Practicality, Validity, and Responsiveness of Using the Proxy Version of the Child Health Utility-9 Dimensions With Children Aged 2 to 5 Years
Related Experiment Video
Updated: Jun 10, 2025
Measuring the Functional Abilities of Children Aged 3-6 Years Old with Observational Methods and Computer Tools
Published on: June 20, 2020
Tracey H Sach1, Hywel C Williams2,
1School of Primary Care, Population Sciences and Medical Education, University of Southampton, Southampton, England, UK; Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, England, UK.
Insights
The proxy Child Health Utility-9 Dimensions (CHU9D) shows potential for assessing health in young children aged 2-5 years, but further research is needed to confirm its validity and responsiveness in pediatric populations.
Area of Science:
- Pediatric Health Outcomes Research
- Health Economics and Outcomes Research
- Child Health Measurement
Background:
- The Child Health Utility-9 Dimensions (CHU9D) is a valuable tool for measuring health utility in children.
- Its application in very young children (2-5 years) using a proxy-reported format requires specific validation.
- Eczema prevention trials provide a relevant context for evaluating pediatric health measures.
Purpose of the Study:
- To assess the practicality, construct validity, and responsiveness of the proxy CHU9D in children aged 2 to 5 years.
- To determine if the proxy CHU9D can effectively differentiate between children with and without eczema and varying severity levels.
- To evaluate the CHU9D's ability to detect clinically meaningful changes in health status over time.
Main Methods:
- Utilized data from the Barrier Enhancement for Eczema Prevention trial, a UK-based randomized controlled trial.
- Parents/carers completed the proxy CHU9D and Patient-Oriented Eczema Measure (POEM) at ages 2, 3, 4, and 5 years.
- Assessed practicality via completion rates, construct validity by comparing CHU9D scores across eczema groups, and responsiveness by change in POEM scores.
Main Results:
- High completion rates for questionnaires (70-87%) and CHU9D (69-94%) were observed across time points.
- Mean utility scores remained stable around 0.934, with minimal differences noted for construct validity (P < .01).
- Responsiveness analysis showed small changes in CHU9D scores corresponding to clinically important changes in POEM scores, indicating limited responsiveness.
Conclusions:
- The proxy CHU9D demonstrates feasibility for use in children aged 2-5 years within a trial setting.
- While showing some potential, the CHU9D exhibited limited construct validity and responsiveness in this young age group.
- Further research is recommended to refine the proxy CHU9D for accurate health utility measurement in preschool-aged children.
Objectives:
This study aimed to assess the practicality, validity, and responsiveness of the proxy Child Health Utility-9 Dimensions (CHU9D) in children aged 2 to 5 years.
Methods:
We used data from the Barrier Enhancement for Eczema Prevention trial, a UK randomized controlled trial testing whether daily emollients in infancy could prevent eczema in high-risk infants. The main parent/carer completed the proxy CHU9D using developers' additional guidance for completion in those younger than 5 years and the Patient-Oriented Eczema Measure (POEM) at ages 2, 3, 4, and 5 years. Practicality was assessed by completion rates. Construct validity assessed whether CHU9D could discriminate between those with/without eczema and between eczema severity levels on POEM. Responsiveness was determined by ability to discriminate between 3 groups: (1) those whose POEM score deteriorated ≥3 points, (2) those whose change was not clinically important (-2.9 to 2.9 points), and (3) those whose POEM score improved ≥3 points. Analysis was conducted in Stata 17.
Results:
Of 1394 children participating in the Barrier Enhancement for Eczema Prevention trial, study questionnaires were completed by 1212 (87%), 981 (70%), 990 (71%), and 976 (70%) at 2, 3, 4, and 5 years. Of these the CHU9D was completed by 1066 (88.0%), 685 (69.8%), 925 (93.4%), and 923 (94.6%), respectively. Mean utility at all time points was approximately 0.934 (range 0.443-1). For construct validity, very small differences in the CHU9D between known groups were observed (P < .01). A total of 801 participants had responsiveness data: 13% deteriorated, 72% had nonclinically important change, and 15% improved. Mean utility change (standardized response mean) for these groups was -0.0198 (0.21), 0.0041 (0.05), and 0.0175 (0.21) showing small change and small responsiveness.
Conclusions:
Proxy CHU9D in 2- to 5-year-old children shows potential but further research is needed.
Related Concept Videos
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:21Factors Affecting Drug Response: Overview
01:30Primary Healthcare Services
In 1978, international leaders convened in Alma-Ata, Kazakhstan, for what would be a pivotal event in global health. The Alma-Ata Declaration was the first to call...
01:03Data Validation
Nursing assessment guides are generally based on holistic models rather than medical...