Developing Self-Efficacy and Recall Questionnaires with and for Children

Purpose/Aims: We will present our process and insights about incorporating children’s input in the development of questionnaires to assess children’s self-efficacy and recall related to healthy eating and physical activity.

Rationale/Conceptual Basis/Background: Many current health-related interventions and assessment tools were developed with and for adults and later adapted for children. However, children are not little adults. To improve their access to healthcare tailored for them, children need to be involved in the research process beginning with the development of child-centered questionnaires.   

Method: We used qualitative design and held five one-hour focus groups at two elementary schools with 39 fourth to sixth grade children to discuss the evolving questionnaires. Initially we attempted to adapt a self-efficacy questionnaire for parents related to their children’s nutrition and physical activity; this questionnaire had Likert-type response options. After two focus groups, we realized adapting this questionnaire would not work. The format and language were beyond the children’s developmental skills. So, collaborating with a panel of children experienced in advising researchers, we drafted our own questionnaires focused on the same concepts as the modified questionnaire but reducing the wordiness, number of questions, and response options. Subsequently, we held three additional focus groups to refine our questionnaires.  

Results:In the focus groups, children shared their concerns, confusion, insights, and suggestions for improvement. In a few instances, the problems we identified were readily solved by the children. As a result of the process, we have a nine-item self-efficacy questionnaire and a ten-item recall questionnaire written in simple, clear language that fifth-graders can complete in less than 5 minutes.

Implications: Whether assessing children in clinical practice or as research participants, nurses should use child-centered questionnaires that have been developed with children as consultants. Until children are directly engaged in questionnaire development, questionnaires might be developed and used that lack reliability and validity for child populations, which can result in faulty conclusions.