Login to Access Video or Poster Abstract: MP86-09
Sources of Funding: Vanderbilt CTSA grant UL1 TR000445 from NCATS/NIH

Introduction

The American Urological Association Symptom Score (AUA-SS) has been the gold standard for assessing lower urinary tract symptoms (LUTS); however, it is frequently incorrectly completed or unfinished due to inadequate literacy/numeracy. We developed the novel FLOW questionnaire to assess LUTS regardless of respondents' literacy/numeracy level. We previously showed the FLOW questionnaire is internally consistent and rapidly administered. Our current study objective is to establish criterion validation of FLOW vs AUA-SS, and perform a critical analysis of the AUA-SS via validated literacy and numeracy scales.

Methods

A total of 161 men were recruited from clinics at Nashville General Hospital, a safety net hospital in Nashville, TN. We collected demographic data and assessed literacy/numeracy using validated tools: the revised Rapid Estimate of Adult Literacy in Medicine (REALM-R), the Brief Health Literacy Screen (BHLS), and the Subjective Numeracy Scale (SNS). Patients were administered the FLOW questionnaire and the AUA-SS. We evaluated the completion rates, completion times, and whether or not patients required assistance to complete either questionnaire.

Results

Median age was 56 years, 99 men (61.5%) identified as Black/African American, and the median REALM-R score was six. There was a significant correlation between FLOW scores and AUA-SS (r=0.63, p<0.001). Among men with adequate health literacy (REALM-R 6-8; n =87), all were able to complete the FLOW and AUA-SS; however, among men with low literacy (REALM-R <6; n =74) all were able to complete the FLOW but only 81% were able to complete the AUA-SS (p<0.001). For the FLOW, health literacy was unrelated to median completion time (21.5 sec), the median number of prompts needed (0), or median score (2). For the AUA-SS, although the median number of prompts needed to complete the questionnaire (2) and median AUA-SS score (10.5) did not differ as a function of the men's health literacy, men with low health literacy who completed it had a median completion time of 129.5 seconds compared to 92 seconds for those with adequate health literacy (p<0.001).

Conclusions

The FLOW questionnaire meets criterion validity due to its strong, significant correlation with the AUA-SS for those who were able to complete both measures. However, a critical analysis of the AUA-SS utilizing valid health literacy and numeracy scales reveals the AUA-SS is frequently not completed, required prompting, and/or took longer to complete for men with low health literacy. Further studies of the FLOW questionnaire in a larger cohort in diverse clinical settings are needed.

Funding

Vanderbilt CTSA grant UL1 TR000445 from NCATS/NIH