The Interactive Child Distress Screener: Development and Preliminary Feasibility Testing

Abstract

BackgroundEarly identification of child emotional and behavioral concerns is essential for the prevention of mental health problems; however, few suitable child-reported screening measures are available. Digital tools offer an exciting opportunity for obtaining clinical information from the child’s perspective.ObjectiveThe aim of this study was to describe the initial development and pilot testing of the Interactive Child Distress Screener (ICDS). The ICDS is a Web-based screening instrument for the early identification of emotional and behavioral problems in children aged between 5 and 12 years.MethodsThis paper utilized a mixed-methods approach to (1) develop and refine item content using an expert review process (study 1) and (2) develop and refine prototype animations and an app interface using codesign with child users (study 2). Study 1 involved an iterative process that comprised the following four steps: (1) the initial development of target constructs, (2) preliminary content validation (face validity, item importance, and suitability for animation) from an expert panel of researchers and psychologists (N=9), (3) item refinement, and (4) a follow-up validation with the same expert panel. Study 2 also comprised four steps, which are as follows: (1) the development of prototype animations, (2) the development of the app interface and a response format, (3) child interviews to determine feasibility and obtain feedback, and (4) refinement of animations and interface. Cognitive interviews were conducted with 18 children aged between 4 and 12 years who tested 3 prototype animated items. Children were asked to describe the target behavior, how well the animations captured the intended behavior, and provide suggestions for improvement. Their ability to understand the wording of instructions was also assessed, as well as the general acceptability of character and sound design.ResultsIn study 1, a revised list of 15 constructs was generated from the first and second round of expert feedback. These were rated highly in terms of importance (mean 6.32, SD 0.42) and perceived compatibility of items (mean 6.41, SD 0.45) on a 7-point scale. In study 2, overall feedback regarding the character design and sounds was positive. Children’s ability to understand intended behaviors varied according to target items, and feedback highlighted key objectives for improvements such as adding contextual cues or improving character detail. These design changes were incorporated through an iterative process, with examples presented.ConclusionsThe ICDS has potential to obtain clinical information from the child’s perspective that may otherwise be overlooked. If effective, the ICDS will provide a quick, engaging, and easy-to-use screener that can be utilized in routine care settings. This project highlights the importance of involving an expert review and user codesign in the development of digital assessment tools for children.

A Mobile Phone–Based Approach for Hearing Screening of School-Age Children: Cross-Sectional Validation Study

“…It is projected that the smartphone subscription will increase from 5 billion in 2018 to 7.2 billion in 2024 [29], and there has been a surge of health-related smartphone apps in recent years [31-36]. Smartphone hearing screening audiometry has been widely implemented as mobile phone gained popularity, and several studies have compared hearing thresholds with standardized automated hearing thresholds obtained in a sound-treated booth [11,13,14,18,28,37-39].…”

Co-design and qualitative validation of animated assessment item content for a child-reported digital distress screener

“…Importantly, no other instrument has assessed full animations as a means of demonstrating emotional or behavioural constructs. The results of this study, along with the high acceptability demonstrated in our original feasibility study ( March et al, 2018 ) show that this approach is highly acceptable to children. It is worth noting that the ICDS instrument has been developed following a co-design and generative participatory design process throughout all stages ( March et al, 2018 ; Zieschank et al, 2020 ), and it seems likely that this has contributed to the overall high appeal of the animations.…”

“…It is intended that the ICDS will be delivered via a user-friendly web-based app and utilized as a broad screening instrument designed to detect self-reported emotional and behavioural difficulties in children aged 5 to 11 years. A prototype version that includes three pairs of original animated cartoon assessment items has been tested by children, with results highlighting the acceptability and feasibility of the animated format ( March et al, 2018 ). Ultimately, the ICDS will utilize up to 15 pairs of contrasting digital animations as assessment items: each representing different socio-emotional or behavioural situations.…”

“…Ultimately, the ICDS will utilize up to 15 pairs of contrasting digital animations as assessment items: each representing different socio-emotional or behavioural situations. The broad social-emotional and behavioural domains and 15 associated constructs were selected by an expert panel in an original pilot study ( March et al, 2018 ).…”

Generative Participatory Design Methodology to Develop Electronic Health Interventions: Systematic Literature Review

“…Similar arguments related to knowledge expression may have driven the choice of stakeholder management outcome measures made by Revenas et al [45]. [41,90,96] eHealth development (number of ideas for development) [30,35,46,52,53,56,63,66,68,69,71,72,75,84,90,92,96] eHealth quality (usability, feasibility) [59,74] User outcome (effectiveness)…”