Environmental factors in disabled children: Craig Hospital Inventory of Environmental Factors (CHIEF) Article Summary
Article: Assessment of environmental factors in disabled children 2–12 years: development and reliability of the Craig Hospital Inventory of Environmental Factors (CHIEF) for Children–Parent Version
Reference: McCauley D, Gorter JW, Russell DJ, Rosenbaum P, Law M, Kertoy M. Assessment of environmental factors in disabled children 2-12 years: development and reliability of the Craig Hospital Inventory of Environmental Factors (CHIEF) for Children-Parent Version: CHIEF for Children-Parent Version. Child: Care, Health and Development. 2013;39(3):337-344. doi:10.1111/j.1365-2214.2012.01388.x
Purpose: The purpose of this study was to adapt the Craig Hospital Inventory of Environmental Factors (CHIEF) into an suitable outcome that could measure environmental factors which limit a disabled child’s activity and participation.
Study Population: The study was conducted with 61 families in Ontario, Canada that had a disabled child between 2-12 years old. The participants were samples of patients attending three children’s treatment centers (CTCs) in Southern Ontario.
Methods:
Secondary data:
The authors analyzed previous studies from CanChild to determine which environmental factors to include in the CHIEF for Children-Parent Version. They assessed the parent feedback in these studies about which barriers were the most frequent (i.e. how often the barriers affected families such as daily or less than monthly) and present (which items presented the largest barrier). The items selected for the questionnaire included barriers from physical, service, attitude, productivity, and policy domains. Once the adjustments were made for the Children-Parent Version, the authors cold mailed their study population to gather primary data about the questionnaire.
Primary Data:
Families who opted-in to the study were asked for their opinions on:
- The ease of completion and clarity of wording
- The usefulness of the information on the questionnaire
- If they thought parents/caregivers would complete the questionnaire for their planning their child’s services
To gather information on test-retest reliability, participants were mailed a second questionnaire 2 weeks after their initial questionnaire was received.
Outcome Measures Included
There are 10 items on the CHIEF for Children-Parent Version Questionnaire including questions on natural environment, child surroundings, information, healthcare services, help, attitudes, support, discrimination, programs and services, and education.
Each item on the CHIEF for children-parent version asks about
- frequency of the problem (ranging from 0/never a problem to 4/daily problem)
- magnitude of the problem ( either 1/little problem or 2/big problem)
Results
- 450 questionnaires were mailed; 61 families completed the initial questionnaires; 45 families completed the initial and second questionnaires
- 78% agreed or strongly agreed that the questionnaire was easy to understand and complete.
- 69% agreed or strongly agreed the questionnaire was useful
- 80% agreed or strongly agreed that families would complete the questionnaire for planning services
- Test-retest reliability and tests for internal consistency yielded acceptable results.
Authors’ Conclusions:
The authors concluded that the CHIEF for Children-Parent Version is an acceptable, easy, and reliable questionnaire in measuring perceived environmental barriers for 2–12-year-old children with disabilities. The questionnaire is relevant to the environmental barriers of this population but, based on parent feedback, may benefit from adding qualitative questions for parents to provide additional details on their child.
Strengths:
In comparison to many previous studies, the authors focused beyond using only samples of children with physical disabilities or a specific diagnosis. Some of the diagnoses of the participants included ADHD, developmental delays, spina bifida, and acquired brain injuries. The study also included a wide range of ages, family composition, and socioeconomic factors. There were varied demographics in factors such as parent income, type of community, and parents’ level of education.
Limitations:
The participation rate was relatively low (61 responses out of 450 solicitations). There may be some bias from the families who chose to return the forms. Also, of the 61 respondents, 40 of the children were male which may potentially overlook any barriers that may be gender specific in this population.
Overall conclusion:
In the “Future Directions” section, the authors mention that that they want to use this questionnaire as part of evaluations for health services by CTCs in Ontario. The methods and studies used to narrow down the questions for the CHIEF Children-Parent Version were relevant to this population. While the study could have benefitted from more participation to eliminate any volunteer bias, the respondents were families who have utilized the CTCs services. They were also able to get information on children with a variety of disabilities and demographic backgrounds despite their small sample size. Based on the authors’ goals, I believe this study was successful. They reduced the original 25 item CHIEF survey to a 10 item Children-Parent version that contained common and relevant barriers to this patient population. Completing medical forms is usually seen as a cumbersome process so having clear, succinct forms can help reduce that burden. Even without qualitative questions, the forms may potentially open dialogue between the families and their providers.
Because of the funding and stakeholders mentioned in the study, there may be a drawback in applying this questionnaire for all children with disabilities. The study was done with CanChild and stakeholders include government and funding agencies in Canada. The authors mentioned that the data in these questionnaires can provide information on perceived barriers by region or to support policy development in those regions. There was also a question in the survey which was chosen over another item because it was more specific to government programs. Since there is variability in policies, resources, and government programs across different regions or countries, there could be limitations to the relevance of the specific items chosen in this condensed version of CHIEF.
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It is helpful to know that the parent version of the CHIEF is easy to follow and that parents find the questionnaire helpful. Going forward, this seems like a quick and simple tool to implement as a Physical Therapist that provides information on a variety of topics to streamline treatment/an initial evaluation.