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.

The FHNSI is a reliable and valid symptom index, which can be administered alone or scored using items embedded within the FACT-H&N.

Spanish-speaking patients enrolled at a much higher rate than English-speaking patients, which is encouraging for future research in this underserved population. One important literacy-related factor (education) did not affect enrollment in Spanish-speaking patients, suggesting that there was no selection bias in this study. Recruiting sites with more indigent patients and long clinic waiting times had higher enrollment, suggesting that monetary compensation and time availability may be important considerations in study participation.