Family Impact Scale Research Articles

Assessing change in the family impact of caries in young children after treatment under general anaesthesia

Objective. To examine the properties, validity and responsiveness of the Family Impact Scale in a consecutive clinical sample of patients undergoing dental treatment under general anaesthesia. Materials and methods. A consecutive clinical sample of parents/caregivers of children receiving dental treatment under general anaesthesia provided data using the Family Impact Scale (FIS) component of the COHQOL© Questionnaire. The first questionnaire was completed before treatment, the follow-up questionnaire 1–4 weeks afterward. Treatment-associated changes in the FIS and its components were determined by comparing baseline and follow-up data. Results. Baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up). All FIS items showed large relative decreases in prevalence, the greatest seen in those relating to having sleep disrupted, blaming others, being upset, the child requiring more attention, financial difficulties and having to take time off work. Factor analysis largely confirmed the underlying factor structure, with three sub-scales (parental/family, parental emotions and family conflict) identified. The parental/family and parental emotions sub-scales showed the greatest treatment-associated improvement, with large effect sizes. There was a moderate improvement in scores on the family conflict sub-scale. The overall FIS showed a large improvement. Conclusion. Treating children with severe caries under general anaesthesia results in OHRQoL improvements for the family. Severe dental caries is not merely a restorative and preventive challenge for those who treat children; it has far-reaching effects on those who share the household and care for the affected child.

Clinical evaluation of the short-form pediatric enuresis module to assess quality of life

The aim of this study was to determine the psychometric properties of the German version of the Pediatric Enuresis Module to assess Quality of Life, Short Form (PEMQOL-SF) in a sample of parents of children with urinary incontinence. The parents of 88 children (63 male, 25 female, mean age: 9.3 [SD ± 2.5, range 6-18] years) with urinary incontinence were asked to complete the PEMQOL-SF. For evaluation of convergence validity, parents and children completed the respective versions of the DCGM-10 and the PinQ questionnaire. Mean PEMQOL-SF scores were 72.2 [SD ± 14.1] (child impact scale) and 73.7 [SD ± 16.5] (family impact scale). The PEMQOL-SF had a Cronbach's alpha of 0.68 (child impact scale) and 0.80 (family impact scale), respectively. PEMQOL-SF child [family] impact scale scores correlated with the DCGM-10 with scores of r = 0.34 (r = 0.13; self-report version) and r = 0.63 (r = 0.48; proxy version) and with the PinQ with scores of r = -0.31 (r = -0.16; self-report version) and r = -0.63 (r = -0.54; proxy version), respectively. The psychometric properties of the PEMQOL-SF were good for the family impact scale, but poor for the child impact scale. In its present form, the PEMQOL-SF cannot be recommended for routine clinical use. Nevertheless, a reduction of questionnaire items could lead to better psychometric properties.

Evaluation of the Family Impact Scale for use in Brazil

Objectives:The objectives of this study were to assess the validity and reliability of the Family Impact Scale (FIS) applied in Brazilian parents after translations and cultural adaptations to Brazilian Portuguese language and to evaluate the nature and extent to which the family functioning is compromised by the child oral conditions.Material and Methods:Parents were recruited from general populations for pre-testing (n=20), validity (n=210) and test-retest reliability (n=20) studies. The children were examined for dental caries, gingivitis, fluorosis and malocclusion.Results:The FIS discriminated among the categories of malocclusion and showed good construct validity. The Cronbach's alpha and intraclass correlation coefficients were 0.87 and 0.90, respectively. Almost 20% of the informants reported some family impact 'sometimes' or 'often/everyday' from the child's oral condition. Impact on FIS domains of this frequency ranged from 13.8% for financial difficulties to 24.4% for parental or family activities.Conclusions:The Brazilian Portuguese version of FIS is valid and reliable. The results suggest that child oral conditions have a negative impact on the family. Further research is required, as these findings were based on cross-sectional study and convenience samples.

