Article Summary
Clinical Summary: Readability of Self-Reported Measures in Psychosis
Patients with psychosis are increasingly asked to complete self-report tools for screening and monitoring, yet cognitive, attentional, and literacy barriers can undermine whether those instruments are usable in practice. This study shows that common psychosis questionnaires are written above recommended reading levels, raising a direct access and equity problem at the point of care.
Design
The readability of psychosis measures was assessed using 4 indices: Flesch Reading Ease, Gunning Fog, SMOG, and FORCAST.
N
14 psychosis measures
Population
measures written in the English language, developed in the United States in the past 27 years between 1997 and 2024, and publicly available
Setting
Systematic reviews and measures were selected from a publicly available literature search in the PsycINFO, PubMed, PubMed Central, and Google Scholar databases.
Key Findings
- All 14 psychosis self-report measures had a mean readability score above the recommended sixth grade level, and all item and instruction sections were written above the recommended reading level.
- The mean reading level of the instruction sections was 9.08 (SD = 1.44, range, 7.13–10.70), and the mean reading level of the item sections was 9.06 (SD = 1.98, range, 7.08–13.79).
- A reading comprehension level of high school or above was required in 8 of 14 measures (62%).
- The PQ-16 measure had the lowest readability scores, with instructions averaging 7.13 and items averaging 7.77, whereas the PROD measure had the highest item readability score at 13.79.
- Across readability indices, the mean of the Gunning Fog index was 7.70, the mean of the Flesch Reading Ease index was 8.42, the mean of the SMOG index was 8.50, and the mean of the FORCAST index was 10.50.
Clinical Bottom Line
Psychosis self-report questionnaires, including their instructions and items, are generally written at roughly a ninth-grade level rather than the recommended sixth-grade level. When using these tools, clinicians should recognize that literacy demand itself can interfere with screening accuracy and equitable access.
Practice Implications
- When selecting among psychosis self-report tools, consider readability as a practical implementation factor, because readability ranged from 7.13 for PQ-16 instructions to 13.79 for PROD items.
- Do not assume that simplifying instructions alone will solve comprehension problems, since instructions averaged 9.08 and items averaged 9.06 across measures.
- Use added support when administering these questionnaires to patients with suspected literacy, cognitive, or attentional limitations, because 8 of 14 measures (62%) required a high school reading level or above.
- Include readability alongside reliability and validity when evaluating or developing psychosis screening instruments, because all 14 measures exceeded the recommended sixth grade level.
