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Psychometric Evaluation of the Turkish Version of the Induction Compliance Checklist in Children Undergoing Mask
Yesim Andiran Senayli1, Nida Kiyici2, Sevgi Ulusoy Tangul3
1Department of Anesthesiology and Reanimation, Yozgat Bozok University, Yozgat, Turkiye.
Insights
The Turkish Induction Compliance Checklist (ICC) reliably assesses children's behavior during anesthesia induction. This validated tool demonstrates excellent agreement among observers, supporting its use in clinical and research settings for improved pediatric care.
Area of Science:
- Pediatric Anesthesiology
- Clinical Assessment Tools
- Child Psychology
Background:
- Children often exhibit distress behaviors (anxiety, crying, resistance) during anesthesia induction.
- Assessing these behaviors is crucial for preventing postoperative issues and ensuring timely recovery.
Purpose of the Study:
- To evaluate the content validity, construct validity, internal consistency, and inter-observer reliability of the Turkish version of the Induction Compliance Checklist (ICC).
- To establish the ICC as a dependable tool for assessing pediatric compliance during anesthesia induction in the Turkish population.
Main Methods:
- Prospective observational study involving 184 children (aged 1-7 years) undergoing anesthesia.
- Translation and expert review for content validity (Davis technique).
- Simultaneous, independent assessments by three observers using the Turkish ICC during mask induction.
- Statistical analyses included Intraclass Correlation Coefficient, Fleiss Kappa/Gwet's AC1 for inter-observer reliability, KR-20/McDonald's omega for internal consistency, and confirmatory factor analysis for construct validity.
Main Results:
- Excellent content validity (I-CVI 0.90-1.00, S-CVI≈0.99) and inter-observer reliability (ICC 0.92-0.97) for the total score.
- Acceptable internal consistency (McDonald's omega 0.66-0.82), though affected by a floor effect due to premedication.
- Confirmatory factor analysis moderately supported a single-factor structure, with high floor effects noted for severe behaviors.
Conclusions:
- The Turkish version of the Induction Compliance Checklist (ICC) is a reliable and valid instrument for assessing children's compliance behaviors during anesthesia induction.
- High content validity and excellent inter-observer agreement support its use in clinical practice and research.
- The Turkish ICC can standardize the evaluation of child behaviors, contributing to enhanced perioperative care quality in the Turkish pediatric population.
Background:
Many children undergoing anesthesia commonly exhibit distress behaviors such as anxiety, crying, and physical resistance. Assessment of this behavior is important as it could lead to postoperative behavioral changes and delayed recovery.
Aim:
The aim of this study was to evaluate the content validity, construct validity, internal consistency, and inter-observer reliability of the Turkish version of the Induction Compliance Checklist (ICC), which was developed to assess compliance behaviors in children during anesthesia induction.
Methods:
The study was planned as a prospective observational study. Following translation of the original ICC, content validity was examined using the Davis technique with the opinions of 10 experts. Next, Turkish ICC was applied simultaneously and independently by three independent observers during mask induction to 184 children (ASA I-III) aged 1-7 years undergoing anesthesia and surgery. Inter-observer reliability was evaluated with Intraclass Correlation Coefficient (ICC) and Fleiss Kappa/Gwet's AC1; internal consistency with KR-20 and McDonald's omega; and construct validity with single-factor confirmatory factor analysis (WLSMV). Item analysis was performed with a tetrachoric correlation matrix, floor and ceiling effects.
Results:
Content validity was excellent (I-CVI 0.90-1.00, S-CVI≈0.99). Inter-observer reliability for the total score was excellent: InCC (1, 2) = 0.92 (95% CI: 0.90-0.94), InCC (2, 3) = 0.97 (95% CI: 0.96-0.98). At the item level, Gwet's AC1 values ranged from 0.81 to 0.97, while Kappa values were generally 0.75-0.90 except for M11. Internal consistency was at an acceptable level with KR-20 0.49-0.52 and McDonald's omega 0.66-0.82. These results are low due to the floor effect caused by premedication. Confirmatory factor analysis moderately supported the single-factor structure (best fit in Observer Surgeon: CFI = 0.927, TLI = 0.907). High floor effect was prominent especially in rarely observed severe behaviors (M7-M11); strong correlation was observed between M9-M10 (0.89-0.94).
Conclusions:
Following rigorous analysis, we found that the Turkish ICC is a reliable and valid tool that can assess children's compliance behaviors during pediatric anesthesia induction. Excellent inter-observer agreement and high content validity support its suitability for clinical and research use. The Turkish Induction Compliance Checklist is a reliable and valid measurement tool in the Turkish pediatric population. It can contribute to standardized evaluation of child behaviors during anesthesia induction and help improve the quality of perioperative care.
