title: Development of a Smiling Touchscreen multimedia program for HRQoL assessment in subjects with varying levels of literacy.
abstract: OBJECTIVE
  As low literacy affects the assessment of health-related quality of life (HRQoL) in several ways (e.g., subject eligibility and cost of administration), better approaches to HRQoL assessment in subjects with varying literacy levels are needed.
  
  
  METHODS
  We developed a multimedia touchscreen program (the Smiling Touchscreen, ST) to administer HRQoL instruments to subjects with varying levels of Chinese language and computer literacy, using an iterative process where patients' input on design, clarity of instructions, and user-friendliness were repeatedly gathered and incorporated in development. The ST thus has several user-friendly features for low-literacy subjects (e.g., presentation of individual items using visual and auditory stimuli, voice-text synchronization, and visual analog scale with a touch and drag function), which we evaluated using qualitative and quantitative methods.
  
  
  RESULTS
  The ST was well accepted by subjects (n = 66, 76% female, median [interquartile] age: 49.0 [40.0, 56.0]) with high (n = 43) or low (n = 23) literacy, 98% of whom found it easy or very easy to use, and 85% found the voice-text synchronization feature useful. In low-literacy subjects without computer experience (30%), none reported any difficulties using the ST. The median (interquartile) time spent to complete the ST (four Instruction and Practice screens, 24 questions, one visual analog scale) for high- and low-literacy groups was 13.9 (9.6, 23.9) and 23.2 (15.8, 26.5) minutes, respectively. Among subjects expressing a preference (n = 47), 21 (47%) favored the ST over interviewer- or self-administration.
  
  
  CONCLUSIONS
  The ST is well accepted by subjects with varying literacy levels, including those without computer experience. It is thus a promising new approach for HRQoL assessment among subjects with varying literacy levels.
authors.affiliation: Singapore General Hospital, Singapore. julian.thumboo@sgh.com.sg
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
authors.forename: Hwee-Lin
authors.initials: HL
authors.lastname: Wee
authors.forename: Yin-Bun
authors.initials: YB
authors.lastname: Cheung
authors.forename: David
authors.initials: D
authors.lastname: Machin
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.forename: Kok-Yong
authors.initials: KY
authors.lastname: Fong
mesh_terms: D000161:Acoustic Stimulation; D004522:Educational Status; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D015397:Program Evaluation; D011594:Psychometrics / Q000295:instrumentation*; D011788:Quality of Life; D012219:Rheumatology / Q000295:instrumentation; D012846:Singapore; D014110:Touch; D014584:User-Computer Interface; D014796:Visual Perception