The Readability of Patient-Reported Measures in Early Psychosis

Area of Science:

• Psychiatry and Mental Health
• Health Services Research
• Patient-Reported Outcomes

Background:

• Patient-reported measures are vital for early psychosis intervention.
• Individuals with psychosis often have lower educational attainment and cognitive challenges.
• Readability of these measures is critical but unexamined in psychosis care.

Purpose of the Study:

• To assess the readability of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) used in early psychosis intervention.
• To identify potential barriers to accessing and accurately completing these measures for the target population.

Main Methods:

• A scoping review identified 111 measures used in early intervention services for psychosis (2000-2024).
• 104 measures (89 PROMs, 15 PREMs) were analyzed for readability using three established formulas.
• Readability was assessed on instructions, items, and total scales.

Main Results:

• 82.7% of measures exceeded the recommended 6th-grade reading level.
• Instructions were significantly harder to read (mean grade 9.44) than items (mean grade 7.95).
• Patient-reported experience measures (PREMs) were less readable than PROMs; co-developed measures also exceeded readability thresholds.

Conclusions:

• The majority of patient-reported measures in early psychosis are not easily accessible due to high readability levels.
• This poses risks to data validity, patient inclusion, and equitable representation.
• Integrating readability assessments and centering lived experience in measure development is essential for patient-centered care and epistemic justice.