Page 233 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

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. 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 Chapter 5, the results of the studies described in this thesis were 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 were provided. In summary, the current prototype of the TTSQ does not yet fully solve the problems native and minority patients with low (health) literacy have with completing the adapted questionnaire. It needs to be improved in both usability and validity aspects. Much work needs to be done to further develop the TTSQ and test it on psychometric properties. Big challenges in future development and testing the TTSQ are the recruitment of vulnerable members of the hard-to-reach native and minority target populations and finding research methods that suit the abilities and needs of these participants. This is expected to be a very challenging, labor- and time-consuming process. On the other hand, having a usable, valid and reliable TTSQ may well save a lot of time and money in both research and clinical practice in the future. If future research shows that the use of the TTSQ reduces costs and increases quality of care, investing in the development of a TTSQ which contains large numbers of questionnaires in various language versions may become interesting to health insurance companies and other investors.
Theworthandlegitimacyofroutineuseofhealth-relatedquestionnaires in their current state in clinical practice 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 patient- reported measures. If a questionnaire is not tested in a research population that is representative for a ‘real life patient population’,
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