Exploring the Use of Pictorial Approaches in the Development of Paediatric Patient-Reported Outcome Instruments: A...

Area of Science:

• Pediatric Health Outcomes Research
• Health Psychology
• Measurement Science

Background:

• Text-based patient-reported outcome measures (PROMs) can be challenging for children, especially those with developmental delays or chronic illnesses.
• Pictorial PROMs, utilizing visual elements, present a viable alternative for assessing health-related quality of life (HRQoL) in pediatric populations.
• This review addresses the need for accessible HRQoL assessment tools for children.

Purpose of the Study:

• To systematically identify and describe pediatric PROMs that incorporate pictorial elements.
• To evaluate the development methods and characteristics of these pictorial PROMs.
• To provide insights into effective tools for children's HRQoL self-reporting.

Main Methods:

• Systematic literature review following PRISMA guidelines.
• Searched seven electronic databases from inception to March 1, 2022, with no country restrictions for English-language studies.
• Evaluated identified PROMs against ISPOR good practice guidelines for development and context.

Main Results:

• Identified 22 pediatric pictorial PROMs (28 versions), primarily developed in the USA and UK for ages 3-18.
• Common response options included Likert scales with pictorial anchors (e.g., happy-sad faces) in 54% of PROMs.
• Child participation in development was noted in 46% of PROMs, with interviews being the most common development method (61%).

Conclusions:

• Pediatric pictorial PROMs are effective, child-friendly tools for assessing HRQoL in children facing challenges with text-based measures.
• Evidence suggests pictorial PROMs enhance self-reporting and measurement properties compared to text-only versions.
• Further research is recommended for developing and validating pictorial PROMs, emphasizing co-design with children from the outset.