Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .
Background  Patient-reported outcome measures ( PROMs ) are intended to reflect outcomes relevant to patients .
They are increasingly used for healthcare quality improvement .
To produce valid measures , patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities .
The talking touchscreen: a new approach to outcomes assessment in low literacy.
PURPOSE Cancer patients who are deficient in literacy skills are particularly vulnerable to experiencing different outcomes due to disparities in care or barriers to care . Outcomes measurement in low literacy patients may provide new insight into problems previously undetected due to the challenges of completing paper- and -pencil forms . DESCRIPTION OF STUDY A multimedia program was developed to provide a quality of life assessment platform that would be acceptable to patients with varying literacy skills and computer experience .  One item at a time is presented on the computer touchscreen , accompanied by a recorded reading of the question . Various colors , fonts and graphic images are used to enhance visibility , and a small picture icon appears near each text element allowing patients to replay the sound as many times as they wish . Evaluation questions are presented to assess patient burden and preferences . RESULTS An ethnically diverse group of 126 cancer patients with a range of literacy skills and computer experience reported that the ' talking touchscreen ' ( TT ) was easy to use , and commented on the usefulness of the multimedia approach . CLINICAL IMPLICATION S The TT is a practical , user-friendly data acquisition method that provides greater opportunities to measure self-reported outcomes in patients with a range of literacy skills
Conclusion Our findings suggest that people with low literacy skills or learning disabilities are left out of the development of PROMs .
Background  Patient-reported outcome measures ( PROMs ) are intended to reflect outcomes relevant to patients .
They are increasingly used for healthcare quality improvement .
To produce valid measures , patients should be involved in the development process but it is unclear whether this usually includes people with low literacy skills or learning disabilities .