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J Contin Educ Nurs. 2001 Mar-Apr;32(2):60-7.

The effect of reading ability and response formats on patients' abilities to respond to a patient satisfaction scale.

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Department of Adult Health Nursing, School of Nursing, East Carolina University, Greenville, North Carolina 27858, USA.


This study investigated the relationship between reading ability and patient satisfaction measured with a 5-point Likert scale, a yes/no/uncertain choice, and a pictorial format. The study sample included 48 patients, 16 patients with third to fifth grade reading levels and 32 patients with reading levels of sixth grade or above. The mean percent agreement among the positively worded items on all three scales exceeded 80% regardless of reading level and response format. All of the patients had difficulty with the negatively worded items in all three formats, with the percent agreement dropping to only 49% between the negative items on the yes/no/uncertain and pictorial formats in the lower reading group.

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