title: Adapting a patient satisfaction instrument for low literate and Spanish-speaking populations: comparison of three formats.
abstract: OBJECTIVE
  To compare responses to print versions of the Consumer Assessment of Healthcare Providers and Systems 2.0 survey (CAHPS) to those for an illustration enhanced format and a telephone based interactive voice response format.
  
  
  METHODS
  First, 2015 adult patients awaiting primary care visits completed: demographic information, Test of Functional Health Literacy (S-TOFHLA), CAHPS in one of three formats: print, illustrated, or interactive voice. A second sample of 4800 active patients was randomized to receive alternative formats.
  
  
  RESULTS
  Response rates for the illustrated (31.3%) and print (30.4%) formats were significantly higher than for the interactive voice format (18.1%). The results of the illustrated format were comparable to the traditional text version, but required about 2 min more to complete by both low and high literacy groups. There were almost no invalid responses for the interactive voice format, but the format was associated with lower CAHPS satisfaction scores.
  
  
  CONCLUSIONS
  Despite extensive efforts to produce formats tailored to individuals with limited literacy, surprisingly we found no consistent advantages to either alternative format. In fact, the interactive voice format yielded lower satisfaction scores and lower response rates.
  
  
  CONCLUSIONS
  Practitioners need to ensure the health instruments they use are aligned with literacy skills and delivery preferences of their consumers. The lack of benefit of the illustrated form does not support investment of resources in these formats to measure satisfaction. The interactive voice response deserves more study--do lower scores register limited access to or use of telephones, irritation or true signal?
authors.affiliation: Center for Health Equity Research and Promotion, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA. sheaja@mail.med.upenn.edu
authors.forename: Judy A
authors.initials: JA
authors.lastname: Shea
authors.forename: Carmen E
authors.initials: CE
authors.lastname: Guerra
authors.forename: Janet
authors.initials: J
authors.lastname: Weiner
authors.forename: Abigail C
authors.initials: AC
authors.lastname: Aguirre
authors.forename: Karima L
authors.initials: KL
authors.lastname: Ravenell
authors.forename: David A
authors.initials: DA
authors.lastname: Asch
mesh_terms: D000328:Adult; D000368:Aged; D003144:Communication Barriers; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys / Q000379:methods*; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D010414:Pennsylvania; D011795:Surveys and Questionnaires; D013689:Telephone