Using cognitive interviews with children to test the content validity of a paediatric patient reported experience measure
Year: 2026
Type: article
Abstract: BACKGROUND: Paediatric patient reported experience measures (pPREMs) can help children's voices be heard to evaluate and improve healthcare delivery. However, no standardised child-completed pPREM has been co-designed with children and validated in Australia. This research aimed to test the content validity of a co-created pPREM using an iterative, participatory approach with children. METHODS: 21 children aged 6-11 years were recruited across four Australian hospitals. Children participated in online cognitive interviews to evaluate pPREM items and rating scales (using 'stars' or 'smiley faces') for their understandability, usability, relevance and importance related to their needs in hospital. Framework analysis was conducted iteratively, with items refined after the first round of interviews based on children's feedback. RESULTS: Most (n=20; 95%) children understood the instructions. After nine interviews, two items were revised: 'Someone I knew could stay with me' changed to 'Family and friends could be with me' and 'I was able to talk to other patients', to 'I was able to talk to other kids in hospital'. Following these revisions, all children understood most (13 of 18=72%) items. In the remaining five items, some phrases, such as 'Care and treatment', were not easily understood, and items were edited according to children's feedback. Most children (n=14; 67%) preferred the 'smiley faces' rating system, and 83% (n=15) reported the number of questions as the right amount. Children generally found all items important, although some items did not apply to all and a 'Does not apply to me' response option was added. CONCLUSIONS: Children aged 6-11 years can meaningfully engage with a co-designed pPREM. Cognitive interviews and an iterative approach helped identify and rectify comprehension issues. It is feasible to involve children in the design of pPREMs and doing so strengthens pPREMs' usability and understandability.
Source: BMJ Paediatrics Open
Authors: Karlen R Barr, Erika Fortunati, Zachary Studniberg, Jessica Nikolovski, Leslie White, Sarah Elliott, Lynn McCartney, Dianna Smith-McCue, Mary Noah, Girish Swaminathan, James R John, Claire Treadgold, Aaron Hall, Ann Dadich, Barb Vernon, Elesha Toscano, Harriet Hiscock, Josephine Chow, Leanne Johnston, Lisa Whitehead, Mandie Foster, Valerie Sung, Valsamma Eapen
Institutions: UNSW Sydney, South Western Sydney Local Health District, The University of Sydney, Macquarie University, ACT Government, Sydney Children’s Hospitals Network, Women's and Children's Health Network, Northern Territory Health Services, Royal Darwin Hospital, Australian Commission on Safety and Quality in Health Care, NSW Agency for Clinical Innovation, Western Sydney University, Children's Health Queensland Hospital and Health Service, The University of Melbourne, The University of Queensland, University of Jordan, Edith Cowan University, Auckland University of Technology, Royal Children's Hospital, Murdoch Children's Research Institute
Language: English
Subfield: General Health Professions
Field: Health Professions
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7214439822