Readability of the current preparticipation cardiovascular screening questionnaires: Are they suitable for athletes?

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background Pre-participation screening (PPS) is now implemented by the majority of the leading sporting organisations around the globe, where the presence of the personal symptoms and family history questionnaire has to date been constant among all. The leading cardiology and sporting bodies of the AHA, ESC, IOC and FIFA all however independently publish, and advocate altered variations of the form, which are not validated, and based on expert opinion alone. Purpose The National Institute of Health (NIH) recommend questionnaires be written at a reading age of between 11-14 years. To date the readability and suitability of commonly used PPS questionnaires has not been investigated; thus, it was our aim to assess the readability of several PPS questionnaires from the leading sporting and cardiology organisations. Methods Readability analysis was performed on the PPS questionnaires from the leading sporting and cardiology organisations 1) AHA; 2) The PPE monograph; 3) ESC; 4) FIFA; 5) IOC. To assess the readability of the questionnaires, several formulae were applied, using multiple regression equations to predict the reading ability needed to understand the given text. The readability formula used were the Flesch Kincaid, Flesch Reading Ease, New Dale-Chall, SMOG scale, FORCAST, Coleman-Liau, and the Gunning Fog scale. Results Readability analysis demonstrated that the PPS questionnaires had an average reading age of between 14 and 18 years, resulting in all falling outside the NIH recommended reading age. The best performing questionnaire in terms of readability was the IOC questionnaire (average 13.7 years). The questionnaire with the highest reading age was the AHA 14-step (18.4 years), where 34.3% of the total words within the questionnaire were considered difficult according to the New Dale-Chall list. Questions relating to symptoms were considered easier to comprehend than family history questions. This was also exemplified by percentage of "unfamiliar" words, with symptoms questions having an average of 19.4%, while family history questions having an average of 27.3%. Within the sub analysis of individual questions, chest pain, syncope and palpitations were questions documented by all organisations, however the wording of these showed notable variation, with an average 7.5-year difference in reading age between questionnaires. Conclusion The readability of the current PPS questionnaires exceed the NIH recommended reading age of 11-14 years. Readability is an integral part of health literacy, and should a question be too difficult for an athlete to comprehend, this misunderstanding may lead to them rejecting the questionnaire or providing an inaccurate response. The PPS questionnaire remains a mainstay within the screening process, yet more research needs to be conducted to establish athlete comprehension and tailor future questionnaires towards this, with the goal of improving specificity and sensitivity.