in Daily Practice: Development and Evaluation of an Implementation Strategy for Physiotherapists in the Netherlands. Physiotherapy Canada 67(4):357-364.

Calvert, M., Brundage, M., Jacobsen, P.B., Schünemann, H.J., Efficace, F. (2013). The CONSORT Patient-Report Outcome (PRO) extension: implications for clinical trials and practice. Health and Quality of Life Outcomes 11:184.

Kotronoulas, G., Kearney, N., Maquire, R. (2014). What is the value of the routine use of patient-reported outcome measures toward improvement of patient outcomes, processes of care and health services outcomes in cancer care? A Systematic review of controlled trials. Journal of Clinical Oncology 32:1480-1501.

Ahmed, S., Berzon, R.A., Revicki, D.A., Underking, W.R., Moinpour, C.M., Basch, E., Reeve, B.B., Wu, A.W. (2012). The use of patient-reported outcomes (PRO) within comparative effectiveness research: implications for clinical practice and health care policy. Medical Care 50(12):1060-1070.

Reuben, D.B., Tinetti, M.E. (2012). Goal-oriented patient care – an alternative health outcomes paradigm. New England Journal of Medicine 366(9):777-779.

Duncan, E.A., Murray, J. (2012). The barriers and facilitators to routine outcome measurement by allied health professionals in practice: a systematic review. BioMed Central Health Services Research 12:96.

Swinkels, R.A.H.M., Peppen van, R.P.S., Wittink, H., Custers, J.W.H., Beurskens A.J.H.M. (2011). Current use and barriers and facilitators for implementation of standardized measures in physical therapy in the Netherlands. BioMed Central Musculoskeletal Disorders 12:106.

Moran, P., Kelesidi, K., Guglani, S., Davidson, S., Ford, T. (2012). What do parents and carers think about routine outcome measures and their use? A focus group study of CAMHS attenders. Clinical Child Psychology and Psychiatry 17:65–79.

Happell, B. (2008). Meaningful information or a bureaucratic exercise? Exploring the value of routine outcome measurement in mental health. Issues in Mental Health Nursing, 29:1098–1114.

Davis, F.D. (1989). Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Quarterly 13(3):319-340.

Twickler, T.B., Hoogstraaten, E., Reuwer, A.Q., Singels, L., Stronks, K., Essink-Bot, M. (2009). Laaggeletterdheid en beperkte gezondheidsvaardigheden vragen om een antwoord in de zorg. Nederlands Tijdeschrift voor Geneeskunde 153(A250):1-6.

Fourage, D., Houtkoop, W., Velden van der, R. (2011) Laaggeletterdheid in Nederland. Resultaten van de Adult Literacy and Life Skills Survey (ALL) [Low literacy in The Netherlands. Results of the Adult Literacy and Life Skills Survey (ALL)]. 's-Hertogenbosch, Utrecht, Maastricht: Expertisecentrum Beroepsonderwijs.

Paasche-Orlow, M.K., Wolf, M.S. (2007). The causal pathways linking health literacy to health outcomes. American Journal of Health Behaviour 31(1):S19-S26.

Tourangeau, R., Rips, L.J., Rasinski, K. (2000). The psychology of survey response. Cambridge: Cambridge University Press.

DeWalt, D.A., Berkman, N.D., Sheridan, S., Lohr, K.N., Pignone, M.P. (2004). Literacy and Health Outcomes. A systematic review of the literature. Journal of General Internal Medicine 19:1228-1239.

Nutbeam, D. (1998). Health Promotion Glossary. Health Promotion International 13:349-364.

Heide van der, I., Wang, J., Droomers, M., Spreeuwenberg, P., Rademakers, J., Uiters, E. (2015). The relationship between health, education, and health literacy: results from the Dutch Adult Literacy and Life Skills survey. Journal of Health Communication: International Perspectives 18(1):172-184.

Alphen van, A., Westerman, M.J., Visschedijk, J.H.M., Hertogh, C.M.P.M. (2013). A qualitative study of Falls Efficacy Scale-International/Hips. What do we measure? Tijdschrift voor gerontologie en geriatrie 44:3-11.

Liu, R.D.K., Buffart, L.M., Kersten, M.J., Spiering, M., Brug, J., Mechelen van, W., Chinapaw, M.J.M. (2011). Psychometric properties of two physical activity questionnaires, the AQuAA and the PASE, in cancer patients. BioMed Central Medical Research Methodology 11:30.

Pool, J.J.M., Hiralal, S.R., Ostelo, R.W.J.G., Veer van der, K., Vet de, H.C.W. (2010). Added value of qualitative studies in the development of health related patient reported outcomes such as the pain coping and cognition list in patients with sub-acute neck pain. Manual Therapy 15:43-47.

Matata, B., Hinder, S., Steele, S., Gibbons, E., Jackson, M. (2013). Patients’ attitudes and perceptions of two health-related quality-of-life questionnaires used to collect patient-reported outcome measures in the English National Health Service: A qualitative study of patients undergoing cardiac interventions. SAGE Open Medicine 1:12.

