Abstract
OverviewThe World Health Organization Disability Assessment Schedule for children (WHODAS-Child) is a disability assessment instrument based on the WHO's International Classification of Functioning, Disability and Health for children and youth. It is modified from the original adult version specifically for use with children. The aim of this study was to assess the WHODAS-Child structure and metric properties in a community sample of children with and without reported psychosocial problems in rural Rwanda.MethodsThe WHODAS-Child was first translated into Kinyarwanda through a detailed committee translation process and back-translation. Cognitive interviewing was used to assess the comprehension of the translated items. Test-retest reliability was assessed in a group of 64 children. The translated WHODAS-Child was then administered to a final sample of 367 children in southern Kayonza district in rural southeastern Rwanda within a larger psychosocial assessment battery. The latent structure was assessed through confirmatory factor analysis. Reliability was evaluated in terms of internal consistency (Cronbach's alpha) and test-retest reliability (Pearson's correlation coefficient). Construct validity was explored by examining convergence between WHODAS-Child scores and mental disorder status, and divergence of WHODAS-Child scores with protective factors and prosocial behaviors. Concordance between parent and child scores was also assessed.ResultsThe six-factor structure of the WHODAS-Child was confirmed in a population sample of Rwandan children. Test-retest and inter-rater reliability were high (r = .83 and ICC = .88). WHODAS-Child scores were moderately positively correlated with presence of depression (r = .42, p<.001) and post-traumatic stress disorder (r = .31, p<.001) and moderately negatively correlated with prosocial behaviors (r = .47, p<.001). The Kinyarwanda version of the WHODAS-Child was found to be a reliable and acceptable self-report tool for assessment of functional impairment among children largely referred for psychosocial problems in the study district in rural Rwanda. Further research in low-resource settings and with more general populations is recommended.
Highlights
The scope of health extends beyond the realm of disease to the wider domain of overall human functioning
The lowest, .57, was the item ‘‘In the last 30 days, how much do your parents or other family members spend on your health condition or problems that you may have?’’ It is possible that this item does not sufficiently tap the underlying domain of limits in participation in society, even though it closely resembles the item in the participation in society domain of the WHODAS II, ‘‘How much of a problem did your family have because of your health problems?’’ Another possibility is that children are not able to accurately report this information
This study examines the structure and psychometric properties of the WHODAS-Child, a recently developed version of the WHODAS-II for children and youth, in a sample of Rwandan children ages 10–17 who were largely referred for further
Summary
The scope of health extends beyond the realm of disease to the wider domain of overall human functioning. Improvement in functional impairment is often a key criterion that society uses to evaluate the effectiveness of programs and treatments. Crosscultural standardization of measurement of functioning has received considerable attention given its importance in evaluating global health programs as well as relating health status to economic development [1]. When assessing functional impairments in children and adolescents, vast contextual differences pose particular challenges. The role of children in household and community life differs across cultures, and resource constraints might impact the meaning of certain domains of functioning. Many standard measures of daily functioning in children refer to school responsibilities and activities which may be less reliable questions for use in low-resource settings where some children may have limited access to school for reasons unrelated to functioning
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