Readability and Understandability of Spanish Urogynecology Questionnaires

INTRODUCTION: The Hispanic population is the largest minority group in the United States. This group overall has a low healthcare status due to multiple factors, including language barriers and, in particular, limited health literacy. OBJECTIVE: To evaluate the readability and understandability of Spanish language urogynecology quality of life questionnaires based on literacy standards. METHODS: We identified five Spanish language-validated questionnaires assessing female sexual function, pelvic floor dysfunction, and related qualify of life: Pelvic Floor Impact Questionnaire – 7 (PFIQ-7), Prolapse and Inconsistence Knowledge Questionnaire (PIKQ), Pelvic Floor Distress Inventory Questionnaire – 20 (PFDI-20), Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire – 12 (PISQ-12), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire – IR (PISQ-IR). For readability, we analyzed the questionnaires in accordance with the American Medical Association (AMA) recommended standard of 6th-grade reading level using two validated readability calculators: the Fernandez-Huerta readability tool and Inflesz Readability Scale. For understandability, we used the Patient Education Materials Assessment Tool – Spanish (PEMAT-S), defining understandable documents as those with a score of 70% or higher. We calculated mean readability scores for all questionnaires combined and for each individual questionnaire. We also performed a sub-analysis by scoring each question within each questionnaire. Readability scores were calculated by one reviewer and referenced against an online Spanish readability calculator. Two independent reviewers scored each questionnaire for understandability. Univariate and descriptive statistics were calculated to compare outcomes using Stata. RESULTS: For readability, on average, the questionnaires were written above a 6th-grade reading level. The mean readability scores ranged from 4–6th grade to 11–12th grade, with the PISQ-IR having the best readability (and only questionnaire meeting the 6th-grade reading level goal) and the PFIQ-7 having the lowest readability (Figure 1). For understandability, the average was below the goal of 70%, with a mean score of 64% for all questionnaires combined (95% CI [48, 76]). The individual PEMAT scores show a range from 43% to 71% with the PFDI-20 having the highest understandability and the PISQ-IR having the lowest understandability (Figure 2). CONCLUSIONS: Our results indicate poor readability and understandability for the Spanish-validated questionnaires assessing pelvic floor and sexual dysfunction. Therefore, these questionnaires may not be accessible for many of our Spanish-only patients. This information may help improve commonly used patient assessment tools to better serve our Spanish-only patients’ needs.