Article Figures & Data
Figures
- Fig. 1.
Process of instrument development, testing, and reduction for CHSA.
- Fig. 2.
Differences in mean CHSA:48 scale scores by symptom severity (study IV baseline visit).
- Fig. 3.
Differences in mean CHSA:48 scale scores by medication use severity (study IV baseline visit).
Tables
Criterion Source 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 deleted Study II Low item covariance (<mean) with majority of other scale items Study II Test Psychometric Assessment Study Design Study I Content validity Cross-sectional Study II Internal consistency reliability Cross-sectional Study III Internal consistency reliability Cross-sectional Study IV Internal consistency reliability Longitudinal Test–retest reliability Validity Study II
(n = 100)Study III
(n = 102)Study IV
(n = 74)Respondent (%) Mother 78.4 86.3 87.8 Father 9.8 8.8 5.4 Other 6.9 4.9 6.8 Missing 4.9 -0- -0- Child gender (%) Male 40.6 35.3 51.4 Female 59.4 64.7 48.6 Child age (y) Mean = 8.9;
range = 5–12Mean = 7.3;
range = 3–12Mean = 9.1;
range = 5–12Child race/ethnicity (%) Black 35.1 66.7 74.3 White 51.5 33.3 1.4 Asian 1.0 -0- 1.4 Spanish or Hispanic 9.3 -0- 17.6 Other 4.1 -0- 4.1 Missing -0- -0- 1.4 Parent age (y) Father Mother Father Mother Father Mother Mean = 38.5;
range = 25–66Mean = 35.3;
range = 24–57* * Mean = 38.4;
range = 22–56Mean = 37.1;
range = 21–74Percentage missing 20.1 7.0 25.7 4.1 Parent marital status (%) Married 52.6 38.2 47.3 Single 17.9 33.3 28.4 Separated/divorced/widowed 29.5 28.4 20.3 Missing -0- -0- 4.1 Highest level of education completed (%) Father Mother Father Mother Father Mother High school graduate or less 41.8 39.8 59.0 52.0 40.6 44.6 Some college or more 55.8 60.2 34.7 48.0 37.9 54.1 Don't know 2.5 -0- 6.3 -0- 1.4 -0- Missing -0- -0- -0- -0- 20.3 1.4 Respondent employment status (%) * * Employed outside the home 58.1 Full-time homemaker 10.8 Unemployed 21.7 Other 6.9 Missing 2.8 Total household income (%) * <$14 999 38.9 28.4 $15 000–29 999 33.3 35.1 $30 000–60 000 20.0 24.3 >$60 000 7.8 10.8 Missing -0- 1.4 Child stopped breathing or was intubated because of asthma (%) 12.2 14.7 5.4 Child ever used steroids >4 times in a 6-mo period (%) 39.5 42.2 25.7 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 (%) 28.6 36.3 39.2 ↵* Not collected.
Mean Standard Deviation Minimum Maximum Valid N % Floor % Ceiling Physical health Study II 63.22 19.94 10.00 98.33 94 -0- -0- Study III 70.66 22.03 18.33 100.00 101 -0- 3.0 Study IV 71.51 20.55 20.00 100.00 72 -0- 5.6 Activity (child) Study II 67.60 23.73 10.00 100.00 96 -0- 18.8 Study III 78.52 22.59 -0- 100.00 101 1.0 30.7 Study IV 78.63 20.95 30.00 100.00 73 -0- 27.4 Activity (family) Study II 72.60 22.73 8.33 100.00 97 -0- 17.5 Study III 73.00 21.89 4.17 100.00 102 -0- 16.7 Study IV 86.13 18.92 29.17 100.00 73 -0- 39.7 Emotional health (child) Study II 61.53 29.22 -0- 100.00 95 4.2 9.5 Study III 72.53 26.90 -0- 100.00 99 2.0 26.3 Study IV 68.70 28.06 -0- 100.00 73 2.7 21.9 Emotional health (family) Study II 61.40 20.22 20.59 94.12 97 -0- -0- Study III* 61.22 15.23 19.44 91.67 101 -0- -0- Study IV 66.77 17.65 25.00 100.00 74 -0- 1.4 ↵* Study III Emotional health (family) scale computed based on 9 of 17 scale items.
Study II (n = 100) Study III (n = 102) Study IV (n = 74) Item–Total Correlation α* Item–Total Correlation α* Item–Total Correlation α* 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 - Table 6.
Test–Retest Reliability of the CHSA:48 in the Subsample of Children Judged to be Clinically Stable Over Time (Study IV)
Scale Baseline Visit—48 Hours' Follow-up Valid
NumberTest-Retest r
Between FormsIntraclass r Coefficient
(95% Confidence Interval,
Lower to Upper Range)Physical health 61 .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)
In this issue
Reliability and Validity of the Children's Health Survey for Asthma
