title: Designing an illustrated patient satisfaction instrument for low-literacy populations.
abstract: Up to 25% of adults in the United States have difficulty with everyday reading tasks. As patients, adults with low literacy may not be able to complete many self-administered written questionnaires, which often are used to obtain information from patients and to gauge their satisfaction with care. We developed an illustrated version of a patient satisfaction instrument used by the Veterans Health Administration. This paper describes the extensive design process used to develop, pilot-test, and revise this 63-item illustrated instrument. A total of 438 patients were interviewed over a 1-year period to obtain feedback on illustrations, with at least 15 people viewing and commenting on each picture and revision. All pictures were revised, with the majority revised at least 4 times. We report on this iterative design process as well as on lessons we learned in illustrating questions for low-literacy populations.
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. weinerja@mail.med.upenn.edu
authors.forename: Janet
authors.initials: J
authors.lastname: Weiner
authors.forename: Abigail
authors.initials: A
authors.lastname: Aguirre
authors.forename: Karima
authors.initials: K
authors.lastname: Ravenell
authors.forename: Kim
authors.initials: K
authors.lastname: Kovath
authors.forename: Lindsay
authors.initials: L
authors.lastname: McDevit
authors.forename: John
authors.initials: J
authors.lastname: Murphy
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care / Q000379:methods / Q000523:psychology*; D001154:Art; D001878:Books, Illustrated; D003144:Communication Barriers; D004522:Educational Status; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D018802:Patient-Centered Care; D015143:Philadelphia; D010865:Pilot Projects; D017064:Process Assessment, Health Care; D011795:Surveys and Questionnaires / Q000592:standards*; D013664:Teaching Materials / Q000592:standards*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data