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Chapter 6
showing questions and answer categories in separate screens without a back function caused respondents to lose an overview of the whole questionnaire. This made it harder for them to decide whether or not they should select an answer or instead go on to following screens in the hope that these would contain more suitable answers. On the other hand, being provided with specific answer options made some respondents fail to actively search their memories and retrieve information about situations in which they were limited because of their health problem. The problems within the response processes led to invalid and incomplete results in 20 of the 24 cases. The participants did not notice the incorrectness and incompleteness of their answers, witnessing the fact that all participants reported they recognized themselves in the overall outcomes. No educational group in this research population stood out from the rest in the kind or number of problems that arose. Chapter 4.2 evaluates the usability of the Dutch version of the TTSQ in a population of physical therapy patients with diverse levels of health literacy and a Dutch background. The results of this usability study show that all 24 Dutch participants were very satisfied with the ease of use and efficiency with which they were able to operate the questionnaire. The ease of use exceeded the expectations of the participants. However, the data on effectiveness showed 13 different kinds of problems occurring during operation of the questionnaire. According to the severity rating system of Nielsen & Loranger, nine of these problems were not likely to influence future usage of the tool substantially, but four problems needed to be addressed before the Dutch version of the TTSQ could be released. The less educated and less experienced participants were in using mobile technology, the more problems they encountered. Chapter 4.3 describes the evaluation of the usability of the Turkish version of the TTSQ in a population of physical therapy patients with different levels of health literacy and a Turkish background living in the Netherlands. The results of this study confirm that participants with lower education and less experience in using mobile technology are less able to operate the TTSQ effectively. Most of the 11 Turkish participants, who were in general lower educated and less health literate than participants in the usability study of the Dutch version of the TTSQ, were not particularly satisfied or dissatisfied about the overall ease of use of the Turkish TTSQ. Two Turkish participants, who had no prior experience using mobile technology, felt that, regardless of what kind of improvements might be made, it would just be too difficult for them to learn to work
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