Catherine C. Lewis

Assessment of children's health status: Field test of new approaches.

The assessment of childrens health status presents unique difficulties. These include parent-child differences in reports of functioning, knowledge of what constitutes age-appropriate functioning, obtainment of accurate information for child, and demonstration of the predictivity of health status measures. Recent measures (the Functional Status II-R and instruments from the RAND Health Insurance Experiment) address physical, social, and psychologic domains of childrens health. The authors modified these instruments to develop short (7 and 14 items) questionnaires (RAND, FSQ) to assess child health. Scoring on these questionnaires was compared with traditional measures of illness severity and medical service utilization. The authors also evaluated coding illness-specific and general health limitations (FSQ-S and FSQ-G, respectively). Patients included the parents of 113 children with chronic illness (100 asthmatics). Measure stability was evaluated over a 6-month period in a subset of patients. Internal consistency (Cronbachs alpha) of the seven-item RAND measure was .78, the FSQ-S .78, and the FSQ-G .73 to .89 during repeated samplings over 6 months. The FSQ-S and Rand seven-item measure were moderately correlated (.47, P<.001). The authors observed significant correlations among alternate codings of the FSQ and RAND and between the FSQ-S, FSQ-G, RAND, and severity measure with traditional indices of medical service utilization. Parents were more likely to attribute certain functional status problems (e.g., being tired) to illness than they were other problems (e.g., moodiness or interest in things). The findings demonstrate that these measures have acceptable psychometric properties and provide preliminary evidence of construct validity in a group of young children with asthma. Using general and specific measures will provide differing pictures of a childs functioning. No single measure completely taps the impact of illness as measured by a panel of traditional indicators of illness burden and medical service utilization.

Measuring the impact of medical care on children

To assess the impact of medical care on children we have developed a conceptual model based on both theoretical considerations and empirical research. Child health is viewed as the ability to participate fully in developmentally appropriate activities and requires physical, psychological, and social energy. The medical system influences health through interventions addressing these domains. Many methodologic issues are unique to the measurement of medical care processes and outcomes for children. Problems in measuring the process of medical interviews include developing systems that capture the dynamics of interactions, assess the cognitive appropriateness and metaphorical interpretation of language, and reflect the emotional impact of certain incidents. Issues that confound measurement of childrens views include position bias, acquiescence response bias, and limited understanding of negatively worded items. Further, the concordance between parent and children reports or health constructs varies widely, which suggests the need to include childrens reports to obtain a comprehensive view of their health.

A health-education program for day-care centers.

How did we reduce day-care respiratory illness? By systematically teaching infection-control practices to day-care staff.

Interviewing Pediatric Patients

The landmark studies of Korsch and colleagues documented the importance of communication between physicians and parents during the pediatric office visit (Korsch, Gozzi, and Francis, 1968; Francis, Korsch, and Morris, 1969). These widely quoted studies showed that when adults (usually the mothers of the children brought to the emergency room) were able to express their concerns they were more satisfied and more compliant with their child’s management. These studies, however, focused on younger children and did not look at how important it was that the children themselves express their concerns. The following two transcripts of interviews demonstrate the importance of viewing the role of children as increasingly autonomous agents in the medical interview as they grow older. The differing impact of the following two interactions on fostering responsible health behavior in children is evident.