Inter-Rater Reliability, Construct Validity, and Feasibility of the Modified “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires for Assessing the Use of Complementary Health Approaches in Pediatric Oncology
Abstract
:1. Introduction
2. Materials and Methods
2.1. Hypotheses
2.2. Participants
2.3. Procedure
2.4. Measures
2.5. Data Analysis
3. Results
3.1. Participants
3.2. Inter-Rater Reliability
3.3. Construct Validity
3.3.1. Convergent Construct Validity
3.3.2. Relationships between Variables Measured via the Modified WHAT and Theoretically Relevant Factors
3.4. Feasibility of Administration
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Questionnaires | Type | # of Items | Content | Time (min) | Evidence of Reliability and Validity | Hypotheses |
---|---|---|---|---|---|---|
Diary of CHA use | Self-report | 3 | Items:
| <5 |
| H2: Convergent construct validity |
Proxy-report | 3 | <5 | ||||
WHAT | Self-report | 13 | Domains:
| 10 |
| H1: Inter-rater reliability H2: Convergent construct validity H3: Hypotheses testing |
Proxy-report | 15 | 10 | ||||
Feasibility of administration | Self-report | 5 | Adapted items: the WHAT was
| 2 |
| H4: Feasibility of administration |
Proxy-report | 5 | 2 | ||||
PedsQL | Self-report | 23 | Domains:
| <5 |
| H3: Hypotheses testing |
Proxy-report | 23 | <5 | ||||
Satisfaction of CHA use | Proxy-report | 4 | Adapted items:
| <1 |
| H3: Hypotheses testing |
ITR 3.0 | Chart review | 4 | Items:
| N/A |
| H3: Hypotheses testing |
Children, n = 24 | |
Age in years, mean (SD) | 14.3 (2.8) |
Female sex. n (%) | 12 (50) |
School grade level, n (%) | |
Grade 3 | 1 (4.2) |
Grade 4 | 2 (8.3) |
Grade 5 | 1 (4.2) |
Grade 6 | 3 (12.5) |
Grade 8 | 1 (4.2) |
Grade 9 | 4 (16.7) |
Grade 10 | 4 (16.7) |
Grade 11 | 4 (16.7) |
Grade 12 | 2 (8.3) |
Child’s cancer diagnosis, n (%) | |
Lymphoma | 8 (33.3) |
Acute Lymphoblastic Leukemia | 5 (20.8) |
Acute myeloid leukemia | 2 (8.3) |
Ewing sarcoma | 3 (12.5) |
Osteosarcoma | 2 (8.3) |
Central nervous system tumour | 2 (8.3) |
Neuroblastoma | 1 (4.5) |
Other cancer diagnosis | 1 (4.2) |
Duration of illness in years, mean (SD) | 2.8 (3.8) |
Diagnosed with relapsed cancer, n (%) | 3 (12.5) |
Cancer treatment +, n (%) | |
Chemotherapy | 23 (95.8) |
Radiation therapy | 9 (37.5) |
Immunotherapy | 5 (20.8) |
Surgery | 4 (16.7) |
Stem Cell Transplant | 2 (8.3) |
Other treatments | 2 (8.3) |
Intensity of treatment score, mean (SD) | 3 (0.5) |
Child’s PedsQL score (self-report), mean (SD) | 58.3 (15.2) |
Parents, n = 24 | |
Age in years, mean (SD) | 42.4 (8.6) |
Female sex, n (%) | 18 (75) |
Parent’s relationship with the child, n (%) | |
Biological mother | 17 (70.8) |
Biological father | 6 (25) |
Other | 1 (4.2) |
Parent’s marital status, n (%) | |
Married or living common-law | 19 (79.2) |
Separated | 2 (8.3) |
Divorced | 2 (8.3) |
Single | 1 (4.2) |
Child’s caregiver at home, n (%) | |
Child lives with one parent (mother or father) | 4 (16.7) |
Child lives with both parents | 20 (83.3) |
