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Chapter 5
in using mobile technology, the more problems they encountered. The results of the usability study of the Turkish version of the TTSQ, presented in Chapter 4.3, confirm that participants with less education and less experience in using mobile technology were less able to operate the TTSQ effectively. Most of the 11 Turkish participants, who were in general educated to a lower level and less health literate than participants in the usability study of the Dutch version of the TTSQ, were neither distinctly satisfied nor 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 with the tool. Seventeen different kinds of problems were found, of which three needed to be addressed during future development of the tool based on their Nielsen and Loranger severity score [7]. Because the research team had managed to recruit very vulnerable participants in terms of educational level, health literacy level, experience with using mobile technology, health and social status, the results of this study gave good insight in how hard it is for this group, not only to handle technology that is new to them, but to participate in a research project in the first place.
In the current Chapter 5, the results of the studies described in this thesis are put into a broader perspective by reflecting on the use of questionnaires in clinical practice in general and comparing both the methods used and results found within this thesis to those of other studies on similar tools. Finally, recommendations for clinical practice and future research are provided.
HEALTH LITERACY AND THE USE OF QUESTIONNAIRES
The hypothesis underlying the research project described within this thesis was that adapting and using a questionnaire to help patients with low HL to explicate, order and prioritize their symptoms and limitations would help them to take a more active part in provider- patient interaction during the diagnostic process of physical therapy treatment. This hypothesis was based on one of the pathways Paasche-Orlow and Wolf described in their conceptual model, in which inadequate health literacy, caused by factors such as ethnic background, socio-economic status, language proficiency and age, causes problems within provider-patient interaction which has a negative effect on health outcomes (see fig. 5.1) [8]. The use of PROMs
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