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Validation and Acceptability of the Mobile App Version of the Control of Allergic Rhinitis and Asthma Test for
Dulce Abreu da Mata1, Inês Pais-Cunha1, Sandra Catarina Ferraz2
1Unidade Autónoma de Gestão da Mulher e Criança, Pediatrics Department, Unidade Local de Saúde São João, Porto, Portugal.
Insights
The electronic Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) is validated and equivalent to the paper version. This digital tool can improve pediatric telemonitoring for asthma and allergic rhinitis.
Area of Science:
- Pediatric Pulmonology
- Digital Health
- Health Measurement Validation
Background:
- The electronic Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) shows promise for pediatric telemonitoring.
- Validation of the electronic CARATKids against its paper-based counterpart is necessary.
Purpose of the Study:
- To validate the electronic CARATKids questionnaire against the established paper-based version.
- To assess the reliability and agreement between the two CARATKids formats.
Main Methods:
- A cross-sectional study involving 51 children with asthma or allergic rhinitis and their caregivers.
- Comparison of paper and electronic CARATKids versions administered in a randomized order.
- Analysis of internal consistency, reliability (ICC, Bland-Altman), and convergent validity (Spearman correlation) following COSMIN guidelines.
Main Results:
- The electronic CARATKids demonstrated excellent reliability (ICC=0.95) and strong agreement with the paper version (Spearman correlation=0.95).
- Internal consistency was high for both versions (paper: 0.79, electronic: 0.83).
- A significant proportion of participants preferred the electronic version, indicating good acceptance.
Conclusions:
- The electronic CARATKids is equivalent to the paper-based version, showing high validity and reliability.
- The digital format is well-accepted by children and caregivers.
- Implementation via mobile health technologies can enhance remote monitoring and management of pediatric asthma and allergic rhinitis.
Background:
The electronic version of the Control of Allergic Rhinitis and Asthma Test for Children (CARATKids) has the potential to enhance pediatric telemonitoring but has not yet been validated.
Objective:
This study aimed to validate the electronic version of CARATKids against the paper-based version.
Methods:
A cross-sectional study was conducted between April and December 2024 in a tertiary hospital in northern Portugal. Children with asthma or allergic rhinitis and their caregivers were recruited during pulmonology outpatient appointments. CARATKids comprises 13 yes or no questions, 8 addressed to the child and 5 to the caregiver, and the total score ranges from 0 to 13. The electronic CARATKids was made available through a mobile app. Both paper and electronic versions were administered in a randomized order before and after the appointment. In addition, participants' preferences between the two administration versions were assessed. Internal consistency (Cronbach α), reliability (intraclass correlation coefficient [ICC], Bland-Altman analysis), and convergent validity (Spearman coefficient) were analyzed following COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidelines.
Results:
A total of 51 children (median 9, IQR 8-11 years; n=29, 57% male) and respective caregivers (median 41, IQR 7-45) years were included. The CARATKids total score was similar across the paper (median 5, IQR 3-8) and electronic (median 5, IQR 3-7) versions. The internal consistency was 0.79 for the paper version and 0.83 for the electronic version. The reliability between the two versions was excellent (ICC 0.95, 95% CI 0.91-0.97). The Bland-Altman analysis showed strong agreement between the two versions, with a mean difference of 0.04 (95% CI -1.99 to 2.07). The Spearman correlation between the two versions was 0.95 (P<.001). In total, 63% (n=32) of children and 61% (n=31) of caregivers were indifferent to the version used, while 33% (n=17) and 35% (n=18), respectively, preferred the electronic version.
Conclusions:
The electronic version of CARATKids appears to be equivalent to the paper-based version of the questionnaire, with good acceptance by children and caregivers. CARATKids implementation in mobile health technologies has the potential to enhance remote child monitoring and optimize the management of asthma and allergic rhinitis.