Ethnic background, n (%) | |
White (Caucasian) | 9 (37.5) |
Black (e.g., African, Haitian, Jamaican, Somali) | 8 (33.3) |
Arab/West Asian (e.g., Armenian, Egyptian, Iranian, Lebanese, Moroccan) | 3 (12.5) |
South East Asian | 2 (8.3) |
Latin American | 1 (4.2) |
South Asian | 1 (4.2) |
Educational background, n (%) | |
Graduated secondary/high school | 3 (12.5) |
Some college/technical school | 1 (4.2) |
Graduated college/technical school | 3 (12.5) |
Graduate degree | 14 (58.3) |
Prefer not to answer | 3 (12.5) |
Work status, n (%) | |
Full-time | 10 (41.7) |
Not working | 7 (29.2) |
Part-time | 4 (16.7) |
Prefer not to answer | 3 (12.5) |
Spouse’s educational background, n (%) | |
Some high school | 1 (4.2) |
Graduated secondary/high school | 3 (12.5) |
Graduated college/technical school | 3 (12.5) |
Some graduate school | 1 (4.2) |
Graduate degree | 8 (33.3) |
Other degree | 1 (4.2) |
Prefer not to answer | 2 (8.3) |
Missing data | 5 (20.8) |
Spouse’s work status, n (%) | |
Full-time | 8 (33.3) |
Part-time | 4 (16.7) |
Not working | 4 (16.7) |
Prefer not to answer | 3 (12.5) |
Missing data | 5 (20.8) |
Household annual income in Canadian Dollar, n (%) | |
Less than $24,999 | 2 (8.3) |
$25,000 to $49,999 | 10 (41.7) |
$50,000 to $74,999 | 1 (4.2) |
$100,000 to $149,999 | 3 (12.5) |
$200,000 or more | 2 (8.3) |
Prefer not to answer | 5 (20.8) |
Number of people live in the household, mean (SD) | 3.8 (1.6) |
CHA use by parents, n (%) | |
Yes | 11 (45.8) |
CHA use intensity, n (%) | |
High (more than five types of CHA) | 2 (8.3) |
Medium (2–4 types of CHA) | 4 (16.7) |
Low (1 type of CHA) | 5 (20.8) |
No use of CHA | 13 (54.2) |
Parent’s expectations of the child’s CHA use +, n (%) | |
CHA use would let the child feel better | 17 (70.8) |
CHA use would prevent the child’s illness/symptom | 2 (8.3) |
CHA use was safe to use | 2 (8.3) |
Other | 2 (8.3) |
CHA use would treat the child’s symptoms | 1 (4.2) |
Parent’s satisfaction of child’s recent CHA use outcome, n (%) | |
Dissatisfied | 4 (16.7) |
Neutral | 13 (54.2) |
Satisfied | 5 (20.8) |
Very satisfied | 2 (8.3) |
Parent’s satisfaction of CHA cost, n (%) | |
Very dissatisfied | 1 (4.2) |
Dissatisfied | 8 (33.3) |
Neutral | 6 (25) |
Satisfied | 7 (28.2) |
Very satisfied | 1 (4.2) |
Not applicable | 1 (4.2) |
Parent’s satisfaction of CHA availability, n (%) | |
Dissatisfied | 3 (12.5) |
Neutral | 12 (50) |
Satisfied | 8 (33.3) |
Very satisfied | 1 (4.2) |
Parent’s satisfaction of the safety of CHA, n (%) | |
Dissatisfied | 2 (8.3) |
Neutral | 11 (45.8) |
Satisfied | 10 (41.7) |
Very satisfied | 1 (4.2) |
Monthly cost of CHA in Canadian Dollar, mean (SD) | 155 (168) |
Awareness of HCPs about child’s use of CHA (parent’s report), n (%) | |
Yes | 7 (29.2) |
No | 7 (29.2) |
Do not know | 10 (41.7) |
Parent’s satisfaction with conventional treatments, n (%) | |
Very satisfied | 3 (12.5) |
Satisfied | 15 (62.5) |
Neutral | 6 (25) |
Child’s PedsQL score (proxy-report), mean (SD) | 56.3 (15) |
