Readability and Comprehensibility of Tinnitus Patient-Reported Outcome Measures: Application of the Evaluative...

This study assessed the readability and comprehensibility of patient-reported outcome measures (PROMs) related to tinnitus using both readability formulas and the Evaluative Linguistic Framework for Questionnaires (ELF-Q).

Nine validated tinnitus PROMs were evaluated using three readability formulas: FORCAST, Gunning FOG, and Flesch Reading Ease. Each PROM was also analyzed using the ELF-Q, which assesses structural and linguistic features influencing comprehension. The Mini-Tinnitus Questionnaire (Mini-TQ) was reformatted using ELF-Q principles to demonstrate improvements in usability.

Most PROMs exceeded recommended reading levels, with readability scores indicating high school-level demands. ELF-Q analysis revealed that all PROMs required modifications; three needed only minor changes, while four required major revisions. The reformatted Mini-TQ was the only version rated fully acceptable on ELF-Q criteria.

Readability and structural clarity are often overlooked in PROM development. The ELF-Q offers a practical tool for identifying and addressing issues that affect patient comprehension and response burden. Incorporating both readability formulas and ELF-Q during development or clinical selection of PROMs may enhance accessibility and reliability of patient-reported data.