Using plain language and adding communication technology to an existing health-related questionnaire to help generate accurate information: Qualitative study

Marlies Welbie*, Harriet Wittink, Marjan J. Westerman, Ilse Topper, Josca Snoei, Walter L.J.M. Deville

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review


Background: Low-educated patients are disadvantaged in using questionnaires within the health care setting because most health-related questionnaires do not take the educational background of patients into account. The Dutch Talking Touch Screen Questionnaire (DTTSQ) was developed in an attempt to meet the needs of low-educated patients by using plain language and adding communication technology to an existing paper-based questionnaire. For physical therapists to use the DTTSQ as part of their intake procedure, it needs to generate accurate information from all of their patients, independent of educational level. Objective: The aim of this study was to get a first impression of the information that is generated by the DTTSQ. To achieve this goal, response processes of physical therapy patients with diverse levels of education were analyzed. Methods: The qualitative Three-Step Test-Interview method was used to collect observational data on actual response behavior of 24 physical therapy patients with diverse levels of education. The interviews included both think-aloud and retrospective probing techniques. Results: Of the 24 respondents, 20 encountered one or more problems during their response process. The use of plain language and information and communication technology (ICT) appeared to have a positive effect on the comprehensibility of the DTTSQ. However, it also had some negative effects on the interpretation, retrieval, judgment, and response selection within the response processes of the participants in this study. No educational group in this research population stood out from the rest in the kind or number of problems that arose. All respondents recognized themselves in the outcomes of the questionnaire. Conclusions: The use of plain language and ICT within the DTTSQ had both positive and negative effects on the response processes of its target population. The results of this study emphasize the importance of earlier recommendations to accompany any adaption of any questionnaire to a new mode of delivery by demonstrating the difference and equivalence between the two different modes and to scientifically evaluate the applicability of the newly developed mode of the questionnaire in its intended setting. This is especially important in a digital era in which the use of plain language within health care is increasingly being advocated.

Original languageEnglish
Article numbere140
Pages (from-to)1-13
Number of pages13
JournalJournal of Medical Internet Research
Issue number4
Publication statusPublished - 23 Apr 2018


No external funding was received by the Utrecht University of Applied Sciences to conduct this study. The study was registered with the Medical Ethics Commity of the Acadamic Medical Centre of Amsterdam, which declared that it does not fall under the scope of the “Medical Research Involving Human Subjects Act.” The study was conducted according to the principles of the Declaration of Helsinki. All respondents provided written informed consent. The respondents names used in this paper are all fictitious to protect their privacy.

FundersFunder number
Laurea University of Applied Sciences


    • Educational status
    • Physical therapy specialty
    • Qualitative research
    • Questionnaires
    • Surveys


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