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Agreement between written and video questions for comparing asthma symptoms in ISAAC
1Wellington Asthma Research Group, Dept of Medicine, School of Medicine, Wellington, New Zealand. crane@wnmeds.ac.nz
Insights
The International Study of Asthma and Allergies in Childhood found that written asthma questionnaires are interpreted differently by adolescents compared to video questionnaires. This variation impacts wheezing prevalence data, highlighting the need for further research into symptom interpretation.
Area of Science:
- Pediatric Allergy and Immunology
- Epidemiology of Respiratory Diseases
- Childhood Asthma Research
Background:
- The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One established global prevalence of childhood asthma, rhinitis, and eczema.
- Video questionnaires were introduced to assess asthma symptoms and signs in children, complementing existing written methods.
- Understanding variations in symptom reporting is crucial for accurate epidemiological comparisons.
Purpose of the Study:
- To compare the agreement between a video questionnaire and a written questionnaire regarding current wheezing symptoms in adolescents.
- To investigate how each questionnaire contributes to wheezing prevalence estimates across different centers, regions, and language groups.
- To explore the impact of audiovisual versus written symptom presentation on adolescent interpretation and reporting of wheezing.
Main Methods:
- A video questionnaire depicting asthma symptoms was administered to approximately 317,000 13-14-year-old children across 99 centers in 40 countries.
- Responses from the video questionnaire were compared with answers to the ISAAC written question about current wheezing.
- Statistical analysis included calculating the proportion of agreement and Cohen's kappa coefficient to assess concordance between the two methods.
Main Results:
- The video questionnaire generally yielded a lower prevalence of wheezing compared to the written questionnaire, though responses were highly correlated (mean agreement = 0.89).
- Agreement was unbalanced, showing good negative agreement but poor positive agreement between the methods.
- Chance-corrected agreement (Cohen's kappa) was generally low, with only 20 centers achieving kappa > 0.4, indicating significant variability in interpretation.
Conclusions:
- Adolescents interpret written questions about wheezing differently from their audiovisual presentation, and this interpretation varies significantly between study centers.
- The variability in understanding and interpretation of written wheezing questions by 13-14 year olds impacts international comparisons.
- Further research into the relationship between written and audiovisual symptom presentation is necessary for improved asthma prediction and diagnosis.
Abstract:
Phase One of the International Study of Asthma and Allergies in Childhood (ISAAC) has reported the prevalence of asthma, rhinitis and eczema symptoms in children. In 99 centres from 40 countries, a total of just under 317,000 13-14-yr-old children also completed a video questionnaire, showing the symptoms and signs of asthma. This first video sequence has been compared to the ISAAC written question asking about current wheezing to explore variations in agreement and the contribution of each questionnaire to wheezing prevalence between centres, by region and language groups. In general, responses to the video questionnaire gave a lower prevalence than the siritten questionnaire and responses were closely correlated. The overall proportion of agreement was high, mean 0.89. but unbalanced, with good negative agreement but poor positive agreement. Chance corrected agreement using Cohen's kappa coefficient, was generally low, with onl 20 centres with kappa >0.4. The contribution of each questionnaire to wheezing prevalence also varied between centres and suggests that written questions about wheezing are variably understood and interpreted by 13-14 yr olds. International comparisons of wheezing and its audiovisual presentation suggest that adolescents interpret a written question about wheezing differently from its audiovisual presentation and that this interpretation shows variation between centres. This relationship and the interpretation of both written and audiovisual presentation of symptoms requires further study in order to better predict asthma.