Abstract
There are no standard methods for assessing the quality of young children's perceptions of their health and well-being and their ability to comprehend the tasks involved in reporting their health. This research involved three cross-sectional studies using cognitive interviews of 5–11-year-old children (N = 114) to determine their ability to respond to various presentations of pictorially illustrated questions about their health. The samples had a predominance of children in the 5–7-year-old range and families of lower and middle socio-economic status. The research questions in Study 1 involved children's ability to convert their health experiences into scaled responses and relate them to illustrated items (n = 35); Study 2 focused on the type of response format most effectively used by children (n = 19); and Study 3 involved testing children's understanding of health-related terms and use of a specific recall period (n = 60). The results of Study 1 showed that children identified with the cartoon drawing of a child depicted in the illustrated items, typically responding that the child was at or near their own age and of the same gender, with no differences related to race. Study 2 results indicated that children responded effectively to circles of graduated sizes to indicate their response and preferred them to same-size circles or a visual analogue scale. Tests of three-, four-, and five-point response formats demonstrated that children could use them all without confusion. In Study 3, expected age-related differences in understanding were obtained. In fact, the 5-year-old children were unable to understand a sufficient number of items to adequately describe their health. Virtually all children 8 years of age and older were able to fully understand the key terms and presentation of items, used the full five-point range of response options, and accurately used a 4-week recall period. Six- and seven-year-olds were more likely than older children to use only the extreme and middle responses on a five-point scale. No pattern of gender differences in understanding or in use of response options was found. We conclude that children as young as eight are able to report on all aspects of their health experiences and can use a five-point response format. Children aged 6–7 had difficulty with some health-related terms and tended to use extreme responses, but they understood the basic task requirements and were able to report on their health experiences. These results provide the guidance needed to develop and test a pediatric health status questionnaire for children 6–11 years old.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
La Greca AM. Issues and perspectives on the child assessment process. In: La Greca AM (ed), Through the eyes of the child: Obtaining self-reports from children and adolescents, Boston: Allyn and Bacon, 1990: 3–17.
Landgraf JM, Abetz LN. Measuring health outcomes in pediatric populations: Issues in psychometrics and application. In: Spiker B (ed), Quality of Life and Pharmacoeconomics in Clinical Trials. 2nd edn. Philadelphia: Lippincott-Raven Publishers, 1996: 793–802.
Brewster AB. Chronically ill hospitalized children's concepts of their illness. Pediatrics 1982; 69: 355–362.
Perrin EC, Gerrity PS. There's a demon in your belly: Children's understanding of illness. Pediatrics 1981; 67: 841–849.
Harter S, Pike R. The pictorial scale of perceived competence and acceptance for young children. Child Dev 1984; 55: 1969–1982.
Breton JJ, Bergeron L, Valla JP, et al. Quebec child mental health survey: Prevalence of DSM-III-R mental health disorders. J Child Psychol Psychiatry 1999; 40: 375–384.
Valla JP, Bergeron L, Bérubé H, Gaudet N, St-Georges M. A structured pictorial questionnaire to assess DSM-III-R-based diagnoses in children (6–11 years): Development, validity, and reliability. J Abnormal Child Psychol 1994; 22: 403–423.
Stone WL, Lemanek KL. Developmental issues in children's self-reports. In: LaGreca AM (ed), Through the Eyes of the Child: Observing Self-Reports from Children and Adolescents, Boston: Allyn and Bacon, 1990: 18–55.
Byrne BM. Measuring Self-Concept across the Life Span. Washington, DC: American Psychological Association, 1996: 52–58.
Burbach DJ, Peterson L. Children's concepts of physical illness: A review and critique of the cognitive-developmental literature. Health Psych 1986; 5: 307–325.
Ross DJ, Ross SA. Childhood pain: The school-aged child's viewpoint. Pain 1984; 20: 179–191.
Harbeck C, Peterson L. Elephants dancing in my head: A developmental approach to children's concepts of specific pains. Child Dev 1992; 63: 138–149.
McGrath PA, Seifert CE, Speechley KN, Booth JC, Stitt L, Gibson MC. A new analogue scale for assessing children's pain: An initial validation study. Pain 1996; 64: 435–443.
Zeltzer LK, LeBaron S, Richie DM, Reed D, Schoolfield J, Prihoda TJ. Can children understand and use a rating scale to quantify somatic symptoms? Assessment of nausea and vomiting as a model. J Consul Clin Psych 1988; 56: 567–572.
Nelson N. Comprehension of spoken language by normal children as a function of speaking rate, sentence difficulty, and listener age and sex. Child Dev 1976; 47: 299–303.
