title: Readability of common health-related quality-of-life instruments in female pelvic medicine.
abstract: OBJECTIVE
  The average American adult reads below the eighth-grade level. To determine whether self-reported health-related quality-of-life questionnaires used for pelvic floor disorders are appropriate for American women, we measured reading levels of questionnaires for urinary incontinence (UI), pelvic organ prolapse (POP), and fecal incontinence (FI).
  
  
  METHODS
  An online literature search identified questionnaires addressing UI, POP, and FI. Readability was assessed using Flesch-Kincaid reading level and ease formulas. Flesch-Kincaid grade level indicates the average grade one is expected to completely and lucidly comprehend the written text. Flesch-Kincaid reading ease score, from 0 to 100, indicates how easy the written text can be read.
  
  
  RESULTS
  Questionnaires were categorized by UI, POP, FI, and combined pelvic floor symptoms. The median Flesch-Kincaid reading level was 7.2, 10.1, 7.6, and 9.7, for UI, POP, FI, and combined pelvic floor symptoms, respectively. Reading levels varied greatly between questionnaires, with only 54% of questionnaires written below the eighth-grade level.
  
  
  CONCLUSIONS
  We identified significant variation in reading levels among the questionnaires and found the 2 most commonly used questionnaires per survey in 2008 at Society of Urodynamics and Female Pelvic Medicine and Urogenital Reconstruction were above the recommended eighth-grade reading level. As specialty societies focus on standardizing questionnaires for research, reading levels should be considered so they are generalizable to larger populations of women with pelvic floor disorders.
authors: Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Beverly Hills, CA, USA. angerj@cshs.org
authors: Alexandriah N
authors: AN
authors: Alas
authors: Jonathan
authors: J
authors: Bergman
authors: Gena C
authors: GC
authors: Dunivan
authors: Rezoana
authors: R
authors: Rashid
authors: Shelby N
authors: SN
authors: Morrisroe
authors: Rebecca G
authors: RG
authors: Rogers
authors: Jennifer T
authors: JT
authors: Anger
mesh_terms: D032882:Comprehension; D004522:Educational Status; D005242:Fecal Incontinence / Q000523:psychology; D005260:Female; D006801:Humans; D059952:Pelvic Floor Disorders / Q000523:psychology*; D056887:Pelvic Organ Prolapse / Q000523:psychology; D011788:Quality of Life; D011795:Surveys and Questionnaires / Q000592:standards*; D014549:Urinary Incontinence / Q000523:psychology
references: J Clin Epidemiol. 2003 Jan;56(1):52-60
references: 12589870
references: Neurourol Urodyn. 2008;27(2 Suppl):101-52
references: 18266202
references: N Engl J Med. 2006 Jan 5;354(1):4-7
references: 16394296
references: Obstet Gynecol. 1987 Sep;70(3 Pt 1):378-81
references: 3627585
references: Int J Clin Pract. 2010 Dec;64(13):1824-31
references: 21070533
references: JAMA. 2001 May 23-30;285(20):2612-21
references: 11368735
references: Qual Life Res. 1994 Oct;3(5):291-306
references: 7841963
references: Neurourol Urodyn. 2010;29(1):4-20
references: 19941278
references: Am J Obstet Gynecol. 2001 Mar;184(4):552-8
references: 11262452
references: Dis Colon Rectum. 2000 Jan;43(1):9-16; discussion 16-7
references: 10813117
references: J Gen Intern Med. 2004 Dec;19(12):1228-39
references: 15610334
references: Am J Obstet Gynecol. 2001 Dec;185(6):1388-95
references: 11744914
references: J Urol. 2010 May;183(5):1977-81
references: 20303519
references: Control Clin Trials. 2003 Oct;24(5):629-42
references: 14500059