Auger, C., Demers, L., Desrosiers, J., Giroux, F., Ska, B., Wolfson, C. (2007). Applicability of a toolkit for geriatric rehabilitation outcomes. Disability and Rehabilitation 29(2):97–109.

Bonevski, B., Randell, M., Paul, C., Chapman, K., Twyman, L., Bryant, J., Brozek, I., Hughes, C. (2014). Reaching the hard-to-reach: a systematic review of strategies for improving health and medical research with socially disadvantaged groups. Biomed Central Medical Research Methodology 14:4.

CBS Statistics Netherlands. (2015). Population, gender, age and origin. Den Haag/Heerlen: CBS Statistics Netherlands http://statline.cbs.nl/StatWeb/publication/?VW=T&DM=SLNL&PA=37325&D1=a&D2=0&D3=0&D4=0&D5=0-4,137,152,220,237&D6=0,4,9,(l-1),l&HD=130605-0936&HDR=G2,G1,G3,T&STB=G4,G5 (last accessed 8 December 2015).

Beurskens, A.J., Vet de, H.C., Koke, A.J., Lindeman, E., Heijden van der, G.J., Regtop, W., Knipschild, P.G. (1999). A patient-specific approach for measuring functional status in low back pain. Journal of Manipulative and Physiological Therapeutics 22(3):144-148.

Beurskens, A.J.H.M. (1996). A patient-specific approach for measuring functional status in low back pain. In: Low back pain and traction: thesis. Maastricht: Rijksuniversiteit Limburg.

Stratford, P. (1995). Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada, 47(4):258-63.

Beatty, P.C., Willis, G.B. (2007). Research synthesis: the practice of cognitive interviewing. Public Opinion Quarterly 71(2):287–311.

Collins, D. (2003). Pretesting survey instruments: An overview of cognitive methods. Quality of Life Research 12:229-238.

Fransen, M.P., Van Schaik, T.M., Twickler, T.B., Essink-Bot, M.L. (2011), Applicability of internationally available health literacy measures in the Netherlands. Journal of Health Communication 16(3):134-149.

Braun, V., Clarke, V. (2006). Using thematic analysis in psychology. Quality Research in Psychology 3(2):77-101.

Groot, W., Maassen van den, Brink H. (2006). Stil vermogen. Onderzoek naar de maatschappelijke kosten van laaggeletterdheid. Amsterdam: University of Amsterdam.

Hahn, E.A., Hangyan, D., Garcia, S.F., Choi, S.W., Victorson, D., Cella, D. (2010). Literacy-fair measurement of health-related quality of life will facilitate comparative effectiveness research in Spanish-speaking cancer outpatients. Medical Care 48(6):S75-S82.

Hofmann, J.N., Checkoway, H., Borges, O., Servin, F., Fenske, R.A., Keifer, M.C. (2010). Development of a computer-based survey instrument for organophosphate and n-methyl-carbamate exposure assessment among agricultural pesticide handlers. Annals of Occupational Hygiene 54(6):640-650.

Thornberry, J., Bhaskar, B., Krulewitch, C.J., Wesley, B., Hubbard, M.L., Das, A. (2002). Audio computerized self-report interview use in prenatal clinics: audio computer-assisted self-interview with touch screen to detect alcohol consumption in pregnant women: application of a new technology to an old problem. Computers Informatics Nursing 20(2):46-52.

Bhatnagar, T., Brown, J., Saravanamurthy, P.S., Kumar, R.M., Detels, R. (2013). Color-coded audio computer-assisted self-interviews (C-ACASI) for poorly educated men and women in a semi-rural area of South India: “Good, scary and thrilling”. AIDS and Behaviour 17(6):2260-2268.

Yost, K.J., Webster, K., Baker, D.W., Jacobs, E.A., Anderson, A., Hahn, E.A. (2010). Acceptability of the Talking Touchscreen for health literacy assessment. Journal of Health Communication 15(2):80-92.

Thumboo, J., Wee, H.L., Cheung, Y.B., Machin, D., Luo, N., Fong, K.Y. (2006). Development of a smiling touchscreen multimedia program for HRQoL assessment in subjects with varying levels of literacy. Value in Health 9(5):312-319.

Saha, S., Beach, M.C. (2011). The impact of patient-centered communication on patients’ decision making and evaluations of physicians: A randomized study using video vignettes. Patient Education and Counseling 84(3):386-392.

Williams, M.V., Baker, D.W., Parker, R.M., Nurss, J.R. (1998). Relationship of functional health literacy to patients’ knowledge of their chronic disease. A study of patients with hypertension and diabetes. Archives of Internal Medicine 158(2):166-172.

Nicklin, J., Cramp, F., Kirwan, J., Urban, M., Hewletts, S. (2010). Collaboration with patients in the design of Patient-Reported Outcome Measures: capturing the experience of fatigue in rheumatoid arthritis. Arthritis Care Research 62(11):1552-1558.

Terwee, B., Mokkink, L.B., Knol, D.L., Ostelo, R.W.J.G., Bouter, L.M., Vet de, H.C.W. (2012). Rating the methodological quality in systematic reviews of studies on measurement properties: a scoring system for the COSMIN checklist. Quality of Life Research 21(4):651-657.