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Toward ensuring health equity: Readability and cultural equivalence of OMERACT patient-reported outcome measures

Tugwell, Peter S.; Singh, Jasvinder A.; Duru�z, Mehmet Tuncay; Sreih, Antoine G.; Flurey, Caroline; Maxwell, Lara J.; Petkovic, Jennifer; Epstein, Jonathan; Buchbinder, Rachelle; Welch, Vivian; Rader, Tamara; Lyddiatt, Anne; Clerehan, Rosemary; Christensen, Robin; Boonen, Annelies; Goel, Niti; Maxwell, Lara; Toupin-April, Karine; De Wit, Maarten; Barton, Jennifer; Flurey, Caroline A; Jull, Janet; Barnabe, Cheryl; Sreih, Antoine; Campbell, Willemina; Pohl, Christoph; Duroz, Mehmet; Singh, Jasvinder; Tugwell, Peter; Guillemin, Francis


Peter S. Tugwell

Jasvinder A. Singh

Mehmet Tuncay Duru�z

Antoine G. Sreih

Caroline Flurey

Lara J. Maxwell

Jennifer Petkovic

Jonathan Epstein

Rachelle Buchbinder

Vivian Welch

Tamara Rader

Anne Lyddiatt

Rosemary Clerehan

Robin Christensen

Annelies Boonen

Niti Goel

Lara Maxwell

Karine Toupin-April

Maarten De Wit

Jennifer Barton

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Caroline Flurey
Associate Professor in Men's Health and Long-term Conditions

Janet Jull

Cheryl Barnabe

Antoine Sreih

Willemina Campbell

Christoph Pohl

Mehmet Duroz

Jasvinder Singh

Peter Tugwell

Francis Guillemin


© Copyright 2015 The Journal of Rheumatology. All rights reserved. Objective. The goal of the Outcome Measures in Rheumatology (OMERACT) 12 (2014) equity working group was to determine whether and how comprehensibility of patient-reported outcome measures (PROM) should be assessed, to ensure suitability for people with low literacy and differing cultures. Methods. The English, Dutch, French, and Turkish Health Assessment Questionnaires and English and French Osteoarthritis Knee and Hip Quality of Life questionnaires were evaluated by applying 3 readability formulas: Flesch Reading Ease, Flesch-Kincaid grade level, and Simple Measure of Gobbledygook; and a new tool, the Evaluative Linguistic Framework for Questionnaires, developed to assess text quality of questionnaires. We also considered a study assessing cross-cultural adaptation with/without back-translation and/or expert committee. The results of this preconference work were presented to the equity working group participants to gain their perspectives on the importance of comprehensibility and cross-cultural adaptation for PROM. Results. Thirty-one OMERACT delegates attended the equity session. Twenty-six participants agreed that PROM should be assessed for comprehensibility and for use of suitable methods (4 abstained, 1 no). Twenty-two participants agreed that cultural equivalency of PROM should be assessed and suitable methods used (7 abstained, 2 no). Special interest group participants identified challenges with cross-cultural adaptation including resources required, and suggested patient involvement for improving translation and adaptation. Conclusion. Future work will include consensus exercises on what methods are required to ensure PROM are appropriate for people with low literacy and different cultures.


Tugwell, P. S., Singh, J. A., Duruöz, M. T., Sreih, A. G., Flurey, C., Maxwell, L. J., …Guillemin, F. (2015). Toward ensuring health equity: Readability and cultural equivalence of OMERACT patient-reported outcome measures. Journal of Rheumatology, 42(12), 2448-2459.

Journal Article Type Article
Acceptance Date May 1, 2015
Publication Date Dec 1, 2015
Deposit Date Jun 15, 2016
Journal Journal of Rheumatology
Print ISSN 0315-162X
Electronic ISSN 1499-2752
Publisher Journal of Rheumatology
Peer Reviewed Peer Reviewed
Volume 42
Issue 12
Pages 2448-2459
Keywords health equity, musculoskeletal conditions, rheumatology, literacy, cultural adaptation
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