在资源匮乏地区测量发育障碍儿童的功能残疾：《发育障碍-儿童残疾评估量表》（DD-CDAS）在巴基斯坦农村地区的效度验证

Measuring functional disability in children with developmental disorders in low-resource settings: validation of Developmental Disorders-Children Disability Assessment Schedule (DD-CDAS) in rural Pakistan.

作者信息

Hamdani Syed Usman, Huma Zill-E, Wissow Lawrence, Rahman Atif, Gladstone Melissa

机构信息

University of Liverpool, Liverpool, UK.

Human Development Research Foundation, Islamabad, Pakistan.

出版信息

Glob Ment Health (Camb). 2020 Jul 13;7:e17. doi: 10.1017/gmh.2020.10. eCollection 2020.

BACKGROUND

Developmental disorders (DDs) in children are a priority condition and guidelines have been developed for their management within low-resource community settings. However, a key obstacle is lack of open access, reliable and valid tools that lay health workers can use to evaluate the impact of such programmes on child outcomes. We adapted and validated the World Health Organization's Disability Assessment Schedule for children (WHODAS-Child), a lay health worker-administered functioning-related tool, for children with DDs in Pakistan.

METHODS

Lay health workers administered a version of the WHODAS-Child to parents of children with DDs ( = 400) and without DDs ( = 400), aged 2-12 years, after it was adapted using qualitative study. Factor analysis, validity, reliability and sensitivity to change analyses were conducted to evaluate the psychometric properties of the adapted outcome measure.

RESULTS

Among 800 children, 58% of children were male [mean (s.d.) age 6.68 (s.d. = 2.89)]. Confirmatory Factor Analysis showed a robust factor structure [χ/df 2.86, RMSEA 0.068 (90% CI 0.064-0.073); Tucker-Lewis Index (TLI) 0.92; Comparative Fit Index (CFI) 0.93; Incremental Fit Index (IFI) 0.93]. The tool demonstrated high internal consistency ( 0.82-0.94), test-retest [Intra-class Correlation Coefficient (ICC) 0.71-0.98] and inter-data collector (ICC 0.97-0.99) reliabilities; good criterion ( -0.71), convergent ( -0.35 to 0.71) and discriminative [M (s.d.) 52.00 (s.d. = 21.97) . 2.14 (s.d. = 4.00); 95% CI -52.05 to -47.67] validities; and adequate sensitivity to change over time (ES 0.19-0.23).

CONCLUSIONS

The lay health worker administrated version of adapted WHODAS-Child is a reliable, valid and sensitive-to-change measure of functional disability in children aged 2-12 years with DDs in rural community settings of Pakistan.

背景

儿童发育障碍（DDs）是重点关注的病症，已制定相关指南以指导在资源匮乏的社区环境中对其进行管理。然而，一个关键障碍是缺乏可供基层卫生工作者使用的开放获取、可靠且有效的工具，用以评估此类项目对儿童结局的影响。我们对世界卫生组织的儿童残疾评估量表（WHODAS - Child）进行了改编和验证，该量表是一种由基层卫生工作者管理的与功能相关的工具，用于巴基斯坦患有发育障碍的儿童。

方法

在通过定性研究对WHODAS - Child进行改编后，基层卫生工作者对400名患有发育障碍的儿童和400名未患发育障碍的2至12岁儿童的家长使用改编后的量表进行评估。进行了因子分析、效度、信度和变化敏感性分析，以评估改编后的结局测量工具的心理测量特性。

结果

在800名儿童中，58%为男性[平均（标准差）年龄6.68（标准差 = 2.89）]。验证性因子分析显示出稳健的因子结构[χ²/df 2.86，RMSEA 0.068（90%置信区间0.064 - 0.073）；塔克 - 刘易斯指数（TLI）0.92；比较拟合指数（CFI）0.93；增量拟合指数（IFI）0.93]。该工具显示出高内部一致性（0.82 - 0.94）、重测信度[组内相关系数（ICC）0.71 - 0.98]和数据收集者间信度（ICC 0.97 - 0.99）；良好的效标效度（-0.71）、收敛效度（-0.35至0.71）和区分效度[M（标准差）52.00（标准差 = 21.97）对2.14（标准差 = 4.00）；95%置信区间-52.05至-47.67]；以及对随时间变化的充分敏感性（效应量0.19 - 0.