Donaldson M, Wales RJ. On the acquisition of some relational terms. In: Hayes JR (ed), Cognition and the Development of Language, New York: Wiley, 1968: 235–268.
Natapoff J. Children's views of health: A developmental study. Am J Public Health 1978; 68: 995–1000.
Natapoff J. A developmental analysis of children's ideas of health. Health Educat Quart 1982; 9: 131–141.
Hergenrather JR, Rabinowitz M. Age-related differences in the organization of children's knowledge of illness. Dev Psychol 1991; 227: 952–959.
Neuhauser C, Amsterdam B, Hines P, Steward M. Children's concepts of healing: Cognitive development and locus of control factors. Am J Orthopsych 1978; 48: 335–341.
Gale A, Lynn R. A developmental study of attention. British J Ed Psych 1972; 42: 260–266.
Hagen JW, Hale GH. The development of attention in children. In: Pick AD (ed), Minnesota Symposia on Child Psychology Minneapolis: University of Minnesota Press, 1973; 7: 117–140.
McKay KE, Halperin JM, Schwartz ST, Sharma V. Developmental analysis of three aspects of information processing: Sustained attention, selective attention, and response organization. Dev Neuropsych 1994; 10: 121–132.
Rebok GW, Smith CB, Pascualvaca DM, Mirsky AF, Anthony BJ, Kellam SG. Developmental changes in attentional performance in urban children from eight to thirteen years. Child Neuropsych 1997; 3: 28–46.
Walden TA, Field TM. Discrimination of facial expressions by preschool children. Child Dev 1982; 53: 1312–1319.
Wechsler D. Wechsler Intelligence Scale for Children-Revised. New York: Psychological Corporation, 1974.
Woodcock RW, Mather N. WJ-R tests of cognitive ability — standard and supplemental batteries: Examiner's manual. In: Woodcock RW, Johnson MB (eds), Woodcock-Johnson Psycho-Educational Battery-Revised, Allen, TX: DLM Teaching Resources, 1990.
Ornstein PA. Children's long-term retention of salient personal experiences. J Traumatic Stress 1995; 8: 581–605.
Schwab-Stone M, Fallon T, Briggs M, and Crowther B. Reliability of diagnostic reporting for children aged 6–11 years: A test-retest study of the diagnostic interview schedule for children-revise. Am J Psychiatry 1994; 151: 1048–1054.
Gathercole SE. The development of memory. J Child Psychol Psychiat 1998; 39: 3–27.
Friedman WJ. The development of children's memory for the time of past events. Child Dev 1991; 62: 139–155.
McGrath PA. Versatile pain measures for children. J Pediatr Som Med 1991; 6: 175.
Valla JP, Bergeron L, Bidaut-Russell M, St-Georges M, Gaudet N. Reliability of the Dominic-R: A young child mental health questionnaire combining visual and auditory stimuli. J Child Psychol Psychiatry 1997; 38: 717–724.
Shahinfar A, Fox NA, Leavitt LA. Preschool children's exposure to violence: Relation of behaviour problems to parent and child reports. Amer J Orthopsych 2000; 70: 115–125.
Raviv A, Raviv A, Shimoni H, Fox N, Leavitt L. Children self report of exposure to violence and its relation to emotional distress. J Appl Dev Psych (in press).
Riley AW, Green BF, Starfield B, Forrest CB, Kang M, Ensminger M. A taxonomy of adolescent health need: reliability and validity of the adolescent health and illness profiles. Med Care 1998; 36: 1228–1236.
Starfield B, Bergner M, Ensminger M, et al. Adolescent health status measurement: Development of the child health and illness profile. Pediatrics 1993; 91: 430–435.
Starfield B, Riley AW, Green BF, et al. The adolescent child health and illness profile: A population-based measure of health. Med Care 1995; 33: 553–566.
Ericsson KA, Simon HA. Verbal Reports as Data: Protocol Analyses, rev edn. Cambridge, MA: MIT Press, 1993.
Forsyth BH, Lessler JT. Cognitive laboratory methods: A taxonomy. In: Biemer PP, Groves RM, Lyberg LE, Mathiowetz NA, Sudman S (eds), Measurement Errors in Surveys, New York: Wiley, 1991: 393–418.
Piaget J. The origins of intelligence in children. New York: International Universities Press, 1952.
Rebok GW. Life-span Cognitive Development. New York: Holt, Rinehart & Winston, 1987.
Rights and permissions
About this article
Cite this article
Rebok, G., Riley, A., Forrest, C. et al. Elementary school-aged children's reports of their health: A cognitive interviewing study. Qual Life Res 10, 59–70 (2001). https://doi.org/10.1023/A:1016693417166
Issue Date:
DOI: https://doi.org/10.1023/A:1016693417166