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Development and Validation of Emoji Response Scales for Assessing Patient-Reported Outcomes.

Carrie A Thompson¹, Paul J Novotny², Kathleen Yost²

¹Division of Hematology, Mayo Clinic, Rochester, MN.

JCO Clinical Cancer Informatics

|January 8, 2025

Summary

Patient-reported outcome scales using emoji demonstrated high validity. These novel emoji scales accurately captured patient well-being, fatigue, and quality of life, offering a new tool for electronic communication.

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Area of Science:

Digital Health
Psychometrics
Patient-Reported Outcomes

Background:

Emoji are increasingly used in electronic communication to convey emotions.
Patient-reported outcome measures (PROMs) are crucial for assessing health status.
Developing novel, engaging PROMs can improve patient engagement and data collection.

Purpose of the Study:

To develop and evaluate the psychometric properties of two novel patient-reported scales incorporating emoji.
To assess the validity and reliability of emoji-based scales for measuring patient well-being and other health outcomes.

Main Methods:

Developed the Emoji-Ordinal Scale and Emoji-Mood Scale.
Pilot studies validated the ordinal nature of emoji and selected representative emoji for emotions.
Construct validity was assessed in 294 patients using Spearman correlations, Wilcoxon tests, and Bland-Altman analyses against Linear Analog Scale Assessments (LASA) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores.

Main Results:

Thurstone scaling confirmed the ordinal nature of the Emoji-Ordinal Scale, with 95% patient agreement on emoji ordering.
High construct validity was observed: Emoji-Ordinal Scale correlations with LASA were 0.70 (emotional well-being), 0.72 (physical well-being), 0.74 (quality of life), and -0.81 (fatigue).
Emoji-Mood Scale ratings showed strong relationships with PROMIS scales for mental and physical health, fatigue, anxiety, sleep, and social activity (P < .0001).

Conclusions:

Scales incorporating emoji are valid tools for collecting patient-reported outcomes.
Emoji-based PROMs offer a promising, engaging method for assessing various aspects of patient health.
Further research can explore the application of emoji scales in diverse clinical populations and settings.