Department of Psychology, York University, Toronto, ON, Canada.
School of Kinesiology & Health Science, York University, Toronto, ON, Canada.
J Pediatr Psychol. 2023 Sep 20;48(9):787-797. doi: 10.1093/jpepsy/jsad050.
The current study discusses the development and preliminary validation of an observational measure of caregivers' distress-promoting behavior (OUCHIE-RV) in the context of toddler routine vaccination.
Measure validation was based on a sample of caregiver-toddler dyads (N = 223) from a longitudinal cohort-sequential study who were observed during toddlers' 12-, 18-, or 24-month routine vaccinations. Validity was assessed using correlations and cross-lagged path analysis and associations were tested between OUCHIE-RV composite scores and toddlers' pain-related distress as well as caregivers' state anxiety, soothing behaviors, heart rate, and heart rate variability. Interrater reliability was examined using intraclass correlations (ICC) and kappa coefficients.
Results of a cross-lagged path analysis indicated positive concurrent (β = .27 to β = .37) and cross-lagged predictive associations (β = .01 to β = .34) between OUCHIE-RV composite scores (reflecting the frequency and intensity of caregivers' distress-promoting behavior) and toddlers' pain-related distress. OUCHIE-RV composite scores were negatively associated with caregivers' concurrent use of physical comfort (r = -.34 to -.24) and rocking (r = -.36 to -.19) and showed minimal associations with caregivers' use of verbal reassurance (r = .06 to .12), state anxiety (r = -.02 to r = .09), heart rate (r = -.15 to r = .05), and heart rate variability (r = -.04 to r = .13). Interrater reliability was strong (Cohen's k = .86 to .97, ICC = .77 to .85).
Findings provide support for the validity and reliability of the OUCHIE-RV as a research tool for measuring caregiver behaviors that promote toddlers' pain-related distress during routine vaccinations and contribute to a better understanding of the dynamics of caregiver-toddler interaction in acute pain contexts.
本研究探讨了在幼儿常规疫苗接种背景下，一种观察性的照顾者痛苦促进行为量表（OUCHIE-RV）的发展和初步验证。
基于一项纵向队列顺序研究中照顾者-幼儿对（N=223）的样本，使用观察法在幼儿 12、18 或 24 个月常规疫苗接种期间对其进行评估。采用相关性和交叉滞后路径分析来评估有效性，并测试 OUCHIE-RV 综合评分与幼儿疼痛相关痛苦以及照顾者的状态焦虑、安抚行为、心率和心率变异性之间的关联。使用组内相关系数（ICC）和kappa 系数来检验评分者间的可靠性。
交叉滞后路径分析的结果表明，OUCHIE-RV 综合评分（反映照顾者痛苦促进行为的频率和强度）与幼儿疼痛相关痛苦之间存在正的同期（β=.27 至 β=.37）和交叉滞后预测关联（β=.01 至 β=.34）。OUCHIE-RV 综合评分与照顾者同期使用身体安慰（r= -.34 至 -.24）和摇摆（r= -.36 至 -.19）呈负相关，与照顾者使用口头安慰（r=.06 至.12）、状态焦虑（r= -.02 至 r=.09）、心率（r= -.15 至 r=.05）和心率变异性（r= -.04 至 r=.13）的关联最小。评分者间的可靠性较强（Cohen's k=.86 至.97，ICC=.77 至.85）。
研究结果为 OUCHIE-RV 的有效性和可靠性提供了支持，该量表可作为研究工具，用于测量在常规疫苗接种期间促进幼儿疼痛相关痛苦的照顾者行为，并有助于更好地理解急性疼痛背景下照顾者-幼儿互动的动态。
