2019. Illustrating the NPDFC
Ambulatory Care Survey for Low Literate Patients
JA Shea, Philadelphia VA Center for Health Equity Research and Promotion, KL Ravenell, Philadelphia VA Center for Health Equity Research and Promotion, CAN Henry, University of Pennsylvania, KM Fosnocht, University of Pennsylvania Health System, JJ Murphy, Philadelphia VA, VJ McDonald, Philadelphia VA Center for Health Equity Research and Promotion, AC Aguirre, University of Pennsylvania, DA Asch, Philadelphia VA Center for Health Equity Research and Promotion
illustrated patient satisfaction instrument (IPSI) was created to address needs
of low literate populations. The
IPSI was compared to the standard 62-item NPDFC printed Ambulatory Care
Satisfaction Survey in terms of 1) completion time; 2) missing data; and 3)
equivalence of subscale scores.
Methods: The IPSI or the
NPDFC was randomly assigned to 1709 patients in primary care waiting areas of
the Philadelphia VAMC and University of Pennsylvania Health System.
Patients also completed the Rapid Estimate of Adult Literacy in Medicine
(REALM). Low literacy was defined
as 8th grade or less. T-tests compared low literate subgroups and high literate
subgroups on completion time, amount of missing and illogical data, and subscale
scores. Differences were expected
between forms for the low literate comparisons favoring the IPSI but not between
the high literate samples.
of those taking the IPSI and 37% of those taking the NPDFC had low literacy
scores. For the low literate samples, completion times were 21.4 minutes for the
IPSI and 18.4 minutes for the NPDFC (p = .01).
For the high literate sample, the times were 19.7 and 15.9, respectively
(p = .007). For both low literate
groups, the median amount of missing data on the item level was 6%. For both high literate groups, the median was 5%.
On many of the 11 subscales for both forms, the high literate groups had
lower (less dissatisfied) mean scores than the low literate groups. On
one subscale (ACCESS), subscale scores were higher (more dissatisfied) for both
low and high literate groups taking the IPSI (p = .04 and p = .03) compared to
Conclusions: The IPSI
performed similarly to the NPDFC. Different
subscale scores require more study and a detailed look at item differences will
highlight where illustrations made a difference.
Impact: More than a third of veterans have low health literacy. If patient satisfaction information is to represent the broad veteran population accurately, it must be collected in a format that is accessible to the substantial proportion of veterans with lower literacy skills. By relying on illustrations, the IPSI may offer advantages to the text instrument.