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Stakeholder-Engaged Measure Development for Pediatric Obstructive Sleep-Disordered Breathing: The Obstructive
Anne R Links1, David E Tunkel1, Emily F Boss1
1Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Insights
A new scale effectively measures parental knowledge of obstructive sleep-disordered breathing (oSDB) and adenotonsillectomy (AT). This tool can help reduce decisional conflict for parents facing these treatment decisions.
Area of Science:
- Pediatric Otolaryngology
- Sleep Medicine
- Health Outcomes Research
Background:
- Parental decision-making regarding adenotonsillectomy (AT) for obstructive sleep-disordered breathing (oSDB) is often complex.
- Decisional conflict experienced by parents may stem from insufficient knowledge regarding oSDB symptoms and AT treatments.
Purpose of the Study:
- To develop and validate a reliable measure assessing parental knowledge about oSDB and AT.
- To provide a tool that can potentially alleviate decisional conflict by improving parental understanding.
Main Methods:
- A sequential scale development design was employed.
- A prototype measure underwent iterative refinement based on feedback from clinician experts and laypersons.
- Psychometric properties, including content validity, criterion validity (expert vs. layman comparison), and reliability (Cronbach's alpha), were rigorously assessed.
Main Results:
- The final 39-item scale covers five key themes: oSDB symptoms, treatment options, AT risks, anesthesia, and AT benefits.
- Clinician experts demonstrated significantly higher scores than laypersons, confirming criterion validity.
- The developed scale exhibited excellent reliability (Cronbach's α = 0.94).
Conclusions:
- The oSDB and AT Knowledge Scale for Parents is a psychometrically sound instrument.
- This validated scale can be effectively utilized to assess parental knowledge concerning oSDB and AT.
Importance:
Parental decision making about adenotonsillectomy (AT) for obstructive sleep-disordered breathing (oSDB) is associated with decisional conflict that may be alleviated with improved knowledge about symptoms and treatments.
Objective:
To develop a measure of parental knowledge about oSDB and AT.
Design, Setting, And Participants:
A sequential design was used for scale development. A prototype measure containing 9 oSDB and AT themes and 85 items was administered in survey format via an online platform. Participants included 19 clinician experts (otolaryngologists and pediatricians) and 13 laymen (parents of children who snore or do not snore, and other adults). Quantitative and qualitative responses were used to modify the measure and create the knowledge scale. Content validity of the scale was established through expert feedback and evaluation. Criterion validity was established with t test comparisons of experts with laymen. Reliability of the responses was assessed with Cronbach α testing.
Main Outcomes And Measures:
An 85-item prototype measure and 39-item modified measure were evaluated for consensus/approval and psychometric integrity.
Results:
Of 45 potential participants, 32 individuals (71%) responded to the prototype scale. Respondents included 19 clinician experts (59%) (otolaryngologists and pediatricians) and 13 laymen (41%) (parents of children who snore [n = 8] or do not snore [n = 2] and other adults [n = 3]); demographic data were not collected. Content analysis and qualitative feedback were largely rated positively: 27 respondents (84%) stated that the measure was a good evaluation of knowledge, 30 respondents (94%) commented that the items were clear, and 31 individuals (97%) approved of its organization, although there were several suggestions for rewording and/or addition of response options. Experts identified themes most important for assessing oSDB (symptoms) and AT (experiences: risks and benefits) knowledge. These qualitative comments were used to modify the scale, and items were eliminated if more than 2 were reported as misleading or less than 85% of clinicians provided correct responses. Five themes (oSDB symptoms, treatment options, AT risks, anesthesia, and AT benefits) and 39 items composed the final scale. Experts scored higher than laymen on the oSDB and AT Knowledge Scale for Parents overall (17 [94%] vs 12 [67%]; Cohen d = 1.96; 95% CI, 1.05-2.86) and within all themes, including experiences of children with oSDB (19 [88%] vs 13 [62%]; Cohen d = 1.53; 95% CI, 0.71-2.32), treatment options (19 [97%] vs 12 [68%]; Cohen d = 1.74; 95% CI, 0.88-2.57), AT risks (17 [97%] vs 12 [59%]; Cohen d = 1.94; 95% CI, 1.03-2.83), anesthesia (17 [97%] vs 12 [79%]; Cohen d = 1.09; 95% CI, 0.29-1.88), and AT benefits (17 [95%] vs 12 [67%]; Cohen d = 1.28; 95% CI, 0.46-2.09), demonstrating criterion validity. All responses demonstrated high reliability (Cronbach α = 0.94).
Conclusions And Relevance:
The oSDB and AT Knowledge Scale for Parents is psychometrically sound for use in the assessment of parental knowledge.
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