Dental treatment under general anaesthesia: the short-term change in young children’s oral-health-related quality of life

This was to assess the short-term change in children's oral-health-related quality of life (OHRQoL) and family impact after dental treatment under general anaesthesia (GA) in the Netherlands. A pretest-posttest design was used. Children (< 8 years) referred to a clinic for specialized paediatric dentistry and who needed treatment under GA were selected to participate and divided across two groups. Fifty out of 80 parents/children couples participated, one group of parents filled out the questionnaires on behalf of their child before and after treatment (N = 31), and the other group only after treatment (N = 19). The questionnaires used were the Children's Fear Survey Schedule-Dental Subscale (CFSS-DS) and Parental Perceptions Questionnaire and Family Impact Scale (PPQ and FIS, forming the OHRQoL score). The oral health was assessed using the decayed-missing-filled surfaces or teeth index (dmfs/dmft) for the primary dentition from the status praesens after treatment. There was a significant difference between the pre- and posttest-scores in group A for both the short version and the long version (short: t = 5.088, df = 20, p < 0.001 and long: t = 6.279, df = 20, p < 0.001). There was no statistically significant difference in CFSS-DS scores before and after treatment (group A) (t = 1.815, df = 13, p = 0.093). The children's OHRQoL improved after treatment under GA according to their parents. As expected, dental fear did not change and should be dealt with after treatment to avoid a child's dental fear to persist in the future. A shorter version of the PPQ and FIS seems useful to assess OHRQoL in very young children.

Is the Child Oral Health Quality of Life Questionnaire Sensitive to Change in the Context of Orthodontic Treatment? A Brief Communication

This study aimed to assess the ability of the Child Oral Health Quality of Life Questionnaire (COHQoL) to detect change following provision of orthodontic treatment. Children were recruited from an orthodontic clinic just prior to starting orthodontic treatment. They completed a copy of the Child Perception Questionnaire, while their parents completed a copy of the Parents Perception Questionnaire and the Family Impact Scale. Normative outcomes were assessed using the Dental Aesthetic Index (DAI) and the Peer Assessment Rating (PAR) index. Change scores and effect sizes were calculated for all scales. Complete data were collected for 45 children and 26 parents. The mean age was 12.6 years (standard deviation = 1.4). There were significant pre-/posttreatment changes in DAI and PAR scores and significant changes in scores on all three questionnaires (P < 0.05). Effect sizes for the latter were moderate. Global transition judgments also confirmed pre-/posttreatment improvements in oral health and wellbeing. The results provide preliminary evidence of the sensitivity to change of the COHQoL questionnaires when used with children receiving orthodontic treatment. However, the study needs to be repeated in different treatment settings and with a larger sample size in order to confirm the utility of the measure.

Development and Preliminary Validation of the Cancer Family Impact Scale for Colorectal Cancer

The aim of our study was to develop a measure of how a family history of colorectal cancer (CRC) affects families from the viewpoint of unaffected family members. Using data from 1,285 participants (637 families) in the Johns Hopkins Colon Cancer Genetic Testing study, we developed and validated The Cancer Family Impact Scale (CFIS), an instrument for use in studies investigating relationships among family factors and CRC prevention behaviors when family history is a risk factor. Through exploratory factor analysis (EFA) using a 50% random sample of participants, we identified 5 latent constructs among 18 items: (1) NEGATIVE: negative effects of cancer on the family; (2) POSITIVE: positive effects of cancer on the family; (3) COMMUNICATE: how families communicate about cancer; (4) FLOW: how information about cancer is conveyed in families; and (5) NORM: how individuals react to family norms about cancer. Confirmatory factor analysis (CFA) on the same sample showed the CFIS to have a reasonably good fit (chi(2) = 389.97, degree of freedom (df ) = 122, root mean square error of approximation = 0.06 [0.05-0.07], comparative fit index = 0.90, Tucker-Lewis index = 0.88, goodness of fit index = 0.94), and findings were cross-validated on the remaining 50% of the participants. The reliability of the scale was alpha = 0.65. The CFIS could be used to clarify the role that family factors play in the association between CRC family history and CRC prevention behaviors, and also aid in the development and evaluation of family-based cancer prevention interventions.

Translation and evaluation of a Chinese version of the Child Oral Health-related Quality of Life measure

This study aims to translate and evaluate the performance of a Chinese version of the Child Oral Health-related Quality of Life (COHQoL) measure composed of the Child Perception Questionnaire (CPQ), Parental Perception Questionnaire (PPQ), and Family Impact Scale (FIS). Chinese versions of the measures were derived through a forward-backward translation. A consecutive sample of 168 children attending paediatric dental and orthodontic clinics in Hong Kong were recruited along with their attending primary caregiver. Children self-completed the 37-item CPQ and their attending primary caregiver self-completed the 31-item PPQ and 14-item FIS consecutively and independently. Reassessments were conducted prior to their next appointment. CPQ, PPQ, and FIS scores were associated with children's global rating of oral health (P < 0.05) and oral well-being (P < 0.05) supporting their construct validity. In addition, variations in CPQ, PPQ, and FIS were apparent with respect to patient group (P < 0.05) supporting their ability to distinguish between patient groups. Cronbach alpha values (internal reliability) and intraclass correlation coefficient values (test-retest reliability) for the three measures were > 0.80. A Chinese version of the three components of the COHQoL measure was developed with minor modifications. In psychometric testing, the validity of the three components was supported and they demonstrated acceptable reliability.

