Abstract
The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children's posthospitalization and postoperative new-onset behavioral changes. However, the psychometric properties of the scale have not been re-evaluated in the past five decades despite substantial changes in the practice of surgery and anesthesia. In this investigation, we examined the psychometric properties of the PHBQ to potentially increase the efficacy and relevance of the instrument in current perioperative settings. This study used principal components analysis, a panel of experts, Cronbach's alpha, and correlations to examine the current subscale structure of the PHBQ and eliminate items to create the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS). Data from previous investigations (N=1064, Mage =5.88) which utilized the PHBQ were combined for the purposes of this paper. A principal components analysis revealed that the original subscale structure of the PHBQ could not be replicated. Subsequently, a battery reduction, which utilized principal components analysis and a panel of experts, was used to eliminate the subscale structure of the scale and reduce the number of items from 27 to 11, creating the PHBQ-AS. The PHBQ-AS demonstrated good internal consistency reliability and concurrent validity with another measure of children's psychosocial and physical functioning. Revising the former subscale structure and reducing the number of items in the PHBQ to create the PHBQ-AS may provide a means for reducing the burden of postoperative behavioral assessment through decreasing time of administration and eliminating redundancy of items and allow for more accurate measurement of child postoperative behavioral changes.
Highlights
The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children’s post-hospitalization and postoperative new-onset behavioral changes
Anesthesia and surgery have been shown to be associated with new onset behavioral changes in children including increases in anxiety, nightmares, problems going to bed, and eating disturbances [3, 4]
If the items did not align with their original subscale structure, we sought to create one overall Post Hospitalization Behavior Questionnaire for Ambulatory Surgery (PHBQ-AS) with no subscales and fewer items
Summary
The Post Hospitalization Behavior Questionnaire (PHBQ) was designed for assessing children’s post-hospitalization and postoperative new-onset behavioral changes. The psychometric properties of the scale have not been re-evaluated in the past five decades despite substantial changes in the practice of surgery. If sleep disturbances and separation anxiety persist from six to twelve months post-surgery they may impact children’s responses to subsequent medical care and may interfere with normal development, socialization, and adjustment to school [5]. Due to these consequences, it is important to accurately assess and treat new onset post-operative behavioral changes in children [1, 6]. This scale is less frequently used for research purposes possibly because some items are not applicable to specific contexts or populations, there is no consensus on how the scale should be scored, the scale may have never been properly evaluated, and the psychometric properties of the PHBQ have not been recently evaluated [1, 9, 10]
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