Dana Barthel

Implementation of the Kids-CAT in clinical settings: a newly developed computer-adaptive test to facilitate the assessment of patient-reported outcomes of children and adolescents in clinical practice in Germany.

PurposeTo describe the implementation process of a computer-adaptive test (CAT) for measuring health-related quality of life (HRQoL) of children and adolescents in two pediatric clinics in Germany. The study focuses on the feasibility and user experience with the Kids-CAT, particularly the patients’ experience with the tool and the pediatricians’ experience with the Kids-CAT Report.MethodsThe Kids-CAT was completed by 312 children and adolescents with asthma, diabetes or rheumatoid arthritis. The test was applied during four clinical visits over a 1-year period. A feedback report with the test results was made available to the pediatricians. To assess both feasibility and acceptability, a multimethod research design was used. To assess the patients’ experience with the tool, the children and adolescents completed a questionnaire. To assess the clinicians’ experience, two focus groups were conducted with eight pediatricians.ResultsThe children and adolescents indicated that the Kids-CAT was easy to complete. All pediatricians reported that the Kids-CAT was straightforward and easy to understand and integrate into clinical practice; they also expressed that routine implementation of the tool would be desirable and that the report was a valuable source of information, facilitating the assessment of self-reported HRQoL of their patients.ConclusionsThe Kids-CAT was considered an efficient and valuable tool for assessing HRQoL in children and adolescents. The Kids-CAT Report promises to be a useful adjunct to standard clinical care with the potential to improve patient–physician communication, enabling pediatricians to evaluate and monitor their young patients’ self-reported HRQoL.

A new computerized adaptive test advancing the measurement of health-related quality of life (HRQoL) in children: the Kids-CAT

Purpose Assessing health-related quality of life (HRQoL) via Computerized Adaptive Tests (CAT) provides greater measurement precision coupled with a lower test burden compared to conventional tests. Currently, there are no European pediatric HRQoL CATs available. This manuscript aims at describing the development of a HRQoL CAT for children and adolescents: the Kids-CAT, which was developed based on the established KIDSCREEN-27 HRQoL domain structure.

Screening for depression in pregnant women from Côte d'Ivoire and Ghana: Psychometric properties of the Patient Health Questionnaire-9

BACKGROUND Major depression in antepartum women is a considerable health problem. This article aims at exploring the psychometric properties of the 9-item Patient Health Questionnaire (PHQ-9) in West African pregnant women. METHODS In a cross-sectional survey, the PHQ-9 was administered to n=639 Ivorian and n=389 Ghanaian women in their last trimester of pregnancy (gestational age range: 28-40 weeks) in 2010-11. Statistical analysis applied methods from both classical test theory (CTT) and item response theory (IRT). RESULTS Internal consistency was Cronbach׳s α=.65 in Côte d׳Ivoire and α=.68 in Ghana. Investigation of factorial validity by confirmatory factor analyses showed that unidimensionality of the PHQ-9 was sufficient. Rasch analyses resulted in excellent item infit and outfit measures. Yet, unidimensionality was questionable in residual principal component analyses. IRT analyses suggested that the response categories were not utilized as intended. Analysis of differential item functioning revealed interviewer-related item bias for several items in both samples. Item-person-fit was not ideal because the PHQ-9 items showed a low discriminability in the region of the latent trait where the majority of the women from the general population were located. Convergent validity was demonstrated by correlations between the PHQ-9 and two measures assessing anxiety and perceived disability. LIMITATIONS Both samples were quite homogenous regarding residence in urban areas and gestational age. CONCLUSIONS In our samples of African pregnant women, depression measured with the PHQ-9 does not appear as an entirely homogenous construct. However, the use of the sum score of the PHQ-9 is appropriate for depression screening purposes.

