Institute of Health and Wellbeing, University of Glasgow, 25 Bute Gardens, G12 8RS, Glasgow, UK.
BMC Health Serv Res. 2012 Nov 26;12:431. doi: 10.1186/1472-6963-12-431.
Patient reported outcome measures (PROMs) are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice.
Taking PROMs recommended for chronic obstructive pulmonary disease (COPD) as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors.
Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs' administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation.
Adjusting PROMs' format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs' purpose and benefit to patients may help to prevent inequality when using PROMs in health services.
患者报告的结果测量（PROMs）是自我报告的健康状况测量方法，越来越多地被用于医疗保健质量改进。然而，文化程度低或有学习障碍的人可能会发现 PROMs 难以完成。我们的研究调查了利益相关者对 PROMs 的可及性和使用的看法，以提出更具包容性的实践建议。
以慢性阻塞性肺疾病（COPD）推荐的 PROMs 为例，我们对 8 名文化程度低或有学习障碍的人进行了访谈，并对 20 名卫生专业人员和 COPD 患者进行了 4 次焦点小组讨论。讨论涵盖了使用 EQ-5D 和圣乔治呼吸问卷作为提示的 PROMs 格式和传递。主题框架分析侧重于三个主要主题：可及性、易用性和背景因素。
可及性包括问卷格式问题，改进建议包括加大字体大小和增加空白。易用性包括对 PROMs 管理的讨论。虽然卫生专业人员建议可以在候诊室完成 PROMs，但患者更喜欢有更多隐私的环境，并可以在那里获得他们认识的人的帮助。背景因素包括与完成 PROMs 相关的其他挑战和更广泛的问题。虽然卫生专业人员强调了系统在管理文化程度低/学习障碍患者方面的困难，但患者参与者强调，了解 PROMs 的目的对于减少恐吓很重要。
调整 PROMs 的格式，给予患者明确的选择完成 PROMs 的地点，并向患者清楚地传达 PROMs 的目的和益处，可能有助于在卫生服务中使用 PROMs 时防止不平等。
