Page 34 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

Chapter 2
In this present study a revision of the definition of Davis [14] is applied to define ‘perceived usefulness’: ‘the degree to which a person believes that using a questionnaire would enhance his health care process’.
Not only is perceived usefulness of PROM important for patients to become advocates, they should also perceive questionnaires as ‘easy to use’ [10]. A revision of the definition of ‘perceived ease of use’ of Davis is used in this study [14]: ‘the degree to which a person believes that using a particular questionnaire would be free from effort’. Large groups, in particular people with low literacy, lack the necessary skills to complete questionnaires. In the Netherlands this concerns 11% of the adult population. Of this 11%, two-thirds has a Dutch and one third a non-Dutch ethnic background [15]. In addition to being low literate, this group generally also suffers from low numeracy and limited problem solving skills [16].
Literacy, numeracy and problem solving skills are all relevant for completing questionnaires. Patients with low literacy are therefore vulnerable when it comes to the usefulness and ‘ease of use’ of questionnaires [17]. Questionnaires are normally text-oriented and presented in a concentrated format which is hard to grasp for low literate persons. It can be questioned whether using questionnaires in a low health literate patient population contributes to their quality of care. It may even complicate the situation. Possible mistakes made by the patient in completing the questionnaire may lead to invalid information. Insufficient literacy, numeracy and problem solving skills might lead to problems in the response process which according to Tourangeau and colleagues exists of four phases: 1. understanding and interpretation of the questions, 2. retrieval of the necessary information from memory, 3. making a judgment about the information needed to answer the question, and 4. responding to the question by choosing the most fit answer possibility [18]. Problems in the response process might yield different information than was intended by its developers. Moreover, the burden of having to complete a task which is hard to fulfil can lead to emotional strain, which makes it even harder for a patient to cope with the complex context of a health care setting.
Low literacy is strongly associated with low health literacy [19]. The World Health Organization defines health literacy as the cognitive and social skills which determine the motivation and ability of individuals
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