Elementary school-aged children's reports of their health: A cognitive interviewing study

There are no standard methods for assessing the quality of young children's perceptions of their health and well-being and their ability to comprehend the tasks involved in reporting their health. This research involved three cross-sectional studies using cognitive interviews of 5-11-year-old childr en (N = 114) to determine their ability to respond to various presentations of pictorially illustrated questions about their health. The samples had a predominance of children in the 5-7-year-old range and families of lower a nd middle socio-economic status. The research questions in Study 1 involved children's ability to convert their health experiences into scaled respons es and relate them to illustrated items (n = 35); Study 2 focused on the ty pe of response format most effectively used by children (n = 19); and Study 3 involved testing children's understanding of health-related terms and us e of a specific recall period (n = 60). The results of Study 1 showed that children identified with the cartoon drawing of a child depicted in the ill ustrated items, typically responding that the child was at or near their ow n age and of the same gender, with no differences related to race. Study 2 results indicated that children responded effectively to circles of graduat ed sizes to indicate their response and preferred them to same-size circles or a visual analogue scale. Tests of three-, four-, and five-point respons e formats demonstrated that children could use them all without confusion. In Study 3, expected age-related differences in understanding were obtained . In fact, the 5-year-old children were unable to understand a sufficient n umber of items to adequately describe their health. Virtually all children 8 years of age and older were able to fully understand the key terms and pr esentation of items, used the full five-point range of response options, an d accurately used a 4-week recall period. Six- and seven-year-olds were mor e likely than older children to use only the extreme and middle responses o n a five-point scale. No pattern of gender differences in understanding or in use of response options was found. We conclude that children as young as eight are able to report on all aspects of their health experiences and ca n use a five-point response format. Children aged 6-7 had difficulty with s ome health-related terms and tended to use extreme responses, but they unde rstood the basic task requirements and were able to report on their health experiences. These results provide the guidance needed to develop and test a pediatric health status questionnaire for children 6-11 years old.