Abstract

Background: Health literate healthcare organizations integrate health literacy considerations into all processes of care, including assessment materials. Attention to health literacy is also central to the clear communication and informed choice that guide trauma-informed care. Posttraumatic stress disorder (PTSD) is the hallmark mental health condition of Veterans Health Administration (VHA), affecting 23% of all users. Over one-third of Veterans with PTSD report health literacy-related difficulties understanding written materials and navigating care. The PTSD Checklist for DSM-5 (PCL-5) poses a substantial response burden, due to literacy level and length, which has been shown to impact the precision of scores. Disadvantaged populations of Veterans will be most affected, as they are at increased risk for both exposure to trauma and limited health literacy. Significance: [Effective and equitable care will rest on our ability to identify health literacy challenges and to reduce the literacy demands of patient-reported PTSD assessment. Doing so will help bring PTSD assessment in line with modern psychometric standards and federal recommendations for drug development and performance measurement. Prior efforts to minimize burden of PTSD assessment have focused on statistical approaches to reduce the number of items administered. Few studies have focused on core elements of content validity by addressing comprehension or health literacy and none benefitted from the substantial expertise in traumatic stress measurement possessed by the study team.] These goals are consistent with VHA research priorities for PTSD, broader Department of Veterans Affairs strategic priorities for tailored care and services to promote equity and access, ethical considerations for clinical research and Healthy People 2030 goals. Innovation & Impact: We blend the modern psychometric methods of the Patient-Reported Outcomes Measures Information System with Veteran engagement to achieve study aims. This approach yields data that supports the comprehension and acceptability of the measure for relevant patient populations. [A low-literacy PTSD measure would significantly reduce response burden and enhance efficiencies for a broad range of clinical processes, such as screening, assessment, and measurement-based care.] Work to fill the gap in PTSD assessment measures must take advantage of the expertise in VHA and must address the needs of Veterans. Specific Aims: [The proposed pilot will: a) test common screens for health literacy and adapt, augment or substitute with items tested in prior work to improve comprehension, relevance and acceptability; b) test PCL- 5 items to document comprehension and acceptability among Veterans; c) refine, revise, and retest PTSD symptom items to achieve Veteran comprehension and acceptability while maintaining content validity; and d) explore the utility of health literacy screens to detect comprehension difficulties for PTSD items. We will test newly developed items with a preliminary item analysis using data from a brief web-based survey.] Methodology: We will use purposive sample to ensure variability in symptom severity, gender, and trauma type. Cognitive interviews are the gold-standard for assessing comprehension and acceptability among a measure’s target population. Data will be coded using rapid qualitative analysis. Expert item review will be used to monitor content validity. Next Steps/Implementation: [Results will provide valuable information to program partners about Veteran comprehension and acceptability for the PCL-5 and health literacy screens. If difficulties are found for health literacy items, we will substitute with additional items cognitively tested in prior work. If comprehension difficulties are found for PTSD items, we will produce a candidate item pool of low-literacy PTSD items. This will establish the potential for a subsequent IIR for psychometric validation of these items to produce a low- literacy low-burden patient-reported measure for PTSD.]

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DRA: Mental, Cognitive and Behavioral Disorders

DRE: Diagnosis, TRL - Applied/Translational

Keywords: None at this time.

MeSH Terms: None at this time.