Page 49 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

Liu et al. [23] reported that their respondents had problems reading and comprehending the questionnaires. All studies found difficulties with the interpretation of questions and response categories due to different perspectives between patients and the developers of the questionnaires. This gives rise to test and if necessary adjust the comprehension and readability of questionnaires on a wider scale.
The results of this study confirm the necessity to collaborate with a target population in all stages of questionnaire development. This not only ensures that the questionnaire comprises concepts and language that is relevant to patients but it also strengthens its face and content validity [45]. Developers should strive to engage representatives of the full variety of patients of their target population in the development process. This means they should use recruitment strategies and research designs that consider the needs of low as well as adequate (health) literate patients. To stimulate questionnaire developers to take ease of use, face and content validity of PROM into account, it is recommended to incorporate assessment of these psychometric criteria in quality evaluation tools like the COSMIN checklist [46].
Strengths and limitations
A limitation of this study is that the PSC was completed in the context of this research, not as part of the physical therapy treatment of the respondents. This seems to have caused some respondents to lose sight of the fact that they should have linked their response selection process to their physical therapy goals. Furthermore the refusal of four of the respondents to work with a professional interpreter caused language problems, which led to less depth in their interviews.
A strength of this study is the large variety of levels of education and literacy within the research population. This contributes to the validity of this study. The fact that only two Dutch respondents seemed to have insufficient Dutch reading skills does not diminish that. These two respondents are exemplary in the way they speak about and handle their inabilities. Because of the taboo on low literacy among Dutch natives it is very hard to include these respondents in research projects [36].
Perceived ease of use and usefulness
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