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to independently complete the PSC [1], which is the most frequently used PROM in Dutch physical therapy practice [39], in a way that meets its purpose. This does not only apply to patients with low health literacy, but to physical therapy patients in general. Additionally, the results of Chapter 4 show how difficult it is to adjust this questionnaire in a way that makes it possible for low literacy people to complete it without the help of anyone else and provide questions and answer options that can only be interpreted in one way, reducing the chances of creating bias. It is known that questionnaires are mostly drawn up by researchers and professionals who want to gather information and quantify the patient’s condition on aspects that they are able to treat, while patients want to share information about the way their condition is affecting their lives [47]. All of this information combined raises the question to what extent using PROMs in ‘real life clinical practice’ really adds to bringing the undiluted patient perspective into the clinical decision-making process.
DEVELOPMENT OF TALKING TOUCHSCREENS SINCE 2003
In 2003 Elisabeth Hahn and David Cella were the first authors who described the necessity of developing a Talking Touchscreen (TT) for low literacy patients [15]. Within this key paper, they drew a very detailed and complete picture of the disadvantaged position of this vulnerable population when it comes to health and the ability to make effective use of health care. This description still applies to the situation of people with low (health) literacy in the Netherlands today [41,48,49]. Although the researchers and design team of the current project did not look at the design of previously-developed TTs and followed their own path during the development of the TTSQ, the first TT described by Hahn and Cella [15] shows many similarities with the prototype of the TTSQ.
Just like the TTSQ that was subject of the current thesis, the TT of Hahn and Cella [15] was developed on a portable touchscreen and one question per screen was shown. Instructions on the functionalities on the screens were given in the first screen. Different from the TTSQ, each question in the TT of Hahn and Cella was automatically read out loud and small picture icons of an ear appeared near each text element, in order for the respondents to be able to replay the sound of each element as many times as they wished to. Figure 5.2 shows sample screens for one question in English and in Spanish.
General discussion
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