PharmacoEconomics ( IF 4.4 ) Pub Date : 2024-02-13 , DOI: 10.1007/s40273-024-01357-z Christine Mpundu-Kaambwa 1 , Norma B Bulamu 2 , Lauren Lines 1 , Gang Chen 3 , David G T Whitehurst 4 , Kim Dalziel 5, 6 , Nancy Devlin 6 , Julie Ratcliffe 1 ,
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Introduction
Children may find self-reporting health-related quality of life (HRQoL) using patient-reported outcome measures (PROMs) presented in text-based formats difficult, particularly younger children and children with developmental delays or chronic illness. In such cases, pictorial PROMs (where pictorial representations are used alongside or to replace text) may offer a valid alternative.
Aim
This systematic literature review focused on identifying and describing paediatric PROMs that incorporate pictorial approaches, providing children with more effective means to express their HRQoL.
Methods
Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Seven electronic databases were searched from inception to 1 March 2022. There were no country restrictions applied to the search; all English-language studies were considered for inclusion in the review. Characteristics and development methods of the identified pictorial PROMs were evaluated against context-specific good practice guidelines published by The Professional Society for Health Economics and Outcomes Research (ISPOR).
Results
A total of 22 paediatric pictorial PROMs, comprising 28 unique versions, were identified. These PROMs were predominantly developed in the USA and the UK, targeting children aged 3–18 years. Likert scales with pictorial anchors, particularly happy–sad faces, were commonly used for response options, appearing in 15 (54%) of the PROMs. Various graphic methods, such as happy–sad faces, cartoons, and thermometers, were adapted to specific content domains. These PROMs covered a wide range of domains, including physical and emotional health and social functioning. Emphasis was placed on content validity, including active child participation in developing pictorial elements. Notably, children's participation was sought during the development of the pictorial elements for 13 (46%) of the PROMs. Various development methods were employed, with 43% of paediatric PROMs using literature reviews, 43% using focus groups, and 32% involving expert consultation. Interviews emerged as the primary method, being employed in 61% of the studies. Additionally, three measures specifically addressed cross-cultural considerations.
Conclusion
Paediatric pictorial PROMs offer child-friendly tools for assessing HRQoL for application with children who find reading and understanding text-based PROMs challenging. There is some evidence that pictorial PROMs facilitate self-report in this population and improve measurement properties compared to text-only PROMs. Further research is needed to develop, validate, and test paediatric pictorial PROMs, with an emphasis on including children from the inception in the co-design process.
中文翻译：
探索图片方法在儿科患者报告结果工具开发中的使用：系统评价
介绍
儿童可能会发现使用以文本格式呈现的患者报告结果测量 (PROM) 自我报告与健康相关的生活质量 (HRQoL) 很困难，特别是年幼的儿童和患有发育迟缓或患有慢性疾病的儿童。在这种情况下，图形 PROM（图形表示与文本一起使用或替代文本）可能提供有效的替代方案。
目的
本系统文献综述的重点是识别和描述结合了图片方法的儿科 PROM，为儿童提供更有效的方式来表达他们的 HRQoL。
方法
遵循系统评价和荟萃分析指南的首选报告项目。从开始到 2022 年 3 月 1 日，对七个电子数据库进行了检索。检索没有国家/地区限制；所有英语语言研究都被考虑纳入审查。根据健康经济学和结果研究专业协会 (ISPOR) 发布的针对具体情况的良好实践指南，对所确定的图形 PROM 的特征和开发方法进行了评估。
结果
总共确定了 22 个儿科图片 PROM，其中包括 28 个独特版本。这些 PROM 主要在美国和英国开发，针对 3 至 18 岁的儿童。带有图片锚点的李克特量表，特别是快乐-悲伤的面孔，通常用于反应选项，出现在 15 个 (54%) 的 PROM 中。各种图形方法，例如快乐-悲伤的面孔、卡通和温度计，都适用于特定的内容领域。这些 PROM 涵盖了广泛的领域，包括身心健康和社会功能。重点放在内容的有效性上，包括儿童积极参与开发图形元素。值得注意的是，在 13 个（46%）PROM 的图形元素开发过程中寻求了儿童的参与。采用了各种开发方法，43% 的儿科 PROM 使用文献综述，43% 使用焦点小组，32% 使用专家咨询。访谈成为主要方法，61% 的研究均采用访谈法。此外，三项措施专门解决了跨文化因素。
结论
儿科图画 PROM 提供了儿童友好型工具，用于评估 HRQoL，适用于那些认为阅读和理解基于文本的 PROM 具有挑战性的儿童。有一些证据表明，与纯文本 PROM 相比，图片 PROM 有助于该人群的自我报告并改善测量特性。需要进一步的研究来开发、验证和测试儿科绘画 PROM，重点是从一开始就将儿童纳入共同设计过程中。
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