Page 196 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE
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Chapter 5
Nine persons with low literacy with a Dutch and one with a Turkish background joined the design team that would develop the Dutch TTSQ. They informed the other members that having low literacy in an information society like the Netherlands is stressful, because it makes people feel unworthy, unsafe and ashamed in the many situations they encounter in daily life in which too much is being asked of them. Asking a low literacy person to complete a questionnaire does put the person at risk of being exposed as having low literacy, when many of these people are very busy hiding this problem on a daily basis. All of the low literacy designers shared examples of situations in which filling out forms had had a negative effect on their own lives or the lives of someone they knew. They mentioned problems like social welfare being stopped, being visited by child protection agencies, having to pay more taxes, etc. This made them reluctant and anxious when asked to fill out forms. They added that these negative feelings could be strengthened by personal characteristics which, according to them, many people with low literacy, including themselves, develop during the course of their lives, such as being unsure, having low self-esteem and doubting their own judgment. In addition, they expressed the view that being in the vulnerable and dependent position of being a patient could strengthen the stress of having to fill out a questionnaire because refusing to complete a questionnaire could have negative effects on the provider-patient relationship and therefore on the quality of care that the provider is able or willing to give to you as a patient. Additionally, three low literacy designers expressed their view that they thought professionals asked patients to fill out questionnaires to be able to put the blame on the patient in case things go wrong. All of these remarks combined gave the researchers and designers of the current research project the insight that patients with low literacy are not able to take advantage of the positive effects that the use of PROMs can have on the quality of provider-patient interaction and health outcomes [9- 14]. Asking low literacy patients to fill out questionnaires can create an unsafe environment for the patient and therefore have negative effects on the patient, provider-patient relationship, and health outcomes. For this reason, a lot of effort was put into the design of the TTSQ to provide users with information on the goal of the questionnaire, the way personal data is handled, the way privacy is guaranteed and to reassure them that there is no time pressure and answers can be adjusted even after the questionnaire is finished. The TTSQ also has an escape button, so users do not feel pressured into completing it. It
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