Development and Initial Testing of the FLOW Instrument, a Novel Assessment of Lower Urinary Tract Symptoms in Men.

To develop a method of assessing lower urinary tract symptoms (LUTS) regardless of literacy/numeracy.

We convened focus groups and developed a questionnaire based on four identified domains of urinary function: Frequency, Incontinence (Leakage), Nocturia (Overnight voiding), and Weak stream (FLOW). We pilot tested the novel questionnaire in 64 men and performed quantitative analysis to determine internal consistency. Criterion validity was established via direct comparison to the American Urological Association Symptom Score (AUA-SS) in a larger cohort of 161 men.

The median time to complete the FLOW questionnaire was 18.0 seconds (IQR 15.8-21.0). The mean number of positive responses to the FLOW instrument was 1.7. Test-retest reliability was 0.91 and Cronbach's alpha was 0.67. In the validation cohort, there was a significant correlation between FLOW scores and AUA-SS (r=0.63, p<0.001). All men, regardless of health literacy completed FLOW; however, fewer men with low health literacy completed AUA-SS compared to men with adequate health literacy (81% vs 100%; 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).

A critical analysis of the AUA-SS utilizing valid health literacy scales reveals it is frequently not completed, requires prompting, and takes longer to complete for men with low health literacy. The FLOW instrument represents a novel method for assessment of LUTS in all men and represents a valid alternative to the AUA-SS.

The Journal of urology. 2017 Apr 11 [Epub ahead of print]

Kelvin A Moses, Daniel Heslop, Derek M Griffith, Arturo Holmes, Lisa Sherden, Consuelo H Wilkins, Kenneth A Wallston

Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA. Electronic address: ., Meharry Medical College, Nashville, TN, USA., Center for Research on Men's Health, Vanderbilt University, Nashville, TN, USA., Meharry-Vanderbilt Alliance and Vanderbilt University Medical Center, Nashville, TN, USA., School of Nursing, Vanderbilt University, Nashville, TN, USA.