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psychological aspects of completing questionnaires into account in designing a TTSQ for people with low literacy.
Chapter 4 describes the evaluation of the Dutch and the later- developed Turkish translation of the TTSQ in a physical therapy context. Chapter 4.1 shows that the use of plain language and information and communication technology (ICT) had a positive effect on the comprehensibility of the Dutch version of the TTSQ. However, it also had some negative effects on the other four aspects of the response process: interpretation, retrieval, judgment, and response selection [6]. Due to the plain language used, some questions lacked detail, which made them multi-interpretable. Multi-interpretation was also problematic in the use of pictures as answer options for limitations in daily activities. Furthermore, 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 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, as witnessed by the fact that all participants reported recognizing 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. In Chapter 4.2, the results of the usability study of the Dutch version of the TTSQ are shown. The data collection for this study was carried out in the same research population at the same time as the data presented in Chapter 4.1 were collected. Results of the usability study show that all 24 Dutch participants were very satisfied with the ease 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 [7], 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
General discussion
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