Comparison of Four Pain Scales Among Hmong Patients with Limited English Proficiency

Background: Little is known about the relevance of existing pain scales for patients with limited English proficiency (LEP). Aims: To determine the ranking and perceptions of four pain intensity scales in LEP Hmong. Design: A sequential mixed-method study. Settings: A Midwestern city, USA. Participants/Subjects: Eight-four Hmong aged 19 to 80 years old. Methods: Participants ranked four pain intensity scales—the Red Gradation Scale, the Black Gradation Scale, the Wong-Baker Faces Pain Rating Scale, and the Faces Pain Scale – Revised— using Likert responses of 1 (most) to 4 (least) on the following factors: the extent to which they liked the scale, perceived it to be accurate, and preferred to use it in clinical settings. A follow-up interview asked participants’ scale selection decisions. Spearman correlations and ordered logistic regression assessed the scale rankings. Thematic analysis was used to analyze the qualitative data. Results: Participants ranked the Wong-Baker Faces Pain Rating Scale as the most liked (3.22 ± 0.95, 50.6%), the most accurate (3.13 ± 0.93, 44.6%), and the most preferred (3.14 ± 1.03, 49.4%). Older Age predicted the selection of this scale. Six themes influenced participants’ ranking decisions: the visual clarity of the scale, their experience or familiarity with the scale, the cultural connotations of pain, the type of emotions provoked by scale, the alignment of pain expression reflected in the scale, and the literacy concerns that the scale addressed. Conclusions: The Wong-Baker Faces could be appropriate for older Hmong. Further validity and reliability studies are needed for the Wong-Baker Faces.