Page 21 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

low (health) literacy patients [33-44]. This opens the possibility for this disadvantaged group to take advantage of the positive effects that using PROMs has on provider-patient interaction [25,26,28-31]. According to the conceptual model of Paasche-Orlow and Wolf, this should eventually influence health outcomes positively [13].
MINORITY GROUPS ARE EVEN MORE VULNERABLE WHEN IT COMES TO HEALTH LITERACY AND COMPLETING QUESTIONNAIRES
Specific subgroups of patients with low HL are formed by patients with low literacy who do not master the native language of the countries in which they live and who belong to a minority group. A ‘minority group’ was defined by Tourangeau et al. as “a group of residents in a nation state, which is a distinct subgroup of that state’s resident population. It is in a non-dominant position, endowed with cultural or linguistic characteristics that differ from other groups. The subgroup has an internal cohesion based on its distinct characteristics.” [48]. People with a Turkish background form the biggest minority group in the Netherlands with 400,367 people [49]. In 2016, The Netherlands Institute for Social Research reported the following characteristics of this minority group: approximately one-third of the Turkish people between 15 and 65 years of age in the Netherlands only went to primary school in comparison to six percent of the Dutch population. Younger people and people who are born in the Netherlands to Turkish parents identify strongly with Turkish people and spent most of their free time with people who identify themselves as Turkish too. Fifty- seven percent of parents with a Turkish background never or almost never communicate in Dutch with their children [50]. The number of people with low literacy and low HL within this population is unknown but, since education and literacy are very strongly associated [51,52] and language, ethnicity, culture and educational level are factors that influence health literacy [13], one can assume that low literacy and low health literacy are overrepresented within this group. In order to reduce health inequality between native and minority groups, researchers of earlier publications on TTs emphasized the importance of creating different language versions of TTs in order to accommodate minority populations [33,34,37,38,41,42].
General introduction
15
1