Page 167 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

Evoluation of the Dutch and Turkish version
of both usability studies of the TTSQ show that this should particularly be improved for the least skilled future users. Therefore, the logical next step is adapting and testing both language versions of the tool solely with inexperienced users who have low literacy. When the pre- tests show that future users at risk of exclusion are able to complete the Turkish and Dutch versions of the TTSQ fully without encountering serious or critical usability problems, pretests on response processes should be conducted to get a first impression of the face validity of both versions of the questionnaire [49]. Additionally, the equivalence of both language versions should be tested using item response theory [50]. Dependent on the results of these response processes and item response theory studies, cultural adaptation of the Turkish TTSQ may be needed to avoid bias from cultural and linguistic effects on interpretation, retrieval, judgment and response selection, which are the four phases of the response process as described by Tourangeau et al. [51]. Both researchers and participants should communicate in Turkish in all future studies on the Turkish TTSQ to avoid the methodological problems encountered in the current study. Recruitment of participants with a Turkish background should be done by intermediaries with Turkish backgrounds, rather than by the researchers themselves, to limit the chance of people agreeing to participate too easily without foreseeing the consequences of their participation. When the results of all pretests are satisfactory, the last step in research should be quantitative usability, validity and reliability testing to produce generalizable data.
No data on levels of literacy, health literacy or digital skills are available for the Turkish minority group in the Netherlands. Research should be done to get insight into these characteristics and into attitudes towards use of information and communication technology in general and of mHealth technology more specifically within this and other minority groups. Otherwise, these already disadvantaged groups may not be able to profit from the advantages of the use of m- and eHealth technologies [52,53,54]. This may add to the ongoing exacerbation of health inequalities in the Netherlands [55].
It is of great importance to keep striving for the development of TT questionnaires which are user-friendly to low literacy minority patients who have not mastered the native language of the countries in which they are living in. Such tools will greatly facilitate data collection within
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