Literacy-fair measurement of health-related quality of life will facilitate comparative effectiveness research in Spanish-speaking cancer outpatients

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Abstract

Background: Health-related quality of life (HRQL) assessment is frequently used in comparative effectiveness research, but low-literacy patients are often excluded. Appropriately translated and user-friendly HRQL measures are essential to ensure inclusion of low-literate and non-English-speaking patients in comparative effectiveness research. Objectives: To compare HRQL responses across literacy levels in Spanish-speaking patients with cancer using a multimedia touch screen program. Subjects: A total of 414 adult patients with cancer (213 with low literacy and 201 with high literacy). Research Design: The touch screen system administered 3 questionnaires: The Functional Assessment of Cancer Therapy-General, the Short Form-36 Health Survey, and the Standard Gamble Utility Questionnaire. Measurement bias was evaluated using item response theory. Effects of literacy on HRQL were evaluated using regression models. Results: Patients rated the touch screen easy to use and commented favorably on the multimedia approach. There was statistically significant item response theory measurement bias in 6 of 10 HRQL subscales; however, only 3 showed meaningful bias. Low-literacy patients had significantly lower mean scores on 3 of 4 Functional Assessment of Cancer Therapy-General subscales, before and after adjustment for patient characteristics. Low-literacy patients also had significantly lower mean scores on 5 of 6 Short Form-36 subscales; adjustment for patient characteristics attenuated or eliminated differences. Similar proportions of low- and high-literacy patients valued their current health as equivalent to perfect health. Conclusions: This study demonstrates the feasibility of this multimedia touch screen program for low-literacy patients. The program will provide opportunities to evaluate the effectiveness of interventions in more diverse patient populations.

Original languageEnglish (US)
JournalMedical Care
Volume48
Issue number6 SUPPL.
DOIs
StatePublished - Jun 1 2010

Fingerprint

Comparative Effectiveness Research
Outpatients
Quality of Life
Neoplasms
Multimedia
Literacy
Health
Feasibility Studies
Health Surveys

Keywords

  • Computer testing
  • Hispanic health
  • Item response theory
  • Literacy
  • Patient-reported outcomes

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

@article{642d6b7b4af148708c9d01d03a2f922e,
title = "Literacy-fair measurement of health-related quality of life will facilitate comparative effectiveness research in Spanish-speaking cancer outpatients",
abstract = "Background: Health-related quality of life (HRQL) assessment is frequently used in comparative effectiveness research, but low-literacy patients are often excluded. Appropriately translated and user-friendly HRQL measures are essential to ensure inclusion of low-literate and non-English-speaking patients in comparative effectiveness research. Objectives: To compare HRQL responses across literacy levels in Spanish-speaking patients with cancer using a multimedia touch screen program. Subjects: A total of 414 adult patients with cancer (213 with low literacy and 201 with high literacy). Research Design: The touch screen system administered 3 questionnaires: The Functional Assessment of Cancer Therapy-General, the Short Form-36 Health Survey, and the Standard Gamble Utility Questionnaire. Measurement bias was evaluated using item response theory. Effects of literacy on HRQL were evaluated using regression models. Results: Patients rated the touch screen easy to use and commented favorably on the multimedia approach. There was statistically significant item response theory measurement bias in 6 of 10 HRQL subscales; however, only 3 showed meaningful bias. Low-literacy patients had significantly lower mean scores on 3 of 4 Functional Assessment of Cancer Therapy-General subscales, before and after adjustment for patient characteristics. Low-literacy patients also had significantly lower mean scores on 5 of 6 Short Form-36 subscales; adjustment for patient characteristics attenuated or eliminated differences. Similar proportions of low- and high-literacy patients valued their current health as equivalent to perfect health. Conclusions: This study demonstrates the feasibility of this multimedia touch screen program for low-literacy patients. The program will provide opportunities to evaluate the effectiveness of interventions in more diverse patient populations.",
keywords = "Computer testing, Hispanic health, Item response theory, Literacy, Patient-reported outcomes",
author = "Hahn, {Elizabeth A} and Hongyan Du and Garcia, {Sofia F} and Choi, {Seung W.} and Jin-Shei Lai and Victorson, {David E} and David Cella",
year = "2010",
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language = "English (US)",
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AU - Hahn, Elizabeth A

AU - Du, Hongyan

AU - Garcia, Sofia F

AU - Choi, Seung W.

AU - Lai, Jin-Shei

AU - Victorson, David E

AU - Cella, David

PY - 2010/6/1

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N2 - Background: Health-related quality of life (HRQL) assessment is frequently used in comparative effectiveness research, but low-literacy patients are often excluded. Appropriately translated and user-friendly HRQL measures are essential to ensure inclusion of low-literate and non-English-speaking patients in comparative effectiveness research. Objectives: To compare HRQL responses across literacy levels in Spanish-speaking patients with cancer using a multimedia touch screen program. Subjects: A total of 414 adult patients with cancer (213 with low literacy and 201 with high literacy). Research Design: The touch screen system administered 3 questionnaires: The Functional Assessment of Cancer Therapy-General, the Short Form-36 Health Survey, and the Standard Gamble Utility Questionnaire. Measurement bias was evaluated using item response theory. Effects of literacy on HRQL were evaluated using regression models. Results: Patients rated the touch screen easy to use and commented favorably on the multimedia approach. There was statistically significant item response theory measurement bias in 6 of 10 HRQL subscales; however, only 3 showed meaningful bias. Low-literacy patients had significantly lower mean scores on 3 of 4 Functional Assessment of Cancer Therapy-General subscales, before and after adjustment for patient characteristics. Low-literacy patients also had significantly lower mean scores on 5 of 6 Short Form-36 subscales; adjustment for patient characteristics attenuated or eliminated differences. Similar proportions of low- and high-literacy patients valued their current health as equivalent to perfect health. Conclusions: This study demonstrates the feasibility of this multimedia touch screen program for low-literacy patients. The program will provide opportunities to evaluate the effectiveness of interventions in more diverse patient populations.

AB - Background: Health-related quality of life (HRQL) assessment is frequently used in comparative effectiveness research, but low-literacy patients are often excluded. Appropriately translated and user-friendly HRQL measures are essential to ensure inclusion of low-literate and non-English-speaking patients in comparative effectiveness research. Objectives: To compare HRQL responses across literacy levels in Spanish-speaking patients with cancer using a multimedia touch screen program. Subjects: A total of 414 adult patients with cancer (213 with low literacy and 201 with high literacy). Research Design: The touch screen system administered 3 questionnaires: The Functional Assessment of Cancer Therapy-General, the Short Form-36 Health Survey, and the Standard Gamble Utility Questionnaire. Measurement bias was evaluated using item response theory. Effects of literacy on HRQL were evaluated using regression models. Results: Patients rated the touch screen easy to use and commented favorably on the multimedia approach. There was statistically significant item response theory measurement bias in 6 of 10 HRQL subscales; however, only 3 showed meaningful bias. Low-literacy patients had significantly lower mean scores on 3 of 4 Functional Assessment of Cancer Therapy-General subscales, before and after adjustment for patient characteristics. Low-literacy patients also had significantly lower mean scores on 5 of 6 Short Form-36 subscales; adjustment for patient characteristics attenuated or eliminated differences. Similar proportions of low- and high-literacy patients valued their current health as equivalent to perfect health. Conclusions: This study demonstrates the feasibility of this multimedia touch screen program for low-literacy patients. The program will provide opportunities to evaluate the effectiveness of interventions in more diverse patient populations.

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