Raters | Weighted Kappa (SE) | 95% CI |
---|---|---|
Dyad 1 | 0.087 (0.089) * | −0.086 to 0.261 |
Dyad 2 | 0.756 (0.065) | 0.628 to 0.884 |
Dyad 3 | 0.540 (0.094) | 0.357 to 0.724 |
Dyad 4 | 0.686 (0.079) | 0.532 to 0.841 |
Dyad 5 | 0.867 (0.053) | 0.763 to 0.972 |
Dyad 6 | 0.987 (0.009) | 0.968 to 1.005 |
Dyad 7 | 0.890 (0.037) | 0.819 to 0.962 |
Dyad 8 | 0.232 (0.143) * | −0.048 to 0.512 |
Dyad 9 | 0.768 (0.061) | 0.648 to 0.888 |
Dyad 10 | 0.794 (0.116) | 0.567 to 1.021 |
Dyad 11 | 0.950 (0.019) | 0.912 to 0.988 |
Dyad 12 | 0.835 (0.052) | 0.734 to 0.936 |
Dyad 13 | 0.976 (0.016) | 0.944 to 1.008 |
Dyad 14 | 0.962 (0.028) | 0.907 to 1.016 |
Dyad 15 | 0.981 (0.019) | 0.943 to 1.019 |
Dyad 16 | 1.000 (0.000) | 1.000 to 1.000 |
Dyad 17 | 0.853 (0.053) | 0.750 to 0.957 |
Dyad 18 | 0.615 (0.085) | 0.448 to 0.782 |
Dyad 19 | 0.676 (0.053) | 0.573 to 0.780 |
Dyad 20 | 0.749 (0.074) | 0.604 to 0.893 |
Dyad 21 | 0.886 (0.082) | 0.725 to 1.047 |
Dyad 22 | 1.000 (0.000) | 1.000 to 1.000 |
Dyad 23 | 0.630 (0.084) | 0.465 to 0.795 |
Dyad 24 | 0.763 (0.044) | 0.677 to 0.848 |
All Dyads | 0.770 (0.056) | 0.660 to 0.881 |
Respondents | Weighted Kappa (SE) | 95% CI |
---|---|---|
Child 2 | 0.951 (0.037) | 0.878 to 1.023 |
Child 3 | 0.000 (0.000) * | 0.000 to 0.000 |
Child 4 | 1.000 (0.000) | 1.000 to 1.000 |
Child 5 | 1.000 (0.000) | 1.000 to 1.000 |
Child 6 | 0.746 (0.069) | 0.610 to 0.881 |
Child 7 | 0.861 (0.090) | 0.685 to 1.037 |
Child 8 | 0.000 (0.000) * | 0.000 to 0.000 |
Child 9 | 0.865 (0.052) | 0.763 to 0.967 |
Child 11 | 0.931 (0.053) | 0.826 to 1.036 |
Child 12 | 0.821 (0.097) | 0.632 to 1.011 |
Child 13 | 0.947 (0.050) | 0.849 to 1.045 |
Child 14 | 1.000 (0.000) | 1.000 to 1.000 |
Child 15 | 0.943 (0.057) | 0.831 to 1.055 |
Child 17 | 0.884 (0.089) | 0.709 to 1.059 |
Child 18 | 0.668 (0.133) | 0.406 to 0.929 |
Child 19 | 0.770 (0.079) | 0.616 to 0.924 |
Child 20 | 0.945 (0.058) | 0.832 to 1.057 |
Child 23 | 1.000 (0.000) | 1.000 to 1.000 |
Child 24 | 0.976 (0.018) | 0.941 to 1.010 |
All children | 0.806 (0.046) | 0.715 to 0.897 |
Respondents | Weighted Kappa (SE) | 95% CI |
---|---|---|
Parent 1 | 0.817 (0.101) | 0.618 to 1.015 |
Parent 2 | 0.968 (0.024) | 0.921 to 1.014 |
Parent 3 | 0.880 (0.060) | 0.764 to 0.997 |
Parent 4 | 1.000 (0.000) | 1.000 to 1.000 |
Parent 5 | 0.951 (0.049) | 0.855 to 1.046 |
Parent 6 | 0.743 (0.065) | 0.616 to 0.871 |
Parent 7 | 0.848 (0.100) | 0.653 to 1.044 |
Parent 9 | 0.749 (0.101) | 0.551 to 0.947 |
Parent 11 | 0.967 (0.025) | 0.917 to 1.016 |
Parent 12 | 0.888 (0.070) | 0.751 to 1.026 |
Parent 13 | 0.941 (0.055) | 0.832 to 1.049 |
Parent 14 | 0.975 (0.025) | 0.926 to 1.025 |
Parent 15 | 0.880 (0.086) | 0.711 to 1.048 |
Parent 17 | 0.944 (0.058) | 0.831 to 1.058 |
Parent 18 | 0.846 (0.094) | 0.661 to 1.031 |
Parent 19 | 0.789 (0.074) | 0.644 to 0.934 |
Parent 20 | 1.000 (0.000) | 1.000 to 1.000 |
Parent 23 | 0.879 (0.064) | 0.753 to 1.005 |
Parent 24 | 0.926 (0.033) | 0.861 to 0.991 |
All parents | 0.894 (0.057) | 0.782 to 1.006 |
