Sylvia H Paz1, Loretta Jones2,3, José L Calderón4, Ron D Hays4,5. 1. UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024-1736, USA. shpaz@ucla.edu. 2. Healthy African American Families, 4305 Degnan Blvd, Suite 105, Los Angeles, CA, 90008, USA. 3. Charles R. Drew University of Medicine and Science, 1731 E 120th St, Los Angeles, CA, 90059, USA. 4. UCLA Division of General Internal Medicine and Health Services Research, Department of Medicine, UCLA, 911 Broxton Avenue, Los Angeles, CA, 90024-1736, USA. 5. RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
Abstract
BACKGROUND: Depression and physical function are particularly important health domains for the elderly. The Geriatric Depression Scale (GDS) and the Patient-Reported Outcomes Measurement Information System (PROMIS®) physical function item bank are two surveys commonly used to measure these domains. It is unclear if these two instruments adequately measure these aspects of health in minority elderly. OBJECTIVE: The aim of this study was to estimate the readability of the GDS and PROMIS® physical function items and to assess their comprehensibility using a sample of African American and Latino elderly. METHODS: Readability was estimated using the Flesch-Kincaid and Flesch Reading Ease (FRE) formulae for English versions, and a Spanish adaptation of the FRE formula for the Spanish versions. Comprehension of the GDS and PROMIS® items by minority elderly was evaluated with 30 cognitive interviews. RESULTS: Readability estimates of a number of items in English and Spanish of the GDS and PROMIS® physical functioning items exceed the U.S. recommended 5th-grade threshold for vulnerable populations, or were rated as 'fairly difficult', 'difficult', or 'very difficult' to read. Cognitive interviews revealed that many participants felt that more than the two (yes/no) GDS response options were needed to answer the questions. Wording of several PROMIS® items was considered confusing, and interpreting responses was problematic because they were based on using physical aids. CONCLUSIONS: Problems with item wording and response options of the GDS and PROMIS® physical function items may reduce reliability and validity of measurement when used with minority elderly.
BACKGROUND:Depression and physical function are particularly important health domains for the elderly. The Geriatric Depression Scale (GDS) and the Patient-Reported Outcomes Measurement Information System (PROMIS®) physical function item bank are two surveys commonly used to measure these domains. It is unclear if these two instruments adequately measure these aspects of health in minority elderly. OBJECTIVE: The aim of this study was to estimate the readability of the GDS and PROMIS® physical function items and to assess their comprehensibility using a sample of African American and Latino elderly. METHODS: Readability was estimated using the Flesch-Kincaid and Flesch Reading Ease (FRE) formulae for English versions, and a Spanish adaptation of the FRE formula for the Spanish versions. Comprehension of the GDS and PROMIS® items by minority elderly was evaluated with 30 cognitive interviews. RESULTS: Readability estimates of a number of items in English and Spanish of the GDS and PROMIS® physical functioning items exceed the U.S. recommended 5th-grade threshold for vulnerable populations, or were rated as 'fairly difficult', 'difficult', or 'very difficult' to read. Cognitive interviews revealed that many participants felt that more than the two (yes/no) GDS response options were needed to answer the questions. Wording of several PROMIS® items was considered confusing, and interpreting responses was problematic because they were based on using physical aids. CONCLUSIONS: Problems with item wording and response options of the GDS and PROMIS® physical function items may reduce reliability and validity of measurement when used with minority elderly.
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