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American Academy of Pediatrics
ELECTRONIC ARTICLE

Reliability and Validity of the Children's Health Survey for Asthma

Linda Asmussen, Lynn M. Olson, Evalyn N. Grant, Joanne Fagan and Kevin B. Weiss
Pediatrics December 1999, 104 (6) e71; DOI: https://doi.org/10.1542/peds.104.6.e71
Linda Asmussen
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Lynn M. Olson
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Evalyn N. Grant
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Joanne Fagan
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Kevin B. Weiss
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Article Figures & Data

Figures

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  • Fig. 1.
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    Fig. 1.

    Process of instrument development, testing, and reduction for CHSA.

  • Fig. 2.
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    Fig. 2.

    Differences in mean CHSA:48 scale scores by symptom severity (study IV baseline visit).

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    Fig. 3.

    Differences in mean CHSA:48 scale scores by medication use severity (study IV baseline visit).

Tables

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    Table 1.

    Criteria Used in the Process of CHSA Item Reduction

    CriterionSource of Data
    Low expert review rating (bottom 50%)Study I
    High ceiling effect (item mean >4.0 on a 5-point scale)Study II
    Low item–total scale correlation (<.60)Study II
    Improved scale α coefficient if item deletedStudy II
    Low item covariance (<mean) with majority of other scale itemsStudy II
    • View popup
    Table 2.

    Studies Assessing Various Psychometric Aspects of the CHSA

    TestPsychometric AssessmentStudy Design
    Study IContent validityCross-sectional
    Study IIInternal consistency reliabilityCross-sectional
    Study IIIInternal consistency reliabilityCross-sectional
    Study IVInternal consistency reliabilityLongitudinal
    Test–retest reliability
    Validity
    • View popup
    Table 3.

    Demographic Characteristics of Study Samples (II to IV)

    Study II
    (n = 100)
    Study III
    (n = 102)
    Study IV
    (n = 74)
    Respondent (%)
     Mother78.486.387.8
     Father9.88.85.4
     Other6.94.96.8
     Missing4.9-0--0-
    Child gender (%)
     Male40.635.351.4
     Female59.464.748.6
    Child age (y)Mean = 8.9;
    range = 5–12
    Mean = 7.3;
    range = 3–12
    Mean = 9.1;
    range = 5–12
    Child race/ethnicity (%)
     Black35.166.774.3
     White51.533.31.4
     Asian1.0-0-1.4
     Spanish or Hispanic9.3-0-17.6
     Other4.1-0-4.1
     Missing-0--0-1.4
    Parent age (y)FatherMotherFatherMotherFatherMother
    Mean = 38.5;
    range = 25–66
    Mean = 35.3;
    range = 24–57
    **Mean = 38.4;
    range = 22–56
    Mean = 37.1;
    range = 21–74
     Percentage missing20.17.025.74.1
    Parent marital status (%)
     Married52.638.247.3
     Single17.933.328.4
     Separated/divorced/widowed29.528.420.3
     Missing-0--0-4.1
    Highest level of education completed (%)FatherMotherFatherMotherFatherMother
     High school graduate or less41.839.859.052.040.644.6
     Some college or more55.860.234.748.037.954.1
     Don't know2.5-0-6.3-0-1.4-0-
     Missing-0--0--0--0-20.31.4
    Respondent employment status (%)**
     Employed outside the home58.1
     Full-time homemaker10.8
     Unemployed21.7
     Other6.9
     Missing2.8
    Total household income (%)*
     <$14 99938.928.4
     $15 000–29 99933.335.1
     $30 000–60 00020.024.3
     >$60 0007.810.8
     Missing-0-1.4
    Child stopped breathing or was intubated because of asthma (%)12.214.75.4
    Child ever used steroids >4 times in a 6-mo period (%)39.542.225.7
    Child ever been hospitalized for asthma (%)**48.6
    Child ever been taken to emergency room/emergency department for asthma (%)**81.1
    Anyone in child's family had allergies, asthma, or eczema (%)86.0*87.8
    Smoker in child's primary household (%)28.636.339.2
    • ↵* Not collected.

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    Table 4.

    Descriptive Statistics for CHSA:48 Scales in Three Study Samples

    MeanStandard DeviationMinimumMaximumValid N% Floor% Ceiling
    Physical health
     Study II63.2219.9410.0098.3394-0--0-
     Study III70.6622.0318.33100.00101-0-3.0
     Study IV71.5120.5520.00100.0072-0-5.6
    Activity (child)
     Study II67.6023.7310.00100.0096-0-18.8
     Study III78.5222.59-0-100.001011.030.7
     Study IV78.6320.9530.00100.0073-0-27.4
    Activity (family)
     Study II72.6022.738.33100.0097-0-17.5
     Study III73.0021.894.17100.00102-0-16.7
     Study IV86.1318.9229.17100.0073-0-39.7
    Emotional health (child)
     Study II61.5329.22-0-100.00954.29.5
     Study III72.5326.90-0-100.00992.026.3
     Study IV68.7028.06-0-100.00732.721.9
    Emotional health (family)
     Study II61.4020.2220.5994.1297-0--0-
     Study III*61.2215.2319.4491.67101-0--0-
     Study IV66.7717.6525.00100.0074-0-1.4
    • ↵* Study III Emotional health (family) scale computed based on 9 of 17 scale items.