Translation and evaluation of a Chinese version of the Child Oral Health‐related Quality of Life measure

Objective. This study aims to translate and evaluate the performance of a Chinese version of the Child Oral Health‐related Quality of Life (COHQoL©) measure composed of the Child Perception Questionnaire (CPQ), Parental Perception Questionnaire (PPQ), and Family Impact Scale (FIS).Basic research design. Chinese versions of the measures were derived through a forward–backward translation. A consecutive sample of 168 children attending paediatric dental and orthodontic clinics in Hong Kong were recruited along with their attending primary caregiver. Children self‐completed the 37‐item CPQ and their attending primary caregiver self‐completed the 31‐item PPQ and 14‐item FIS consecutively and independently. Reassessments were conducted prior to their next appointment.Results. CPQ, PPQ, and FIS scores were associated with children's global rating of oral health (P &lt; 0.05) and oral well‐being (P &lt; 0.05) supporting their construct validity. In addition, variations in CPQ, PPQ, and FIS were apparent with respect to patient group (P &lt; 0.05) supporting their ability to distinguish between patient groups. Cronbach alpha values (internal reliability) and intraclass correlation coefficient values (test–retest reliability) for the three measures were &gt; 0.80.Conclusion. A Chinese version of the three components of the COHQoL measure was developed with minor modifications. In psychometric testing, the validity of the three components was supported and they demonstrated acceptable reliability.

Changes in parent‐assessed oral health‐related quality of life among young children following dental treatment under general anaesthetic

To estimate the nature and magnitude of changes in oral health-related quality of life (OHRQoL) among children having dental treatment under general anaesthetic (GA) and to examine the evaluative properties of the Child Oral Health-related Quality of Life Questionnaire (COHQOL). Data from a consecutive clinical sample of the parents/caregivers of children receiving dental treatment under GA at Wellington and Kenepuru Hospitals were collected from parents using the Parental-Caregivers Perception Questionnaire (P-CPQ) and the Family Impact Scale (FIS), which both form part of the COHQOL Questionnaire. The first questionnaire was completed before treatment or while the participant's child was undergoing treatment. The follow-up questionnaire was completed 1-4 weeks afterward. Treatment-associated changes in OHRQoL were determined by comparing baseline and follow-up data for the mean scores and the prevalence of impacts. The discriminative properties of the instrument were confirmed and then its evaluative properties were assessed (by examining its test-retest reliability, responsiveness and longitudinal construct validity). The minimally important difference was determined for the overall scale and subscales. Complete baseline and follow-up data were obtained for 202 and 130 participants, respectively (64.4% follow-up rate). The evaluative properties of the P-CPQ and FIS were acceptable. There were substantial and highly statistically significant reductions in mean P-CPQ and FIS scores after treatment, with effect sizes ranging from moderate to large, depending on the subscale being examined. The minimally important difference was shown by almost two-thirds of the children treated. The provision of dental treatment under GA for young children with severe dental caries experience is associated with substantial and highly significant improvements in both their OHRQoL and in the impact on their families. The P-CPQ and the FIS show promise as evaluative measures for use in dental health services research.

CHILDHOOD CANCER: Its Impact and Financial Costs for Australian Families

This study evaluated the impact and financial costs of childhood cancer for Australian families by means of a nonrandomized retrospective cross-sectional survey at the oncology department of a large metropolitan pediatric hospital. The Family Impact Scale (a standardized questionnaire) and the self-reported economic burden (a questionnaire on expenses and lifestyle changes) were utilized. Results of the family impact score were compared to a previously published cohort of children with insulin-dependent diabetes mellitus. The participants were 56 parents of children newly diagnosed with cancer in the year 2002. In addition to the expected high social and emotional impacts, the majority of families reported suffering from great or moderate economic hardship. Factors predictive for families at risk included single parenthood, lower household income, and greater distance from the hospital. The results show that the distribution of resources is not equitable and is currently failing to negate significant financial stresses for many Australian families.

Disease severity and associated family impact in childhood atopic dermatitis

Aim: To examine the association between childhood atopic dermatitis (AD) severity and family impact at baseline and after an intervention by a physician specialist, using validated measures of both severity...

The family impact of atopic dermatitis in children: the role of the parent caregiver.

