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Chapter 1
or anyone else [24]. In practice, a PROM is a standardized assessment using one or more questionnaires. Researchers and policy makers believe that routine PROMs have the potential to play a significant role in advancing the quality and patient-centeredness of health care [25,26]. Driven by positive research outcomes, they have been stimulating allied health professionals for decades, not in the least physical therapists, to implement PROMs into their daily practice [27]. Physical therapists use PROMs to guide diagnostic and treatment decisions, treatment planning and/or treatment evaluation. They help to evaluate the burden of disease and treatment from the patients’ perspective [28], stimulate discussion of patient outcomes during consultations and facilitate provider-patient interaction [29,30]. Furthermore, they increase patient satisfaction about provider-patient interaction and clinically significantly reduce prevalence and severity of symptoms [31]. Using traditional paper-based questionnaires is not likely to contribute positively to the situation of patients with low HL though, because low HL is strongly associated with low literacy [32]. Therefore one can assume that in patient populations with low HL the use of questionnaires will not contribute to provider-patient interaction but in fact might complicate the situation further. However, previous research has shown that the use of a Talking Touchscreen (TT) increases the ability of patients with low literacy to complete health- related questionnaires, even if they have limited or no computer skills [33-44].
ADDING TECHNOLOGY INCREASES THE ABILITY OF PATIENTS WITH LOW HEALTH LITERACY TO COMPLETE QUESTIONNAIRES
In 2003, Elisabeth Hahn and David Cella were the first authors to describe the necessity of developing a Talking Touchscreen (TT) for patients with low literacy [33]. Within this key paper, they drew a very detailed 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 fits perfectly with the causal pathways whereby inadequate HL leads to low health outcomes, which were later on described by Paasche-Orlow and Wolf (see Fig. 1.1) [13]. The disadvantaged position of low literacy people in a health care context described by Hahn et al. in 2003 [33] still applies to low literacy people in the Netherlands today [45-47]. Research shows that adding TT technology to questionnaires increases the usability of PROMs for
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