The BELLA study – the mental health module of KIGGS Wave 2

The BELLA study is the module on mental health and health-related quality of life within the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Baseline data collection took place together with KiGGS baseline data collection between 2003 and 2006. This article discusses the fourth follow-up of the BELLA study (BELLA Wave 4), which was surveyed between 2014 and 2017. The aims of the BELLA Wave 4 are to enable longitudinal analyses of health-related quality of life and mental health problems. Dynamic measurement instruments were used to enable a user-friendly and precise assessment of mental health among children, adolescents and young adults. The study’s participants were a sub-sample of around 3,500 KiGGS respondents aged 7 to 29 years. For the first time, in BELLA Wave 4 data were collected exclusively online. The BELLA study targeted both the parents of younger children (aged 7 to 13 years) and adolescents and young adults themselves (aged 11 years and above). Study instruments surveying mental health problems and the use of mental health care services were supplemented by a dynamic measurement tool in the form of a computer adaptive test (CAT) to record data on health-related quality of life. BELLA STUDY · MENTAL HEALTH · QUALITY OF LIFE · HEALTH MONITORING · KIGGS 1. Background and objective The past century has seen significant changes to the challenges facing child health. While medical progress has greatly curbed the threat of infectious diseases, mental disorders such as depression and anxiety disorders are today among the most frequent illnesses affecting children and adolescents [1, 2]. Mental health disorders affect an estimated 20% of children and adolescents in Germany [1-3], and can lead to significant limitations for families, at school and impact a person’s wider social environment [4-6]. Moreover, mental health disorders in children and adolescents have a high risk of becoming chronic, and the development of comorbidities (accompanying diseases) is frequent in this group, which means that further mental disorders might develop [7]. This underlines the high public health relevance of mental health as an important factor in strengthening healthy childhood development and ensuring social participation. Furthermore, subjective well-being and quality of life are considered important aspects for modern concepts of health, especially in terms of prevention and intervention [8]. The BELLA study on mental health is conducted by professors Ulrike Ravens-Sieberer and Fionna Klasen at the University Medical Center Hamburg-Eppendorf’s Child Public Health department and has been from its start one of the supplementary modules of the German The BELLA study – the mental health module of KIGGS Wave 2 Journal of Health Monitoring · 2017 2(S3) DOI 10.17886/RKI-GBE-2017-109 Robert Koch Institute, Berlin Authors: Fionna Klasen*, Franziska Reiß*, Christiane Otto, Anne-Catherine Haller, Ann-Katrin Meyrose, Dana Barthel, Ulrike Ravens-Sieberer * Co-first-authorship University Medical Center Hamburg-Eppendorf Journal of Health Monitoring 2017 2(S3) 52 Journal of Health Monitoring CONCEPTS & METHODS The BELLA study – the mental health module of KIGGS Wave 2 their parents as well as young adults aged 18 to 29 years. The BELLA Wave 4 cross-sectional sample is a subsample of the KiGGS Wave 2 cross-sectional sample and includes children and adolescents aged 7 to 17 years. The target population and sampling method are described in detail in the article New data for action. Data collection for KiGGS Wave 2 has been completed in this issue of the Journal of Health Monitoring. Children and adolescents were randomly drawn from the gross sample and assigned to the BELLA study during sampling for KiGGS Wave 2. An invitation to participate in BELLA Wave 4 required prior participation in KiGGS Wave 2. The longitudinal sample of the BELLA study includes all respondents of the BELLA baseline study (2003-2006), as well as all BELLA Wave 3 (2009-2012) respondents who had in parallel participated in KiGGS Wave 1. Whether respondents had participated in BELLA Waves 1 and 2 was irrelevant. For 7-to 10-year-olds, BELLA Wave 4 surveyed the parental assessment of the children’s mental health and health-related quality of life. For children aged 11 to 13 years, it surveyed both parental assessments and the children’s self-assessment, while adolescents aged 14 years and older were surveyed exclusively by selfassessment. The Federal Commissioner for Data Protection has been informed and approved the study. The survey staff is bound by the provisions of the German Data Protection Act and subject to strict confidentiality. Survey data are treated with absolute confidentiality and pseudonymised prior to being saved and analysed. The National Health Interview and Examination Survey among Children and Adolescents (KiGGS). The module strives for a more in-depth study of mental health and health-related quality of life among children and adolescents in Germany. BELLA Wave 4 has been designed as both a cohort and cross-sectional study, which means that respondents from previous waves (BELLA cohort) as well as a sample of new participants (cross-sectional) is surveyed. This approach provides not only a representative assessment of mental health in German-speaking children and adolescents, but also affords insights into the development of mental health over time, as eleven years have now passed since the baseline study. KiGGS and BELLA baseline data were collected between 2003 and 2006, followed by two subsequent BELLA study waves (Wave 1: 2004-2007, Wave 2: 20052008). Two further BELLA Waves took place in parallel with KiGGS Wave 1 and KiGGS Wave 2 (BELLA Wave 3: 2009-2012, BELLA Wave 4: 2014-2017) (Figure 1). BELLA Wave 4 for the first time applied a dynamic measurement instrument (computer adaptive test, CAT) to monitor health-related quality of life among children and adolescents (Kids-CAT) [9]. Therefore, the BELLA study was able to provide up-to-date reference data for a general population sample to standardise the Kids-CAT. 2. Methodology 2.1 Study design and sampling The BELLA Wave 4 comprises a representative sub-sample of the KiGGS study population sample. It includes roughly 3,500 children and adolescents aged 7 to 17 years, Journal of Health Monitoring 2017 2(S3) BELLA study Wave 4 Fourth wave of the survey on the mental health and health-related quality of life of children, adolescents and young adults in Germany (BELLA study), 2014-2017 Acronym: BELLA BEfragung zum seeLischen WohLbefinden und VerhAlten Implementation: University Medical Center Hamburg-Eppendorf Aim: Providing reliable information on the mental health and health-related quality of life of children, adolescents and young adults in Germany and the possibility for trends and longitudinal analyses. Survey design: Combined online cross-sectional and cohort study BELLA cross-sectional study Population: Children and adolescents with permanent residence in Germany Sampling: BELLA study participants were randomly selected from the cross-sectional sample of KiGGS Wave 2 (registry office sample). An invitation to participate in the BELLA study required prior participation in KiGGS Wave 2. Age range: 7 17 years Sample size: Approximately 1,400 participants BELLA cohort study Sampling: Renewed invitation of all participants in the BELLA baseline study (2003-2006) and BELLA Wave 3 (2009-2012) willing to take part again Age range: 10-29 years Sample size: Approximately 2,100 participants from the baseline survey and Wave 3 Survey period: November 2014 October 2017 More information in German is available at www.bella-study.org

