Page 212 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

Chapter 5
RECOMMENDATIONS FOR FURTHER AND FUTURE DEVELOPMENT OF TALKING TOUCHSCREENS FOR USE IN CLINICAL PRACTICE TO SUPPORT PATIENTS WITH LOW HL
Recommendations for clinical practice
The findings on the difficulties participants had with the use of the PSC, described in Chapter 2 of this thesis, were in accordance with the findings of four other studies on ease of use and respondent burden of regularly used PROMs [28-31]. In all four of these studies, difficulties with the interpretation of questions and response categories were found, due to different perspectives between patients and the developers of the questionnaires. In none of these studies was the level of (health) literacy of the respondents taken into account, which may mean these outcomes are still too positive and not generalizable to a ‘real life patient population’. Based on the knowledge the current PhD study adds to already existing knowledge about problems encountered by patients and clinicians in using PROMs, the worth and legitimacy of routine use in clinical practice of PROMs in their current state may need to be reconsidered.
Clinicians should demand from researchers and developers that they engage representatives of the full variety of members of their target populations in the development and evaluation process of PROMs. This also means that clinicians and developers of practical guidelines should take into account whether or not researchers have considered the needs of patients with low (health) literacy in choosing recruitment, development and evaluation strategies during the development and evaluation process of a PROM. An important step in stimulating questionnaire developers to take ease of use, face and content validity of PROMs into account has already been taken by incorporating assessment of these psychometric criteria into the COSMIN checklist [46]. If a PROM is not tested in a research population that is representative for a ‘real life patient population’, clinicians are right to be very reluctant in using it in clinical practice. The chances are that such a PROM may not add to the quality of valid information exchange, therefore not leading to better provider-patient interaction. In fact, due to factors earlier described in this general discussion, it may diminish the quality of communication and lead to unwanted and dysfunctional situations. If clinicians get the impression that patients are not willing or able to autonomously complete a questionnaire, they
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