Literacy-fair measurement of health-related quality of life will facilitate comparative effectiveness research in Spanish-speaking cancer outpatients

Med Care. 2010 Jun;48(6 Suppl):S75-82. doi: 10.1097/MLR.0b013e3181d6f81b.


Background: Health-related quality of life (HRQL) assessment is frequently used in comparative effectiveness research, but low-literacy patients are often excluded. Appropriately translated and user-friendly HRQL measures are essential to ensure inclusion of low-literate and non-English-speaking patients in comparative effectiveness research.

Objectives: To compare HRQL responses across literacy levels in Spanish-speaking patients with cancer using a multimedia touch screen program.

Subjects: A total of 414 adult patients with cancer (213 with low literacy and 201 with high literacy).

Research design: The touch screen system administered 3 questionnaires: The Functional Assessment of Cancer Therapy-General, the Short Form-36 Health Survey, and the Standard Gamble Utility Questionnaire. Measurement bias was evaluated using item response theory. Effects of literacy on HRQL were evaluated using regression models.

Results: Patients rated the touch screen easy to use and commented favorably on the multimedia approach. There was statistically significant item response theory measurement bias in 6 of 10 HRQL subscales; however, only 3 showed meaningful bias. Low-literacy patients had significantly lower mean scores on 3 of 4 Functional Assessment of Cancer Therapy-General subscales, before and after adjustment for patient characteristics. Low-literacy patients also had significantly lower mean scores on 5 of 6 Short Form-36 subscales; adjustment for patient characteristics attenuated or eliminated differences. Similar proportions of low- and high-literacy patients valued their current health as equivalent to perfect health.

Conclusions: This study demonstrates the feasibility of this multimedia touch screen program for low-literacy patients. The program will provide opportunities to evaluate the effectiveness of interventions in more diverse patient populations.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Comparative Effectiveness Research / methods*
  • Educational Status
  • Feasibility Studies
  • Female
  • Hispanic or Latino
  • Humans
  • Language*
  • Male
  • Middle Aged
  • Neoplasms*
  • Quality of Life*
  • Socioeconomic Factors
  • Surveys and Questionnaires*
  • User-Computer Interface