AT WHAT AGE CAN CHILDREN REPORT ON THEIR OWN HEALTH?

Linda Radecki, Lynn M. Olson, Mary Pat Frintner, Kevin B. Weiss, Robert Siegel.. AAP, Elk Grove, IL; NWU Feinberg School of Medicine, Chicago, IL; CCHMC, Cincinnati, OH.

BACKGROUND: An ongoing debate in pediatric research involves the use of parent proxies to obtain child data but there is little empirical evidence regarding the age at which children become reliable and valid reporters of their own health status.

OBJECTIVE: Examine psychometric properties of a child-report asthma health status measure.

DESIGN/METHODS: In separate interviews, parent and child completed 3 visits over 16 days. Youth questionnaires were interviewer-administered and developed to be child-friendly. The primary instrument was the Children's Health Survey for Asthma-Child (CHSA-C). Three scales were computed - Physical Health (PH), Child Activities (CA), and Emotional Health (EH). Reliability, validity and feasibility were measured.

RESULTS: 414 parent/child pairs completed the study. 59% of children were male; mean age = 10.9 years (range=7-16 years); 46% African American. 42% family income <$30k/year. Reliability (Internal Consistency): Reliability estimates for all age groups were quite high, the majority in the acceptable (.70+) range or better, but Cronbach's alpha tended to increase with child age. Reliability (Test-Retest): Correlation between forms and intraclass correlation coefficients were quite high, but tended to increase with child age. Correlation between forms ranged from .57 (7 yo-PH) to .96 (14 yo-CA). Intraclass correlation coefficients ranged from .76 (13 yo-EH) to .94 (15/16 yo-PH). Validity: Independent samples t-tests examined differences between CHSA-C scale scores and symptom days. Children in each age category with fewer symptom days reported higher mean CHSA-C scores (indicating more positive outcomes). Differences were significant in all but 2 instances. Feasibility: Feasibility of child report was assessed by length of CHSA-C completion time. In general, younger children (7-8 yo) took longer to complete the questionnaire than the oldest participants (12+ vs 7 minutes, respectively).

CONCLUSIONS: Children as young as age 7 can provide statistically sound information about their health status related to symptoms, activity limits and emotional impact but psychometric quality does improve with age. Other important aspects to consider in data collection with young children were related primarily to feasibility issues - most notably increased time for questionnaire completion.