Recent Use of CHA | Child Self-Report (n = 24) | Parent Proxy-Report (n = 24) | ||||||
---|---|---|---|---|---|---|---|---|
CHA Users (n = 18) | CHA Non-User (n = 6) | CHA Users (n = 19) | CHA Non-User (n = 5) | |||||
Variables | n (%) | n (%) | p-value ^ | n (%) | n (%) | p-value ^ | ||
Easy access to CHA | ||||||||
Yes | 14 (77.8%) | 2 (33.3%) | 0.020 * | 16 (84.2%) | 0 | <0.001 * | ||
Parental education | ||||||||
Graduated secondary/high school | 2 (11.1%) | 1 (16.7%) | 0.373 | 2 (10.5%) | 1 (20%) | 0.452 | ||
Some college/technical school | 0 | 1 (16.7%) | 0 | 1 (20%) | ||||
Graduated college/technical school | 3 (16.7%) | 0 | 3 (15.8%) | 0 | ||||
Graduate degree | 10 (55.6%) | 4 (66.7) | 11 (57.9%) | 3 (60%) | ||||
Prefer not to answer | 3 (16.7%) | 0 | 3 (15.8%) | 0 | ||||
Parent’s use of CHA | ||||||||
Yes | 8 (44.4%) | 3 (50%) | 1.000 | 9 (81.8%) | 2 (40%) | 1.000 | ||
Family annual income | ||||||||
Less than $24,999 | 2 (11.1%) | 0 | 0.736 | 2 (10.5%) | 0 | 0.656 | ||
$25,000 to $49,999 | 7 (38.9%) | 3 (50%) | 8 (42.1%) | 2 (40%) | ||||
$50,000 to $74,999 | 1 (5.6%) | 0 | 1 (5.3%) | 0 | ||||
$100,000 to $149,999 | 1 (5.6%) | 2 (33.3%) | 1 (5.3%) | 2 (40%) | ||||
$150,000 to $199.999 | 1 (5.6%) | 0 | 1 (5.3%) | |||||
$200,000 or more | 2 (11.1%) | 0 | 2 (10.5%) | 0 | ||||
Prefer not to answer | 4 (22.2%) | 1 (16.7%) | 4 (21.1%) | 1 (20%) | ||||
Parent’s employment status | ||||||||
Full-time | 6 (33.3%) | 4 (66.7) | 0.124 | 8 (42.1%) | 2 (40%) | 0.499 | ||
Part-time | 2 (11.1%) | 2 (33.3%) | 2 (10.5%) | 2 (40%) | ||||
Not working | 7 (38.9%) | 0 | 6 (31.6%) | 1 (20%) | ||||
Prefer not to answer | 3 (16.7%) | 0 | 3 (15.8%) | 0 | ||||
Parent’s expectation of child’s use of CHA | ||||||||
Feel better | 13 (72.2%) | 4 (66.7%) | 0.632 | 14 (73.7%) | 3 (60%) | 0.518 | ||
Prevent illness/symptoms | 1 (5.6%) | 1 (16.7%) | 1 (5.3%) | 1 (20%) | ||||
Treat symptoms | 1 (5.6%) | 0 | 1 (5.3%) | 0 | ||||
Safe to use | 2 (11.1%) | 0 | 2 (10.5%) | 0 | ||||
Other | 1 (5.6%) | 1 (16.7%) | 1 (5.3%) | 1 (20%) | ||||
Parent’s satisfaction with conventional treatment | ||||||||
Very satisfied | 2 (11.1%) | 1 (16.7%) | 1.000 | 3 (15.8%) | 0 | 1.000 | ||
Satisfied | 11 (61.1%) | 4 (66.7%) | 11 (57.9%) | 4 (80%) | ||||
Neutral | 5 (27.8%) | 1 (16.7%) | 5 (26.3%) | 1 (20%) | ||||
Median (Range) | Median (Range) | U | p-value | Median (Range) | Median (Range) | U | p-value | |
Child’s age (y) | 14.9 (8.5–18) | 16.2 (9.8–17.3) | 30 | 0.109 | 15.3 (10.5–17.1) | 11.8 (8.5–18) | 27 | 0.145 |
Period since cancer diagnosis (y) | 1.3 (0.3–15.8) | 0.9 (0.2–10.4) | 51 | 0.841 | 1.5 (0.3–15.8) | 1.4 (0.4–5.3) | 36 | 0.413 |
PedsQL score | 60.9 (28.3–77.2) | 58.7 (45.7–80.4) | 47 | 0.640 | 55 (32.6–83.7) | 56.5 (30.4–80.4) | 32.5 | 0.286 |
Intensity of cancer treatment | 3 (2–4) | 3 (3–4) | 52 | 0.873 | 3 (2–4) | 3 (3–4) | 28.5 | 0.107 |
Parent’s satisfaction of CHA use | 4 (3–5) | 4 (0–4.5) | 48 | 0.710 | 3.1 (2.3–4) | 3 (2–4) | 43 | 0.773 |
