Readability of Patient-Reported Outcome Measures in Urogynecology

Given the role of patient-reported outcome measures in evaluating pelvic floor symptoms, concerns have been raised regarding whether their required reading levels are appropriate for diverse patient populations. It is important to ensure patients of varying health literacy are able to read them to ensure accurate symptom reporting.

Patient-reported outcome measures (PROMs) are invaluable in health care to guide clinical practice and measure outcomes in clinical trials. Studies of PROM readability have been limited by variability in readability formulas, calculators, and handling of PROM-specific syntax. Our objective was to assess the readability of validated PROMs for pelvic organ prolapse (POP) and urinary incontinence (UI) using 3 validated formulas of readability utilizing a reproducible methodology for handling PROM syntax.

Validated English-language PROMs assessing POP and UI were identified. Questionnaires were analyzed using the Readability Studio software using 3 formulas: (1) Flesh-Kincaid Grade Level, (2) FORCAST, and (3) Gunning-Fog Index.

Forty-three PROMs were assessed. For the 6 PROMs assessing both POP and UI, average readability scores per the Flesh-Kincaid, FORCAST, and Gunning-Fog indices were 1.1, 11.0, and 14.1, respectively. For the 3 POP PROMs, average readability scores per the Flesh-Kincaid, FORCAST, and Gunning-Fog indices were 6.6, 9.8, and 9.4, respectively. Average readability scores for 34 UI PROMs were 9.8, 10.8, and 11.7, respectively. Seven of the PROMs for UI (21%) met the recommended sixth-grade reading level according to at least one of the 3 applied readability formulas. Overall, 81% (N=35) of all PROMs evaluated didn't meet the American Medical Association's (AMA) recommended reading level according to at least one of the 3 formulas.

Most PROMs for UI and POP were not written at the AMA recommended reading level. The limitations of PROMs and their effect on clinical care and research among patients with limited health literacy should be considered. Future studies should focus on improving the accessibility of PROMs among educationally diverse populations.