The influence of patient education level on the International Prostatic Symptom Score

The American Urological Association developed a questionnaire to quantify the severity of symptoms due to benign prostatic hyperplasia (BPH). An additional question relating to the impact of BPH on the quality of life was added, and this questionnaire became known as the International Prostate Symptom Score (I-PSS) and was adopted by the World Health Organization. The objective of our study was to determine the influence of education on the I-PSS and to analyze the relationship of the effect on the questionnaire when self-administered or administered by professional medical personnel. I-PSS was administered to 92 patients 50 to 81 years old (mean age 63) with BPH. Patients were assessed into 2 groups according to the level of education. Group 1 was composed of 68 patients considered literate and group 2 comprised 24 patients considered illiterate by UNICEF criteria. Patients received orientation about the questionnaire and the manner of completion. The symptom index was self-administered (subgroup P) and administered with physician help (subgroup D). Statistical analysis was done using Wilcoxon method for nonparametric samples and regression analysis. The difference between P and D subgroups in group 1 was not statistically significant (p = 0.55). However, the difference between subgroups P and D in group 2 was statistically significant (p < 0.001). There was no correlation between the mean I-PSS in subgroup D of literate and illiterate groups. Our study suggests that illiterate patients were not able to answer the questionnaire but with the help of professional medical personnel the I-PSS could be extended to this group of patients without impairing the quality.