Die BELLA-Studie – das Modul zur psychischen Gesundheit inKiGGS Welle 2

Die „BEfragung zum seeLischen WohLbefinden und VerhAlten“ (BELLA) ist die Modulstudie zur psychischen Gesundheit und gesundheitsbezogenen Lebensqualität der Studie zur Gesundheit von Kindern und Jugendlichen in Deutschland (KiGGS). Die Basiserhebung wurde mit der KiGGS-Basiserhebung 2003 bis 2006 durchgeführt. In diesem Beitrag wird die vierte Folgebefragung der BELLA-Studie (BELLA Welle 4) dargestellt, deren Daten 2014 bis 2017 erhoben wurden. Ziel der vierten BELLA Welle ist es, längsschnittliche Analysen zu gesundheitsbezogener Lebensqualität und psychischen Auffälligkeiten zu ermöglichen. Psychische Gesundheit soll mittels dynamischer Messinstrumente anwenderfreundlich und präzise über Kindheit, Jugend und Erwachsenenalter messbar gemacht werden. An der Befragung nahm eine KiGGS-Unterstichprobe von circa 3.500 jungen Menschen im Alter von 7 bis 29 Jahren teil. Die vierte Welle wurde erstmals als reine Onlinebefragung durchgeführt. Dabei wurden sowohl die Eltern jüngerer Kinder (7 bis 13 Jahre) befragt, als auch die Kinder, Jugendlichen und jungen Erwachsenen selbst (ab 11 Jahre). Neben Instrumenten zu psychischen Auffälligkeiten und Versorgung wurde erstmals ein dynamisches Messinstrument – ein computer-adaptiver Test (CAT) – zur Erfassung der gesundheitsbezogenen Lebensqualität eingesetzt. BELLA-STUDIE · PSYCHISCHE GESUNDHEIT · LEBENSQUALITÄT · GESUNDHEITSMONITORING · KIGGS 1. Hintergrund und Zielsetzung Die Herausforderungen in der Kindergesundheit haben sich in den letzten hundert Jahren deutlich verändert. Während durch die Fortschritte in der Medizin Infektionskrankheiten weitgehend eingedämmt werden konnten, gehören psychische Störungen, wie beispielsweise Depressionen oder Angststörungen, heute zu den häufigsten Erkrankungen im Kindesund Jugendalter [1, 2]. Schätzungsweise 20 % der deutschen Kinder und Jugendlichen sind von psychischen Auffälligkeiten betroffen [1–3], die mit erheblichen Beeinträchtigungen im familiären, schulischen oder erweiterten sozialen Umfeld einhergehen können [4–6]. Zudem besteht ein hohes Risiko der Chronifizierung psychischer Störungen im Kindesund Jugendalter sowie der Entwicklung von Komorbiditäten (Begleiterkrankungen), das heißt dem zusätzlichen Auftreten weiterer psychischer Störungen [7]. Dies verdeutlicht die hohe Public-Health-Relevanz, da die psychische Gesundheit ein wichtiges Fundament Journal of Health Monitoring · 2017 2(S3) DOI 10.17886/RKI-GBE-2017-103 Robert Koch-Institut, Berlin