Children as Reporters of their Own Health Status: An Age-Based Look at Data Quality and Feasibility.
Linda Radecki, Lynn M. Olson, Mary Pat Frintner for the CHIRP Team. Oral platform presentation to the Society for Developmental and Behavioral Pediatrics, 2005.

 

Purpose:An ongoing debate in pediatric research involves the use of parent proxies to obtain child data but little empirical evidence exists as to the age at which children are reliable and valid reporters about their own health status. This study examines the psychometric properties of child-report data on a measure of asthma-related health status.

 

Methods: In separate interviews, parents & children completed three study visits over a 16-day period. Youth questionnaires included were interviewer-administered and developed to be child-friendly. The primary instrument of interest was the Children's Health Survey for Asthma - Child Version (CHSA-C). The measure includes 25 core items used to compute three scales - Physical Health (PH), Child Activities (CA), and Emotional Health (EH). Reliability (internal consistency; test-retest), validity (relationship of CHSA scale scores to number of symptom days) and feasibility (length of time for questionnaire completion) were measured.

 

Results:414 parent/child pairs completed the study. 59% of child respondents were male; mean child age = 10.9 years (range = 7 - 16 years). 46% of child respondents were African American, 37% White, and 11% Hispanic. 42% of families reported yearly income <$30,000. Reliability (Internal Consistency): Reliability estimates for all age groups were quite high, with the majority falling into the acceptable (.70+) range or better. With few exceptions, overall levels of Cronbach's alpha tended to increase with child age. Reliability (Test-Retest): In general, values for test-retest correlation between forms and intraclass correlation coefficient were quite high, but tended to increase with child age. Correlation between forms ranged from .57 (7 yo - PH) to .96 (14 yo - CA). Likewise, intraclass correlation coefficients ranged from .76 (13 yo - EH) to .94 (15/16 yo - PH). Validity: Independent samples t-tests were used to examine differences between CHSA-C scale scores and child-reported symptom days for each age group. Children in each age category with a lower number of symptom days reported higher mean CHSA-C scores (indicating better/more positive outcomes) for every scale. These differences were significant in all but 2 instances. Feasibility: Feasibility of child report was assessed by examining length of CHSA-C completion time. In general, younger (7-8 year olds) took longer to complete the questionnaire than the oldest participants (12+ minutes vs 7 minutes, respectively).

 

Conclusions: Children as young as 7 years of age can provide statistically sound information about their asthma health status related to symptoms, activity limitations and emotional impact but psychometric quality does improve with age. Other important aspects that should be considered when determining whether or not to collect data from young children were related primarily to feasibility issues - most notably increased time for questionnaire completion. The ability to provide high quality data by children in this study, especially those at the younger age range may have been enhanced by the use of a child-friendly, interviewer-administered instrument.