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Development process and cognitive testing of CARATkids - Control of Allergic Rhinitis and Asthma Test for children
Luís Miguel Borrego, João Almeida Fonseca1, Ana Margarida Pereira
1Allergy Department, Centro Hospitalar S, João E,P,E, Porto, Portugal. jfonseca@med.up.pt.
Insights
A new tool, CARATkids, was developed to assess allergic rhinitis and asthma control in children. It is well-understood by children aged 6-12, paving the way for further validation studies.
Area of Science:
- Pediatric Allergy and Immunology
- Respiratory Medicine
- Child Health Outcomes
Background:
- Allergic rhinitis and asthma (ARA) frequently coexist in children, impacting their quality of life.
- Current assessment tools for ARA control, like the CARAT, are designed for adults.
- A pediatric-specific tool is needed to accurately measure ARA control in children.
Purpose of the Study:
- To develop and test the comprehensibility of the Pediatric version of the Control of Allergic Rhinitis and Asthma Test (CARATkids).
- To create a reliable tool for assessing asthma and allergic rhinitis control in children aged 4-12 years.
Main Methods:
- Literature review of existing pediatric asthma and rhinitis control questionnaires.
- Consensus meetings with a multidisciplinary group to develop the CARATkids questionnaire.
- Cognitive testing using qualitative interviews with children (4-12 years) and their caregivers.
Main Results:
- Identified four asthma and no rhinitis control questionnaires for children.
- Developed a 17-item CARATkids questionnaire with illustrations and dichotomous response options.
- Cognitive testing revealed CARATkids is well-understood by children aged 6-12, with minor revisions made for younger children (6-8 years).
- Caregivers preferred dichotomous scales and found the questionnaire clear and complete.
- Agreement between children and caregivers was 61% after revisions.
Conclusions:
- CARATkids is the first questionnaire developed to assess both asthma and allergic rhinitis control in children.
- Content validity was established, and cognitive testing confirmed good understanding among children aged 6-12.
- CARATkids is ready for a validation study to assess its measurement properties.
Background:
Allergic rhinitis and asthma (ARA) are chronic inflammatory diseases of the airways that often coexist in children. The only tool to assess the ARA control, the Control of Allergic Rhinitis and Asthma Test (CARAT) is to be used by adults. We aimed to develop the Pediatric version of Control of Allergic Rhinitis and Asthma Test (CARATkids) and to test its comprehensibility in children with 4 to 12 years of age.
Methods:
The questionnaire development included a literature review of pediatric questionnaires on asthma and/or rhinitis control and two consensus meetings of a multidisciplinary group. Cognitive testing was carried out in a cross-sectional qualitative study using cognitive interviews.
Results:
Four questionnaires to assess asthma and none to assess rhinitis control in children were identified. The multidisciplinary group produced a questionnaire version for children with 17 questions with illustrations and dichotomous (yes/no) response format. The version for caregivers had 4-points and dichotomous scales. Twenty-nine children, 4 to 12 years old, and their caregivers were interviewed. Only children over 6 years old could adequately answer the questionnaire. A few words/expressions were not fully understood by children of 6 to 8 years old. The drawings illustrating the questions were considered helpful by children and caregivers. Caregivers considered the questionnaire complete and clear and preferred dichotomous over the 4-points scales. The proportion of agreement between children and their caregivers was 61%. The words/expressions that were difficult to understand were amended.
Conclusion:
CARATkids, the first questionnaire to assess a child's asthma and rhinitis control was developed and its content validity was assured. Cognitive testing showed that CARATKids is well-understood by children 6 to 12 years old. The questionnaire's measurement properties can now be assessed in a validation study.
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