Readability analysis of Spanish language patient-reported outcome measures in pediatric otolaryngology

Int J Pediatr Otorhinolaryngol. 2021 Nov:150:110934. doi: 10.1016/j.ijporl.2021.110934. Epub 2021 Oct 2.


Background: Pediatric otolaryngology encompasses interactions with a young patient, parent and/or guardian, and the provider. As healthcare transitions toward patient-centered care, clinicians are using direct tools of measurement such as patient-reported outcome measures (PROM) as a modality of communication between the patient and healthcare provider. Therefore, literacy levels of both the patient and their parent or guardian must be considered. Moreover, PROMs administered in pediatric audiology and otolaryngology in Spanish were found to be above the recommended reading level. Assessing the readability of Spanish translated PROMs is vital in providing safe, accurate, and quality care. The goal of this study is to analyze the readability of PROMs in pediatric otolaryngology and assess their compliance with readability recommendations.

Methods: Pediatric otolaryngology PROMs were identified from Powell's systematic review on pediatric otolaryngology PROMs. Spanish pediatric otolaryngology PROMs were selected from a literature search through PubMed ( and Google scholar databases ( After completion of the literature search, seven PROMs were identified. Only four PROMs Spanish validations included the translation of the PROM in their publication. The authors of the remaining PROMs were contacted via email. Ultimately, eight pediatric otolaryngology PROMs were included in this study. The PROMs included were assessed by a Latin Spanish translator for grammar, syntax, and comprehension ease.

Results: Four out of eight PROMs (50%) included in our study had readabilities above the recommended sixth-grade level. The following PROMs were noted with readabilities above the recommended level: tonsil & adenoid health status instrument (TAHSI), the nasal quality of life survey (SN-5), Spanish pediatric voice handicap index (P-VHI), and velopharyngeal insufficiency effects on life outcome (VELO).

Conclusions: Currently, some Spanish translated pediatric PROMs are written at a reading level above the recommended range for patients and their families.

Keywords: Health equity; Outcomes; PROM; Pediatric otolaryngology.

MeSH terms

  • Child
  • Comprehension
  • Health Literacy*
  • Humans
  • Language
  • Otolaryngology*
  • Patient Reported Outcome Measures
  • Quality of Life
  • Transition to Adult Care*