Page 205 - THE DUTCH TALKING TOUCH SCREEN QUESTIONNAIRE

design process resulted in new insights in perspectives of people with low literacy regarding the use of questionnaires. It resulted in knowledge about technical, as well as social and psychological, aspects of completing questionnaires that need to be taken into account when designing for low literacy people. This knowledge was used in the design of the TTSQ and also resulted in published guidelines for designing interactive questionnaires for persons with low literacy. The researchers of the current research project have been able to include some of most vulnerable members of their target populations in their studies. The qualitative approach which has been taken has enabled the researchers to reflect critically and deeply on the usability of the TTSQ for these vulnerable members of the target population. The Three-Step-Test-Interview \[4\] approach proved to be a very useful method to get a deep understanding of the problems and causes of the problems which were encountered by participants during their completion process. All studies together produced knowledge of difficulties people with low (health) literacy face in daily life, health care and, more specifically, in completing (health-related) questionnaires and their participation in research projects. Limitations The co-design strategy conducted in the current research project has not yet led to a tool that is user-friendly and creates valid data for physical therapy patients with low (health) literacy. The results presented in the current thesis offer enough starting points for further development of the TTSQ, but future research will need to prove whether or not adjustments will lead to the desired results. An important lesson learned, though, is that the development of this tool is very time- and labor-intensive. This is due to the qualitative methods that need to be applied in order for vulnerable potential future users of the tool to be able to participate in the studies and the effort that needs to be put into the recruitment of these hard-to- reach participants. Therefore, it will be challenging to find the time and the means to realize such a follow-up project. Because of the lengthy and costly development procedures, investing in the development of tools like the TTSQ will not be cost-effective for commercial parties. A possible follow-up project will be dependent on community funds. General discussion 205 5