Investig Clin Urol.  2018 Sep;59(5):297-304. 10.4111/icu.2018.59.5.297.

Readability assessment of commonly used urological questionnaires

• Betschart
• Abt D
• Schmid HP
• Viktorin P
• Langenauer J
• Zumstein V

• KMID: 2419412
• DOI: http://doi.org/10.4111/icu.2018.59.5.297

Abstract

PURPOSE
This study was performed to assess readability of the most commonly used questionnaires in urology including a separate analysis of their single-items to identify questions that might be especially demanding for patients.
MATERIALS AND METHODS
The guidelines of the European Association of Urology were screened for recommended questionnaires. Readability was analyzed for complete questionnaires as well as their single-items separately using well established readability assessment tools, including Flesch-Kincaid grade level (FKGL), Simple Measure of Gobbledygook grade level (SMOG), Coleman-Liau Index (CLI), Gunning-Fog Index, and the Flesch Reading Ease formula.
RESULTS
A total of 13 questionnaires were included to the analysis. Calculation of grade levels (FKGL, SMOG, CLI, FGI) showed readability scores of 2.7th to 16.7th grade. Easiest readability as calculated by median grade levels was found for the short form of the International Consultation on Incontinence Questionnaires-Female Lower Urinary Tract Symptoms short form (FLUTS-SF) while the short form of the International Index of Erectile Function (IIEF-5) showed the hardest readability. Based on the FKGL between 0% (FLUTS-SF) and 80% (IIEF-5) of the single-items were written above the recommended grade levels.
CONCLUSIONS
The questionnaires that are used most frequently in urology mainly show a satisfactory overall readability. Inadequate readability levels were not only found for individual questionnaires but also for single-items of the majority of assessed questionnaires. This requires consideration for the interpretation of results and when developing novel health-related surveys.

Keyword

Comprehension, reading; Surveys and questionnaires; Urology

MeSH Terms

Comprehension*
Humans
Lower Urinary Tract Symptoms
Smog
Surveys and Questionnaires
Urology
Smog

Figure

• 

  Fig. 1 Comparison of Flesch Reading Ease-scores for the different questionnaires: International Consultation on Incontinence Questionnaires-Female Lower Urinary Tract Symptoms short and long form (ICIQ-FLUTS-SF and -LF), ICIQ-Male Lower Urinary Tract Symptoms long and short form (ICIQ-MLUTS-LF and -SF), 36-Item Short Form Health Survey version 2 (SF-36v2), International Prostate Symptom Score (IPSS), incontinence quality of life (I-QOL), International Cystitis Symptom Index (ICSI), Qualiveen, Chronic Prostatitis Symptom Index (CPSI), Short-Form Qualiveen (SF-Qualiveen), International Index of Erectile Function (IIEF), IIEF-short form (IIEF-5) (‘Plain English’ is recommended for health-related content [12]).

• 

  Fig. 2 Readability grade levels for single-items of the questionnaires. (A) International Prostate Symptom Score (IPSS), (B) International Index of Erectile Function (IIEF), and (C) Chronic Prostatitis Symptom Index (CPSI). FKGL, Flesch-Kincaid grade level; SMOG, Simple Measure of Gobbledygook grade level; CLI, Coleman-Liau Index; GFI, Gunning-Fog Index.

• 

  Fig. 3 Readability grade levels for single-items of the questionnaires. (A, B) International Consultation on Incontinence Questionnaires-Female Lower Urinary Tract Symptoms short and long form (ICIQ-FLUTS-SF and -LF), (C, D) ICIQ-Male Lower Urinary Tract Symptoms long and short form (ICIQ-MLUTS-LF and -SF), (E) incontinence quality of life (I-QOL), (F) Qualiveen, (G) SF-Qualiveen, (H) 36-Item Short Form Health Survey version 2 (SF-36v2), (I) International Cystitis Symptom Index (ICSI), (J) International Index of Erectile Function-short form (IIEF-5). FKGL, Flesch-Kincaid grade level; SMOG, Simple Measure of Gobbledygook grade level; CLI, Coleman-Liau Index; GFI, Gunning-Fog Index.

• 

  Fig. 4 Median grade reading levels and ranges of all single-items of frequently used urological questionnaires (based on the Flesch-Kincaid grade level). SF-36v2, 36-Item Short Form Health Survey version 2; CPSI, Chronic Prostatitis Symptom Index; IPSS, International Prostate Symptom Score; IIEF, International Index of Erectile Function; ICIQ-FLUTS-SF and -LF, International Consultation on Incontinence Questionnaires-Female Lower Urinary Tract Symptoms short and long form; ICIQ-MLUTS-LF and -SF, ICIQ-Male Lower Urinary Tract Symptoms long and short form; I-QOL, incontinence quality of life; ICSI, International Cystitis Symptom Index; SF-Qualiveen, Short-Form Qualiveen.

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