Although some preliminary work exists examining the impact of atopic dermatitis (AD) in children on their families, there is no empirical work examining specific parent caregiver factors that could contribute to the family impact of this condition. We conducted a cross-sectional, exploratory analysis of how parent caregivers are affected by their child's AD, and how certain parent caregiver characteristics and perceptions affect the family impact of this condition. Parent caregivers of children with AD (n = 49) were administered a survey to collect detailed data on socioeconomic status, health perceptions, and caregiving issues. Family impact of the child's AD was measured using a modified AD Family Impact Scale. Multiple regression analyses revealed that three major factors associated with the parent caregiver were correlated with large increases in the family impact scores: 1) perception that the child's condition is severe (13%, p < 0.01), 2) high use of nonmedical services for child's condition (21%, p < 0.01), and 3) financial concern about the child's condition (18%, p < 0.01). These preliminary data indicate distinct characteristics of the parent caregiver that are associated with higher family impact of AD in children. These parent caregiver factors may be important in identifying suitable audiences and areas for education for optimal management of children's AD.

Family impact of child oral and oro-facial conditions.

The aim of this study was to develop and evaluate the Family Impact Scale, a measure of the family impact of child oral and oro-facial disorders. This formed one component of the Child Oral Health Quality of Life Instrument. The scale was developed using a process described by Guyatt et al. (1987) and Juniper et al. (1996). An item pool was developed using a review of existing child health status and family impact questionnaires, interviews with 41 parents-caregivers of children with paedodontic, orthodontic and oro-facial conditions and discussions with dental specialists. The resulting pool of 21 items was used in an item impact study in which 93 parents-caregivers provided data on the frequency and importance of these items. The 14 items identified most frequently or rated the most important were selected for the final questionnaire. The discriminant and construct validity and internal consistency reliability of this 14-item scale were assessed in a study of 266 parents-caregivers from the three clinical groups. Seventy-nine of these participants completed a second copy of the questionnaire to facilitate assessment of test-retest reliability. Family Impact Scale scores ranged from 0 to 33, indicating that the measure was sensitive to variations in family impact. Floor effects were minimal with only 10.2% of subjects having a score of zero and there were no ceiling effects, that is, subjects with maximum scores. Almost three-quarters of parents-caregivers reported some family impact 'sometimes' or 'often/everyday' over the previous 3 months. Impact on parental or family activities of this frequency was reported by 53.0%, impact on parental emotions by 44.0%, conflict in the family by 31.6% and financial difficulties by 31.2%. The measure and its component items were reasonably good at discriminating between the three clinical groups included in the study and showed good construct validity. It had excellent internal consistency reliability with a Cronbach's alpha of 0.83 and was reproducible for parent-caregivers who reported that their child's condition was stable (ICC = 0.80). The study provides some data to suggest that child oral and oro-facial conditions have a pervasive impact on the family. The Family Impact Scale had good technical properties. Its evaluative properties need to be tested in longitudinal studies.

Impact of respiratory symptoms on health-related quality of life and medical resource utilization of patients treated by allergy specialists and primary care providers

Respiratory symptoms associated with allergy and asthma cause substantial health care burden. This observational pilot study compared internal medicine/family practice (IM/FP) and pediatric primary care providers with allergists in the diagnosis, treatment, and health-related quality of life (HRQL) outcomes of adults and children with respiratory symptoms. Two allergists, 2 IM/FP, and 2 pediatricians enrolled 242 patients with respiratory symptoms ages 5 to 16 years old (n = 123) and 17 to 70 years old (n = 119). HRQL questionnaires were completed at enrollment and quarterly for 1 year. The adult questionnaire included SF-36, respiratory symptom role productivity, ITG Asthma Short Form, and allergy symptom index (ASI) scales. The child questionnaire included CHQ-PF28, respiratory symptom family impact, ITG Child Asthma Short Form, and ASI scales. HRQL changes were evaluated over the study period. Adults treated by allergists reported significantly greater improvement in HRQL on 5 of 8 SF-36 scales, the respiratory symptom role productivity scale, 3 of 5 ITG Asthma Short Form scales, and 2 of 4 ASI scales compared with adults treated by an IM/FP (P < 0.05). Pediatric patients treated by allergists had significantly greater improvement on 3 of 15 CHQ-PF28 scales, the respiratory symptom family impact scale, and one ASI scale compared with patients treated by pediatricians (P < 0.05). Compared with patients treated by primary care physicians, patients treated by allergists reported greater improvement in HRQL in a number of scales. Additional research is required to further evaluate the impact of provider specialty and patterns of care on outcomes of respiratory symptoms patients.