Novas ferramentas para avaliação e monitoramento do controle da asma para crianças e adolescentes brasileiros
Background: Despite the existence of questionnaires to assess asthma control in the Brazilian pediatric population, these have limitations mainly related to the lack of structural adequacy for its applicability in different age groups from childhood to adolescence. Objectives: To evaluate the measurement properties of measurement instruments to assess asthma control and to provide novel instruments for assessing, supporting, and monitoring pediatric asthma control for Brazilian population. Methods and results: Three studies were carried out resulting in 5 papers (1 published, 3 for immediate submission and 1 for further finalization). Study 1 comprises a systematic review (SR) of measurement properties of measures for asthma control assessment following the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). This SR summarizes 81 studies, covering 39 instruments. Study 2 comprises the process of translation, cross-cultural adaptation, and evaluation of the measurement properties of the Pediatric Asthma Therapy Assessment Questionnaire (ATAQ) for the Brazilian population. The translated questionnaire, considering its instructions, items, and response options, was considered adequate by the multidisciplinary committee of experts (Fleiss’ kappa > 0.70) and by the target population (30 parents/caregivers of children or adolescents with asthma between 5 and 17 years). The Brazilian version of the ATAQ demonstrated evidence of validity and reliability investigated in a sample of 118 participants. Study 3 comprises the development and content validation of an electronic system for the Assessment, Support and Monitoring of Asthma (e-ASMA), which includes measurement instruments in health (questionnaire and diary) in four versions to children, adolescents and parents/caregivers and the prototype of a mobile app and a portal. The methods of study 3 were performed according to COSMIN. Three focus groups were held with representatives of the target population (5 children, 5 adolescents and their parents/guardians) to build the theoretical conceptual model and support the generation of items. The SR carried out in study 1 allowed the identification of 229 items and of these, 36 items were initially listed as relevant to the questionnaire and 14 items to the diary. Subsequent refinement steps resulted in the generation of 32 items for the questionnaire and 5 items for the diary that were later analyzed, modified and approved by a panel of experts (n=6), resulting in the exclusion of 12 items. In sequence, in-depth interviews were conducted with a sample of 13 children (7-11 years), 6 adolescents (12-18 years), 7 parents/guardians of children aged 4-6 years and 19 parents/guardians of children aged 7-18 years. Conclusions: The SR identified that several measurement instruments were developed to assess asthma control in limited age ranges, using different response scales, and mostly developed in English. The Brazilian version of the ATAQ is cross-culturally adapted and presents evidence of validity and reliability for Brazilian Portuguese. The versions of the questionnaire and diary that comprises the e-ASMA system showed evidence of content validity. These studies can guide future research related to the control of pediatric asthma, and additionally, support the investigation of others measurement properties of the proposed instruments for the e-ASMA and its prototype.
Asma, Criança - adolescente, Inquéritos e questionários, Psicometria
Networked Digital Library of Theses and Dissertations
Universidade Federal do Rio Grande do Norte