Open Access Open Badges Research article

Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

Deepa Jahagirdar12, Thilo Kroll3, Karen Ritchie2 and Sally Wyke1*

Author Affiliations

1 Institute of Health and Wellbeing, University of Glasgow, 25 Bute Gardens, G12 8RS, Glasgow, UK

2 Healthcare Improvement Scotland, 50 West Nile St, G1 2NP, Glasgow, UK

3 Social Dimensions of Health Institute, University of Dundee, 11 Airlie Place, DD1 4HJ, Dundee, UK

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BMC Health Services Research 2012, 12:431  doi:10.1186/1472-6963-12-431

Published: 26 November 2012



Patient reported outcome measures (PROMs) are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice.


Taking PROMs recommended for chronic obstructive pulmonary disease (COPD) as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors.


Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs’ administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation.


Adjusting PROMs’ format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs’ purpose and benefit to patients may help to prevent inequality when using PROMs in health services.

Patient reported outcome measures; Quality improvement; Chronic obstructive pulmonary disease; Low literacy; Learning disabilities