[Skip to Content]
[Skip to Content Landing]
Views 160
Citations 0
Original Investigation
January 2017

Stakeholder-Engaged Measure Development for Pediatric Obstructive Sleep-Disordered BreathingThe Obstructive Sleep-Disordered Breathing and Adenotonsillectomy Knowledge Scale for Parents

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
JAMA Otolaryngol Head Neck Surg. 2017;143(1):46-54. doi:10.1001/jamaoto.2016.2681
Key Points

Question  Is a questionnaire on adenotonsillectomy (AT) performed for obstructive sleep-disordered breathing (oSDB) appropriate for measuring parental knowledge of oSDB symptoms and treatment with AT?

Findings  The oSDB and AT Knowledge Scale for Parents scale was designed using a sequential development process incorporating key content themes highlighted by parents and clinicians. When administered to 19 clinicians and 13 laymen, the measure showed high reliability, and comparisons of laymen and clinician scores showed significant differences, demonstrating the measure’s validity.

Meaning  The oSDB and AT Knowledge Scale for Parents is a stakeholder-developed, psychometrically sound measure that may be used to enhance clinical decision making and patient-centered outcomes research for pediatric oSDB.


Importance  Parental decision making about adenotonsillectomy (AT) for obstructive sleep-disordered breathing (oSDB) is associated with decisional conflict that may be alleviated with improved knowledge about symptoms and treatments.

Objective  To develop a measure of parental knowledge about oSDB and AT.

Design, Setting, and Participants  A sequential design was used for scale development. A prototype measure containing 9 oSDB and AT themes and 85 items was administered in survey format via an online platform. Participants included 19 clinician experts (otolaryngologists and pediatricians) and 13 laymen (parents of children who snore or do not snore, and other adults). Quantitative and qualitative responses were used to modify the measure and create the knowledge scale. Content validity of the scale was established through expert feedback and evaluation. Criterion validity was established with t test comparisons of experts with laymen. Reliability of the responses was assessed with Cronbach α testing.

Main Outcomes and Measures  An 85-item prototype measure and 39-item modified measure were evaluated for consensus/approval and psychometric integrity.

Results  Of 45 potential participants, 32 individuals (71%) responded to the prototype scale. Respondents included 19 clinician experts (59%) (otolaryngologists and pediatricians) and 13 laymen (41%) (parents of children who snore [n = 8] or do not snore [n = 2] and other adults [n = 3]); demographic data were not collected. Content analysis and qualitative feedback were largely rated positively: 27 respondents (84%) stated that the measure was a good evaluation of knowledge, 30 respondents (94%) commented that the items were clear, and 31 individuals (97%) approved of its organization, although there were several suggestions for rewording and/or addition of response options. Experts identified themes most important for assessing oSDB (symptoms) and AT (experiences: risks and benefits) knowledge. These qualitative comments were used to modify the scale, and items were eliminated if more than 2 were reported as misleading or less than 85% of clinicians provided correct responses. Five themes (oSDB symptoms, treatment options, AT risks, anesthesia, and AT benefits) and 39 items composed the final scale. Experts scored higher than laymen on the oSDB and AT Knowledge Scale for Parents overall (17 [94%] vs 12 [67%]; Cohen d = 1.96; 95% CI, 1.05-2.86) and within all themes, including experiences of children with oSDB (19 [88%] vs 13 [62%]; Cohen d = 1.53; 95% CI, 0.71-2.32), treatment options (19 [97%] vs 12 [68%]; Cohen d = 1.74; 95% CI, 0.88-2.57), AT risks (17 [97%] vs 12 [59%]; Cohen d = 1.94; 95% CI, 1.03-2.83), anesthesia (17 [97%] vs 12 [79%]; Cohen d = 1.09; 95% CI, 0.29-1.88), and AT benefits (17 [95%] vs 12 [67%]; Cohen d = 1.28; 95% CI, 0.46-2.09), demonstrating criterion validity. All responses demonstrated high reliability (Cronbach α = 0.94).

Conclusions and Relevance  The oSDB and AT Knowledge Scale for Parents is psychometrically sound for use in the assessment of parental knowledge.