Development and Validation of the Needs of Children's Questionnaire to Measure Children's Needs in Hospital

Friday, 20 July 2018: 1:50 PM

Mandie Jane Foster, PhD1
Lisa Whitehead, PhD, MA, BSc (Hons), RN2
Diana Arabiat, PhD1
(1)School of Nursing and Midwifery, Edith Cowan University, Perth, Western Australia, 6027, Australia
(2)Edith Cowan University, Western Australia, Joondalup, Australia

Aim: To develop and validate the needs of children’s questionnaire, a new instrument to measure school aged children’s needs in hospital. This study will bridge a significant gap in the literature on the self-reported needs of children in hospital.

Background: Child centered care is a philosophy of care where the child is central, forefront and the actor and co-constructor of care delivery and includes the principles of trust, respect, negotiation, information and patience that values the voices, needs and experiences of all children (Carter et al., 2014; Coyne et al., 2016; Foster, 2015). The literature on child centered care and children’s healthcare needs have largely been limited to qualitative designs or tools completed by parents or heath care professionals (Dickenson et al., 2014; Rasmussen et al., 2017). Over the last five years there has been an increase in the inquiry of child centered care (Shields et al., 2017), development of new child self-report measures (Holder, 2012; Ronan et al., 2014; Unit Developmental and Educational Psychology Institute of Psychology, 2017) and modification of existing tools to include the child’s and parents’ perspective (Berman et al., 2016; Orcesi et al., 2014; Rieffe et al., 2016). The way staff assess, plan and implement care to meet children’s healthcare needs are areas that require further inquiry as these interactions could influence health outcomes more than illness severity or demography (Christian, 2012; Foster et al., 2013; Foster et al., 2016; Shields, 2015; Shields 2016). A questionnaire to evaluate if the quality of care received by children in hospital is in line with what children self-report as important and required is needed to maximise positive healthcare experiences and inform healthcare delivery, policy, research and theory development.

Design: This is an instrument development study based on recommendations for developing a reliable and valid questionnaire.

Method: The development of the needs of children’s questionnaire during February 2014 to April 2017, followed six of the seven stages recommended by Hinkin, Tracey and Enz (1997). This included item generation; content adequacy assessment; questionnaire administration; factor analysis; internal consistency assessment and construct validity (Adcock, 2013; Cronbach, 1951; Hinkin et al., 1997; Kline, 2011; Kumar, 2015; Streiner and Kottner, 2014; Tabachnick and Fidell., 2013). Convergent, discriminant and criterion related validity were not assessed due to the absence of available tools to measure the same or dissimilar construct. Psychometric properties were assessed after 175 school aged children completed the needs of children’s questionnaire in four paediatric units over two countries.

Results: Stage one, two and three: A meta-synthesis of the literature generated 65 core statements synthesised into five categories (trust, to be trusted, information, support/relationships and resources). Fifteen multidisciplinary paediatric experts and five school aged children critiqued each statement for appropriateness, content and face value which left a 55 item, three point importance scale. Phase four and five: Eighteen school aged children in critical care critiqued the tool which resulted in a 38 statement, 56 item tool with open ended questions. Sixty-nine school aged children in critical care completed the tool which generated a total importance mean score 136.43 (SD 14.17) and Cronbachs Alpha of .890.

Thematic analysis of the open ended responses generated nine themes (coping strategies, getting better, family, environment, treatment, relationships, facilities, food and visitors) and two syntheses (priorities and choices). The categories were modified to coincide with the thematic analysis and a three point fulfilment Likert scale was added. One hundred and six school aged children in four paediatric areas across two countries completed the tool which resulted in a total importance mean score 134.52 (SD 12.66), fulfilment mean score 121.37 (SD15.88) and Cronbach's Alpha of .910. Phase Six: The Kaiser-Meyer-Olkin measure of sampling adequacy (0.676) and Bartlett's Test of Sphericity were significant (P < 0.001). Explanatory factor analysis with principal axis analysis and promax rotation yielded an eighteen item, five factor model with a 54% variance. The reliability for each factor: activities (0.74), information (0.58), relationships (0.47), caring (0.41), resources (0.66) and total scale (0.74) were acceptable. Confirmatory factor analysis with the 18 items loaded onto their respective factors yielded x2 as 192.841, root mean square error of approximation 0.056 and incremental fit index of 0.856 indicating the model as satisfactory. The result was judged to represent a reasonable model fit with comparative fit index of 0·849, Akaike information criterion of 320.841 and Tucker Lewis Index of 0·781. The root mean square error of approximation 0·056 approached the established criterion of ≤0·06 and the chi-square/d.f. of 1.543 (χ2 = 192.841, d.f. = 125, P < 0·001) still showed room for improvement. Sample adequacy was confirmed by the Kaiser-Meyer-Olkin test (0.676) and Bartlett’s Test of Sphericity (χ2 = 555.554, d.f. = 153, P < 0·001).

Conclusion: This is the first questionnaire that provides a means to measure the importance and fulfillment school aged children place on different concepts/items in hospital and to date indicates good usability and utility. Future testing and validation is needed to evaluate if the new instrument is suitable in other paediatric areas and countries.