Jorge Garavito and Patricia Rodarte, The Warren Alpert Medical School of Brown University; Ronald Navarro, MD
Patient reported outcome measures (PROMs) are increasingly used to quantify patient symptomatology in assessing intervention effectiveness, guiding patient-centered healthcare management, and research. Previous studies have analyzed the readability of English language orthopaedic-specific PROMs; however, the readability of Spanish language orthopaedic-specific PROMs has not been evaluated. Given the prevalence of low health literacy among an increasing number of Spanish-speaking individuals seeking orthopaedic care in the United States, it is imperative that PROMs are at an adequate reading level for patients to answer appropriately. This study aims to assess the readability of publicly available Spanish-language orthopaedic-specific PROMs.
Research Question
What is the readability level of Spanish language orthopaedic-specific patient reported outcome measures (PROMs)?
Background
Patient reported outcome measures (PROMs) are increasingly used to quantify patient symptomatology in assessing intervention effectiveness, guiding patient-centered healthcare management, and research. Previous studies have analyzed the readability of English language orthopaedic-specific PROMs; however, the readability of Spanish language orthopaedic-specific PROMs has not been evaluated. Given the prevalence of low health literacy among an increasing number of Spanish-speaking individuals seeking orthopaedic care in the United States, it is imperative that PROMs are at an adequate reading level for patients to answer appropriately. This study aims to assess the readability of publicly available Spanish-language orthopaedic-specific PROMs.
Methods
PubMed, Google Scholar, and Embase searches were conducted to identify publicly available Spanish language versions of orthopaedic-specific PROMs.The PROMISⓇ Health Organization was contacted to obtain additional the Spanish language versions of the PROMISⓇ questionnaires. A total of 42 Spanish language PROMs were identified and included in this study. The Portable Document Formats were converted to Google Documents and adjusted for formatting. The text of each PROM was inserted into a multilingual readability software (legibile.es), which analyzed the readability of each PROM using the Fernández Huerta and INFLESZ readability formulas. The mean and standard deviation of raw readability scores for the PROMs were calculated. The percentage of PROMs at or below the sixth-grade reading level was also calculated.
Results
The mean of the Fernández Huerta analysis was at an 8th-9th grade reading level (mean= 68.49, SD=15.54) and the INFLESZ was at an 8th-10th grade reading level (mean=63.69, SD=16.04). On average, 14.3% of orthopaedic PROMs were at or below the sixth-grade readability level using Fernández Huerta, while 57.1% of articles were at or below this level using INFLESZ.
Conclusions
On average, Spanish language orthopaedic-specific PROMs are written at a reading level that does not meet NIH/AMA’s sixth-grade recommendation. Therefore, PROM developers and translators should consider the significance of readability when translating PROMs to help diminish health literacy barriers among the Spanish-speaking population seeking orthopaedic care.
About the Authors: Patricia Rodarte and I, Jorge Andrés Garavito are first-generation Mexican-Americans pursuing orthopaedic surgery at The Warren Alpert Medical School of Brown University. We are passionate about improving orthopaedic care for Latin@s and increasing representation of Latin@s in medicine, specifically in orthopaedic surgery. We are very fortunate to have collaborated with Dr. Ronald Navarro, arthroplasty and sports medicine orthopaedic surgeon at Kaiser Permanente and chief of orthopaedic surgery in the Southern California region to bring this project to fruition.
About the Work: Working on this project was uniquely rewarding because it bridges the gap between surgical subspecialty and health justice research, which are areas we are tremendously passionate about; however, they often do not go hand-in-hand. I also recognized the importance of this research project as I read through all of the Spanish-language PROMs we analyzed. I, a bilingual, college-educated student with interpreting experience pursuing a doctorate degree, was perplexed by what some of the words meant and what the questionnaires were asking. Given that most patients filling these questionnaires out have a lower health literacy than me, it must be tremendously challenging for most patients filling these out. Since the questionnaires are likely not filled out as intended due to misunderstandings, there are negative implications for their orthopaedic condition management. It is a gift to be able to contribute to raising awareness about this problem, which will result in improved, patient-centered orthopaedic care for the Spanish-speaking population.
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