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J Urol. 2009 Sep;182(3):1120-5. doi: 10.1016/j.juro.2009.05.027. Epub 2009 Jul 21.

Multimedia version of a standard medical questionnaire improves patient understanding across all literacy levels.

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Department of Urology, School of Medicine, Emory University, Atlanta, Georgia, USA.



Low health literacy is a significant problem in the United States. At the same time written screening tools such as the American Urological Association symptom score are used more frequently at hospitals and clinics. We previously reported that many patients do not fully understand this tool and often provide inaccurate information. To combat this problem we developed a novel multimedia version of the American Urological Association symptom score.


In this randomized, controlled trial we divided 232 patients into a control arm that self-administered the traditional written version of the symptom score and an experimental arm that self-administered the new multimedia version. Patients in each arm were later administered the tool a second time by an interviewer for comparison. Using multivariate analysis we measured disagreement between the self-administered and interviewer administered scores, and compared the 2 arms.


Patients assigned the written and the multimedia version showed an average error of 3.48 and 1.97, respectively (p <0.001), for a 43% decrease. Improvement was noted regardless of patient literacy. Errors by patients with low and high literacy decreased from 4.55 to 2.24 and 3.10 to 1.86 (p = 0.03 and <0.001, respectively).


As a model, the American Urological Association symptom score multimedia version represents an exciting opportunity to improve many other written screening tools since it increased understanding and decreased scoring errors across all literacy levels, possibly allowing physicians to treat patients more effectively.

[Indexed for MEDLINE]

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