Readability of patient-reported outcome questionnaires for use with persons with dysphonia

The purpose of this study was to examine the readability of several published patient-reported outcome (PRO) questionnaires for persons with dysphonia, and to compare the readability results with existing data about average reading levels for English-speaking adults living in the United States.

A search was conducted to identify published PRO questionnaires related to dysphonia that are traditionally completed by patients in a self-administered format.

Reading grade levels were analyzed separately for 12 different voice-related PRO questionnaires using the Flesch Reading Ease, FOG, and FORCAST formulas as computed by a readability calculations software package. Descriptive statistics were also computed across the questionnaires.

The results of this study demonstrate that most PRO questionnaires exceeded the fifth- to sixth-grade reading levels recommended by health literacy experts regardless of the formula applied.

In the demand for standardization of voice-related quality of life assessment tools, developers should consider readability as another testable construct because poor readability may affect validity, reliability and sensitivity. The voice clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or their proxy. Developers of PRO questionnaires should consider reading level of respondents and include information about this when reporting psychometric data.