Peer-reviewed article
Using cognitive interviews with children to test the content validity of a paediatric patient reported experience measure.
Barr KR, Fortunati E, Studniberg Z, Nikolovski J, White L et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tested whether a hospital experience measure designed with children could be understood and used by children aged 6-11 years in Australian hospitals. Researchers used cognitive interviews with 21 children to check if survey items, instructions and rating scales made sense. Children's feedback led to clearer wording, a preferred smiley-face rating system, and an option to skip questions that didn't apply to them, showing that involving children in designing these measures improves their quality.
Key points
- 95% of children understood the survey instructions after refinement
- Two items were revised based on children's feedback to use simpler language ('Family and friends' instead of 'Someone I knew')
- 67% of children preferred smiley-face rating scales over numeric systems
- 83% of children said the number of questions was appropriate
- An iterative approach with cognitive interviews successfully identified and fixed comprehension issues
Limitations
The study involved a small sample of 21 children from four Australian hospitals and does not assess whether the measure actually produces valid results when used to evaluate healthcare. It focuses only on understanding and usability, not on whether the measure reliably captures children's hospital experiences.
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.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Co-design of a pPREM with iterative cognitive interviews with children aged 6-11 years to test and refine survey items, rating scales, and response options based on child feedback
- Population
- 21 children aged 6-11 years recruited across four Australian hospitals
Key finding
95% of children understood survey instructions after revision