147 Barriers to and enablers of the use of the Otology Questionnaire Amsterdam in clinical practice 7 (recommendation of a maximum time investment of 15 minutes), user-friendly, and in addition, clinically relevant.5,12 Based on the findings of our study, patients were willing to invest this time but lacked an understanding of the clinical impact of the OQUA. This can be explained by the missing link between OQUA and the patient’s appointment and the lack of feedback on the results of the OQUA during the consultation. In addition, previous research has shown that the compliance of PROMs can be increased when the patient knows that their answers are used by the professional in the consultation29. Although this supports our implementation strategy of incentivisation, ENT professionals have also reported a barrier in the requirement to provide patients feedback on the results of the OQUA. It is important to take this contradiction into account during the development of the implementation strategy. Nevertheless, providing overview of individual outcomes to the patient seems necessary for increasing clinical impact and lowering the perceived burden of the OQUA. Studies have frequently recorded patients’ perceived difficulties in completing PROMs. These problems were mainly related to PROMs that were too difficult, too confusing or too anxiety-provoking and seemed to be reported primarily by patients with physical or cognitive impairments, or limited computer and language skills.12,13 In our study, the generalizability and interpretability of the questions were discussed as potential difficulties in the use of the OQUA. However, this was only reported as a barrier by a small proportion of patients. On the one hand, this can be explained by previous validation of the OQUA among a large group of patients.11 On the other hand, it is possible that this barrier was underreported in our study due to of the exclusion of patients with a learning disability or cognitive impairment, or insufficient understanding of the Dutch language, the underrepresentation of patients who did not complete the OQUA, and because of the additional information and guidance provided to patients of Deventer Hospital during completion of the OQUA. Furthermore, the educational level of the patients was not taken into account. This may have had an effect of (under)reporting barriers in a patient’s ability to find, understand and use the OQUA, known as the concept of ‘health literacy’.30 These observations, combined with patients’ reported desire to explain their answers, suggest that further research may be needed to draw definitive conclusions about the comprehensibility of the OQUA. The patients’ identified enablers were consistent with the facilitating factors observed in the literature. It is considered to be important to emphasize the individual and generic benefits of the OQUA in supporting information and education to patients.
RkJQdWJsaXNoZXIy MjY0ODMw