A qualitative study examining the validity and comprehensibility of physical activity items: developed and tested in children with juvenile idiopathic arthritis

Author(s): August Floden

Statement of the Problem: Pediatric patients with juvenile idiopathic arthritis (JIA) have demonstrated lower levels of physical activity (PA) than healthy peers. On reaching adulthood, patients with JIA demonstrate a higher prevalence of arterial calcification when compared to age-matched controls, further implicating the importance of early interventions ameliorating cardiovascular inflammation in these patients. However, not all available measurement methods of PA adequately assess PA intensity, duration or modes. Even less so in pediatric populations. Prior to our study, PA-assessment in pediatric JIA populations have used generic questionnaires that have not been applicable to pediatrics and are sometimes comprehendible to the children, rendering the answers unreliable. The purpose of this study is to validity-test a newly developed PA-questionnaire (PAQ) for pediatric JIA-patients between 10-16 years of age.

Methodology & Theoretical Orientations: A qualitative interview-based study, conducted through audiotaped cognitive interviewing to identify children’s comprehension of questionnaire items. Interviews were analyzed independently in two phases; 10 interviews analyzed and questionnaire modified & 20 interviews analyzed, and questionnaire finalized.

Findings: With a decreasing amount of comments per phase (phase 1:219, phase 2:95), the newer layout of the PAQ facilitated recall of directions or efficiency in answering the items. Children found it easier to recall and provide answers on activity specific items rather than intensity-composite questions. The development of the questionnaire took this into consideration.

Conclusion & Significance: The final version of our PAQ, the ASCeND, appear to be easy to answer and comprehend when assessing PA in JIA-patients. Our data indicate there are numerous issues associated with using PAQ intensity items in children related to the conceptualization of strenuous, moderate or light intensity activities. Formatting PAQs to enable easy alignment between activity, intensity and response options appear to reduce issues with tracking responses.