Readability and Understandability of Spanish Language Urogynecology Questionnaires

The objective was to evaluate the readability and understandability of Spanish-language Urogynecology questionnaires.

We identified five common Spanish-language questionnaires assessing pelvic floor function: the Pelvic Floor Distress Inventory Questionnaire-20 (PFDI-20), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-revised (PISQ-IR), the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, the Pelvic Floor Impact Questionnaire-7 (PFIQ-7), and the Prolapse and Inconsistence Knowledge Questionnaire. Readability was assessed with the Fernandez-Huerta readability tool and Indice de Legibilidad de Flesch-Szigriszt (INFLESZ) readability scale based on the American Medical Association 6th grade readability standard. Understandability was measured with the Health Education Materials Assessment Tool, defining understandability as a score of ≥ 80%. Scores were calculated by two native Spanish-speaking reviewers and referenced against an online Spanish readability calculator.

Readability of the questionnaires was generally suboptimal, scoring above a 6th grade reading level. The PFIQ-7 had the worst mean reading level of 11th to 12th grade, whereas the PISQ-IR had the best mean reading level of 6th grade-the only one meeting the readability standard of ≤ 6th grade. The variability of reading levels was widest for the PFDI-20 and narrowest for the PFIQ-7. For understandability, the PISQ-IR scored the lowest at 42%, whereas the PFD1-20 scored the highest at 71%, with none meeting the goal of ≥ 80%.

Readability and understandability for these Spanish-language questionnaires assessing pelvic floor dysfunction were generally low. These materials could be optimized for our Spanish-only patients to improve both research and direct patient care in this population.