Readability of patient-reported outcome questionnaires for use with persons with swallowing disorders

The purposes of this study were to examine the readability of published patient-related outcome (PRO) questionnaires for persons with swallowing problems, and to compare the readability results to existing data about average reading levels of English-speaking adults living in the United States. A search was conducted to identify published PRO questionnaires related to swallowing problems that traditionally are completed by patients in a self-administered format. Reading grade levels were analyzed separately for four different swallowing-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 all four 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 swallowing-related quality-of-life assessment tools, developers should consider readability as another testable construct, since poor readability may affect validity, reliability, and sensitivity. The swallowing clinician should consider the average reading level needed to understand a particular PRO questionnaire when administering it to a patient or his or her proxy. Developers of PRO questionnaires should consider the reading level of respondents and include information about this when reporting psychometric data.