| Learning Objective #1: Examine the psychometric evidence supporting the use of the Working Alliance Inventory-CD for children, adolescents with chronic illness and their parents | |||
| Learning Objective #2: Identify potential applications of the Working Alliance Inventory-CD as a predictor of treatment compliance in pediatric chronic illness management |
Introduction: Findings are presented from a pilot study to determine the reliability, relevance, and feasibility of using child and adult versions of the Working Alliance Inventory (WAI: Horvath, 1982; Horvath & Greenberg, 1989), borrowed from the field of psychotherapy research and adapted for use in a population of pediatric patients with chronic blood disorders, their parents/guardians, and their health care providers.
Methods: The 12 scales (eg., child relationship with hematologist {MD} [12 item], parent relationship with nurse practitioner {NP} [36 items]) of the adapted WAI were administered during in-person interviews to patients 7 years of age and older and to parents/guardians of the patients. The patient’s MD and NP completed the forms individually.
Results: A total of 34 children (X=10.47 years, 94% African American, 88% diagnosed with Sickle Cell Disease [SCD], 58.8% male), 13 adolescents (X=16.8 yrs., 69.2% African American, 53.8% with SCD, 69% male), and 43 parents/guardians (97.6% female, 88.4% mothers) participated in this study. Internal consistency estimates using Cronbach alpha yielded alphas ranging from .79 - .98, indicating strong internal consistency for all 12 versions of the WAI. Chronbach alphas for 12 item newly developed child version of the WAI were .83 (child’s relationship with MD or NP), .96 (parent/guardian relationship with MD or NP), and .92(parent perception of their childs’ relationship with the MD or NP). Eight of the 12 scales had test-retest reliability co-efficients of r=.66 or greater significant at the p< .05 level.
Conclusions: Each version of the adapted WAI has strong internal consistency. While test-retest reliability of most of the scales was strong, four versions of the tool need scrutiny. Parents, children, and adolescents were asked to provide feedback about the scale items following administration. Comments were generally positive especially regarding the opportunity to express opinions about their relationships with health care providers.
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