    • View popup
    Table 5.

    Internal Consistency of the CHSA:48 in Three Study Samples

    Study II (n = 100)Study III (n = 102)Study IV (n = 74)
    Item–Total Correlationα*Item–Total Correlationα*Item–Total Correlationα*
    Physical health—15 items.91.92.92
     Shortness of breath.75.90.65.91.64.92
     Tightness in the chest.73.90.62.91.67.92
     Wheezing without a cold.47.90.69.91.54.92
     Cough.41.91.63.91.61.92
     A cold that won't go away.33.91.67.91.56.92
     Wheezing with a cold.38.91.64.91.56.92
     Difficulty sleeping.67.90.73.91.68.92
     Rapid heart rate or pounding of heart (attributable to medications).68.90.54.91.63.92
     Headache (attributable to medications).56.90.33.92.68.92
     Upset stomach/vomiting (attributable to medications).54.90.59.91.74.91
     Tightness in the chest (attributable to medications).73.89.75.91.72.91
     Irritable or fussy (attributable to medications).71.90.71.91.70.91
     Fatigue/tires easily (attributable to medications).67.90.69.91.66.92
     Difficulty paying attention or sitting still (attributable to medications).58.90.46.92.46.92
     Difficulty sleeping at night (attributable to medications).75.89.70.91.78.91
    Activity (child)—5 items.89.87.87
     Limited in school gym classes.80.85.77.81.69.85
     Limited in playing sports or running outside.82.85.80.81.73.83
     Limited in very strenuous activities.79.86.77.82.77.83
     Limited in moderate activities.76.87.71.84.77.83
     Limited in mild activities.54.91.47.89.57.87
    Activity (family)—6 items.85.81.86
     Changed family plans or trips because not sure when attack could occur.64.82.55.79.65.84
     Canceled social plans because child had a problem with asthma.64.82.58.78.78.83
     Avoided activities or places that might trigger an attack.57.84.55.79.69.86
     Lost sleep.61.83.67.76.72.84
     Missed work or school.62.83.46.81.66.84
     Normal routine was changed.74.80.65.77.63.85
    Emotional health (child)—5 items.91.87.90
     Frustrated about having asthma.78.89.59.86.72.88
     Is frustrated having to rely on asthma treatments.72.90.77.82.79.86
     Is frustrated by having to limit activities because of asthma.76.89.60.86.67.89
     Is upset about having asthma.82.88.84.80.80.86
     Is upset by having to take asthma treatments.78.89.67.84.75.87
    Emotional health (family)†—17 items.90.65.86
     Bothered by frequent trips to doctor's office or hospital.61.89——.61.85
     Bothered by finding a babysitter who can handle child's asthma.61.89.49.58.37.86
     Bothered by getting child to take asthma medications.57.89.30.63.49.85
     Bothered by having necessary equipment for asthma at home.61.89.26.64.52.85
     Bothered by keeping house clean to avoid triggering attack.55.89.44.60.55.85
     Child's asthma caused stress in family.63.89.39.61.69.85
     Frustrated other people don't understand what it's like to have a child with asthma.65.89.39.61.59.85
     Sometimes get angry and ask “Why my child?”.62.89——.58.85
     Have doubts if doing the right things in treatment of child's asthma.57.89——.55.85
     Confident about handling a severe attack of child's asthma.10.91−.05.69−.03.88
     Sometimes lose hope that child will get better.53.89——.58.85
     Concerned about side-effects child could get from taking medicine for a long time.48.89.35.62.48.86
     Worry about cost of child's medical care for asthma.60.89——.37.86
     Worry that child is not getting good medical care for asthma.49.89——.43.86
     Worry that asthma causes child to be left out from playing with other children.58.89——.64.85
     Cost of medical care for child's asthma causes stress in our family.56.89——.41.86
     Concerned about problems from asthma that child currently has or may have in future.63.89.38.62.52.85
    • ↵* α values reported for individual items are α if item is deleted from scale.

    • ↵† AAP/Arkansas project Emotional Health [family] scale computed based on 9 of 17 scale items.

    • View popup
    Table 6.

    Test–Retest Reliability of the CHSA:48 in the Subsample of Children Judged to be Clinically Stable Over Time (Study IV)

    ScaleBaseline Visit—48 Hours' Follow-up
    Valid
    Number
    Test-Retest r
    Between Forms
    Intraclass r Coefficient
    (95% Confidence Interval,
    Lower to Upper Range)
    Physical health61.86.82  (.62–.90)
    Activity (child)62.86.85  (.75–.91)
    Activity (family)63.82.81  (.71–.88)
    Emotional health (child)64.62.60  (.41–.74)
    Emotional health (family)62.81.77  (.60–.87)
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1 Dec 1999
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Reliability and Validity of the Children's Health Survey for Asthma
Linda Asmussen, Lynn M. Olson, Evalyn N. Grant, Joanne Fagan, Kevin B. Weiss
Pediatrics Dec 1999, 104 (6) e71; DOI: 10.1542/peds.104.6.e71

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Reliability and Validity of the Children's Health Survey for Asthma
Linda Asmussen, Lynn M. Olson, Evalyn N. Grant, Joanne Fagan, Kevin B. Weiss
Pediatrics Dec 1999, 104 (6) e71; DOI: 10.1542/peds.104.6.e71
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