Md Shajedur Rahman Shawon, Fariha Binte Hossain, Moushumi Hasan, Mohammad Rifat Rahman
Gender differences in the prevalence of anxiety and depression and care seeking for mental health problems in Nepal: Analysis of nationally representative survey data
Global mental health (Cambridge, England)
patientreported outcomes measurement information system promis may used assess individual patients perspective physical mental social health either standard computer adaptive testing cat patient questionnaires questionnaires used across disciplines however seen considerable application orthopaedic surgery patient characteristics associated promis cat completion examined within context social determinants health social deprivation health literacy patient understanding content promis cat assessed 1 patient demographics including social deprivation associated completion promis cat questionnaires 2 health literacy level associated completion promis cat questionnaires 3 patients lower health literacy higher odds completing promis cat without fully understanding content june 2022 august 2022 crosssectional study performed via paper survey administered patients single urban quaternary academic medical center orthopaedic subspecialty clinics foot ankle trauma handupper extremity surgeons considered englishspeaking patients aged 18 older including limited reading andor writing abilities eligible provided received ipad clinic complete promis cat questionnaire part routine standard clinical care completed questionnaire via patient portal visit 946 patients considered eligible study period convenience sample 36 339 946 patients approached inclusion due clinic time constraints fifteen percent 52 339 declined participate leaving 85 287 339 patients analysis median range age study participants 49 years 35 64 fiftyeight percent 167 287 study participants selfidentified nonhispanic black african american 26 75 287 nonhispanic white even proportions observed across education levels high school graduate less 29 82 287 college 25 73 287 college graduate 25 71 287 advanced degree 20 58 287 eighteen percent 52 287 patients reported annual income bracket usd 0 13000 17 48 287 reported usd 120000 fortysix percent 132 287 patients worked fulltime 21 59 287 retired 23 66 287 unemployed disability primary outcome interest selfreported promis cat questionnaire completion grouped fully completed partially completed part completed overall selfreported promis cat questionnaire completion proportions 80 229 287 full completion 13 37 287 partial completion 7 21 287 part completed collected national area deprivation index adi score brief health literacy screening tool brief part study survey associate level completion additionally patient understanding promis cat assessed likertscaled responses study survey question directly asked whether patient understood questions promis cat questionnaire responses question may limited social desirability bias hence may overestimate many individuals genuinely understood questionnaire content however benefit approach efficiently allowed us estimate ceiling effect patient comprehension promis cat likely high degree specificity detecting lack comprehension adi score adjusted age associated promis cat completion partial completion 100 95 ci 098 101 p 072 part completed 101 95 ci 099 103 p 045 patients lower health literacy scores however likely complete part assigned questionnaires patients higher scores part completed 085 95 ci 075 097 p 002 additionally 74 26 35 patients fully understand promis cat questionnaire questions still fully completed themhence 11 26 229 patients fully completed promis cat fully understand content among patients selfreporting full completion promis cat health literacy data 99 227 229 patients inadequatemarginal health literacy likely patients adequate health literacy fully understand questions 21 14 67 versus 8 12 160 326 95 ci 142 749 p 0005 within urban socioeconomically diverse orthopaedic patient population health literacy associated promis cat questionnaire completion lower health literacy levels increased likelihood completing part assigned promis cat questionnaires additionally patients completed promis cat without fully understanding questions indicates patient completion guarantee comprehension questions validity scores even among patients low health literacy substantive concern fidelity data gathered promis cat clinical implementation promis cat orthopaedic populations benefit research health literacy increase questionnaire completion ensure patients understand content questions answering increase internal validity outcome measure