CHA monthly cost (CAD) | 100 (0–500) | 127.5 (0–500) | 42.5 | 0.436 | 100 (0–500) | 50 (0–50) | 36 | 0.427 |
Future use of CHA | Yes (n = 27) | No or not sure (n = 3) | Yes (n = 32) | No or not sure (n = 2) | ||||
Variables | n (%) | n (%) | p-value ^ | n (%) | n (%) | p-value ^ | ||
Helpfulness of recent use of CHA + | ||||||||
Helpful | 14 (51.9%) | 1/3 (33.3%) | 0.446 | 14 (43.8%) | 1 (50%) | 1.000 | ||
Somewhat helpful | 11 (40.7% | 1/3 (33.3%) | 16 (50%) | 1 (50%) | ||||
Not sure | 2 (7.4%) | 1/3 (33.3%) | 2 (6.3%) | 0 | ||||
Future use of CHA | Yes (n = 14) | No or not sure (n = 3) | Yes (n = 17) | No or not sure (n = 7) | ||||
Variables | Median (Range) | Median (Range) | U | p-value | Median (Range) | Median (Range) | U | p-value |
CHA monthly cost (CAD) | 100 (100–500) | 50 (0–500) | 47 | 0.420 | 100 (0–500) | 155 (0–500) | 54 | 0.723 |
Parent’s satisfaction of CHA use | 4 (3–5) | 4 (0–4.5) | 42 | 0.260 | 3 (2–4) | 3 (2.3–5) | 57 | 0.872 |
Administration Feasibility Questions | Child’s Self-Report n = 24 | Parents’ Proxy-Report n = 24 | ||
---|---|---|---|---|
Mean (SD) | Cronbach’s Alpha | Mean (SD) | Cronbach’s Alpha | |
Were the instructions and questions in the WHAT questionnaire easy to understand? * | 5.54 (1.29) | 0.853 | 5.67 (1.37) | 0.829 |
Was the WHAT questionnaire easy to use? * | 5.67 (1.72) | 5.83 (1.69) | ||
If you were given the WHAT questionnaire, would you complete it? * | 5.71 (1.06) | 5.83 (1.05) | ||
Was the layout of the WHAT questionnaire easy to follow? * | 5.63 (1.52) | 5.83 (1.38) | ||
How would you rate the amount of time taken to complete the WHAT questionnaire? ** | 5.67 (1.40) | 5.88 (1.36) | ||
Overall | 5.64 (0.23) | 5.81 (0.22) |
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© 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
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Alqudimat, M.R.; Toupin April, K.; Jibb, L.; Victor, C.; Nathan, P.C.; Stinson, J. Inter-Rater Reliability, Construct Validity, and Feasibility of the Modified “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires for Assessing the Use of Complementary Health Approaches in Pediatric Oncology. Children 2023, 10, 1500. https://doi.org/10.3390/children10091500
Alqudimat MR, Toupin April K, Jibb L, Victor C, Nathan PC, Stinson J. Inter-Rater Reliability, Construct Validity, and Feasibility of the Modified “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires for Assessing the Use of Complementary Health Approaches in Pediatric Oncology. Children. 2023; 10(9):1500. https://doi.org/10.3390/children10091500
Chicago/Turabian StyleAlqudimat, Mohammad R., Karine Toupin April, Lindsay Jibb, Charles Victor, Paul C. Nathan, and Jennifer Stinson. 2023. "Inter-Rater Reliability, Construct Validity, and Feasibility of the Modified “Which Health Approaches and Treatments Are You Using?” (WHAT) Questionnaires for Assessing the Use of Complementary Health Approaches in Pediatric Oncology" Children 10, no. 9: 1500. https://doi.org/10.3390/children10091500