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Capturing Children's Voices in Healthcare: Development of the PREM-Ped Questionnaire
E Broström1,2, J Granhagen Jungner1,2, C Bartholdson1,2
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
Insights
We developed PREM-Ped, a child-friendly questionnaire to measure healthcare experiences. This tool supports quality improvement by capturing children's perspectives in paediatric care.
Area of Science:
- Pediatric healthcare quality improvement
- Patient experience measurement
- Child health services research
Background:
- Patient-reported experience measures (PREMs) are crucial for assessing healthcare quality, especially in pediatrics.
- PREMs are less developed for children compared to patient-reported outcome measures (PROMs).
- Capturing children's healthcare experiences is vital for upholding their right to be heard.
Purpose of the Study:
- To describe the development of PREM-Ped, a questionnaire for children's healthcare experiences.
- To conduct an initial psychometric evaluation of the PREM-Ped questionnaire.
- To create a child-friendly tool for assessing paediatric care quality.
Main Methods:
- PREM-Ped was developed through a participatory process, including focus groups with children and cognitive interviews.
- A pilot study involved 586 children aged 4-15 years completing the PREM-Ped in a Swedish hospital.
- Psychometric properties were evaluated using a Rasch measurement model, and validity was assessed by comparing acute and elective care experiences.
Main Results:
- A short, comprehensible, and child-friendly questionnaire (PREM-Ped) was successfully developed.
- Initial psychometric evaluation indicated satisfactory measurement properties for the questionnaire.
- PREM-Ped demonstrated validity by differentiating between experiences in acute and elective care settings.
Conclusions:
- PREM-Ped is a valuable tool for measuring children's healthcare experiences.
- The questionnaire supports systematic, child-centred quality improvement initiatives.
- PREM-Ped can be utilized for benchmarking paediatric healthcare quality.
Aim:
Patient-reported experience measures (PREMs) capture how care is experienced and are essential quality indicators in paediatric healthcare, supporting children's right to be heard. Compared with patient-reported outcome measures (PROMs), which assess health status and well-being, PREMs are less developed, particularly for children. This study aimed to describe the development and initial psychometric evaluation of PREM-Ped, a short, child-friendly questionnaire designed to capture children's own healthcare experiences.
Methods:
PREM-Ped was developed using a multi-step, participatory process. Content validity was established through a focus group with children who had experience of paediatric healthcare. The questionnaire was refined through four iterative rounds of cognitive interviews. A digitally administered pilot study was conducted in out- or inpatient units at Astrid Lindgren Children's Hospital in Sweden during spring 2025. Children aged 4-15 years completed the PREM-Ped after care (n = 586). Qualitative data were analysed thematically. Validity was examined by comparing experiences in acute and elective care. Psychometric properties were evaluated using a unidimensional Rasch measurement model.
Results:
The development process resulted in a short, comprehensible questionnaire suitable for children and adolescents. Initial psychometric evaluation demonstrated satisfactory measurement properties. Validity was supported, with PREM-Ped distinguishing between acute and elective care settings.
Conclusion:
We developed PREM-Ped, a short, child-friendly questionnaire that enables meaningful measurement of children's healthcare experiences and may support benchmarking and systematic child-centred quality improvement.
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