Initial Psychometric Testing of a Pain Quality Pictogram Tool Among Hmong Limited English Proficient and Bilingual Community Members and Healthcare Practitioners.
Maichou Lor, Nora Cate Schaeffer, Roger Brown
PMID 38431504WHAT IT FOUND
Eight of 15 Hmong pain pictograms were matched almost perfectly, but six were less reliable or unclear.
Nurses should not rely on those pictures for soreness, numbness, tingling, aching, internal burning, or leg cramps until the tool is revised.
Key findings
01Eight of 15 pain pictograms were matched almost perfectly to the intended Hmong pain phrase by community members.
02Eleven of 15 pictograms met the 0.70 threshold for practitioner ratings of relevance, representation, and comprehension.
03The pictograms for aching, internal burning, leg cramp, numbness, soreness, and tingling were matched by fewer than 77% of community members.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 49 community members and 11 healthcare practitioners were recruited by convenience sampling, so the results may not apply to other Hmong patients or clinicians. The healthcare practitioners were mainly registered nurses and young (mean age 24.4 years), so their ratings may not reflect experienced pain assessors. The tool was not tested in real clinical encounters or checked against pain diagnoses or treatment decisions. Participants completed the survey online, and the paper could not confirm they used the required 15-inch screen; smaller screens may have made pictures hard to see. Twenty community members used a helper, and language proficiency was self-reported rather than formally measured. Findings apply to Hmong language and culture and may not transfer to other limited English proficiency groups.
Declared interests
No conflict of interest was declared. The article is listed as NIH extramural research support.
The easy way to misread this
Do not read this as proof that the pictogram tool improves pain assessment or patient care. It was tested only for whether participants matched pictures to phrases and whether practitioners rated the pictures as relevant, representative, and understandable.