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Readability of Common Health-Related Quality-of-Life Instruments in Female Pelvic Medicine

Alas, Alexandriah N. MD*; Bergman, Jonathan MD; Dunivan, Gena C. MD; Rashid, Rezoana BS§; Morrisroe, Shelby N. MD; Rogers, Rebecca G. MD; Anger, Jennifer T. MD, MPH§

Female Pelvic Medicine & Reconstructive Surgery: September/October 2013 - Volume 19 - Issue 5 - p 293–297
doi: 10.1097/SPV.0b013e31828ab3e2
Original Articles

Objectives 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.

This study assessed the readability of the health-related quality-of-life instruments used for urinary incontinence, pelvic organ prolapse, and fecal incontinence.

From the *Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Beverly Hills; †Department of Urology, University of California Los Angeles, Los Angeles, CA; ‡Division of Urogynecology, University of New Mexico, Albuquerque, NM; and §Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Beverly Hills, CA.

Reprints: Jennifer T. Anger, MD, MPH, Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, 99 La Cienega Blvd, #307, Beverly Hills, CA 90211. E-mail:

The authors have declared they have no conflicts of interest.

This study was supported by the NIDDK (1 K23 DK080227-01, Dr Anger).

© 2013 by Lippincott Williams & Wilkins