NEW TOOLS FOR ASSESSING AND MONITORING ASTHMA CONTROL IN BRAZILIAN CHILDREN AND ADOLESCENTES
Surveys and Questionnaires; Psychometrics; Child; Adolescent
Background: The assessment and routine monitoring of asthma control are essential aspects for an adequate management and treatment of the disease, especially in childhood and adolescence. Despite the existence of adapted 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 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 after implementing the suggestions provided the committee and 1 manuscript for further finalization). Study 1 comprises a systematic review of measurement properties of existing measures for asthma control assessment. The methods of this study followed the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN). This review summarizes 79 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. This study was conducted according to international recommendations. 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 presented 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 three versions to children, adolescents and parents/caregivers and the prototype of a mobile app. The development and analysis of the content validity of these instruments were performed according to COSMIN. 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 systematic review 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, these items were administered through in-depth interviews with a sample of 10 children (7-11 years) and 6 adolescents (12-18 years) and 21 parents/guardians, of which 6 parents/guardians for children aged 4-6 years. Conclusions: The systematic review identified that several measurement instruments were developed to assess asthma control in limited age ranges. These instruments use different response scales, and most were 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. The studies that comprise this thesis 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.