Is the Strengths and Difficulties Questionnaire applicable to lower educated adolescents?

Background The Strengths and Difficulties Questionnaire self-report (SDQ-SR) is a widely used instrument to identify emotional and behavioral problems by Preventive Child Healthcare (PCH). It is a valid instrument in more highly educated adolescents, however evidence regarding lower educated adolescents (vocational school) is lacking. The aim of this study was to compare the psychometric properties of the SDQ-SR when used with less well and more highly educated ('higher') adolescents, and to explore opinions of adolescents and PCH professionals regarding its suitability. Methods We included 426 adolescents (130 lower and 296 higher educated), who completed the SDQ-SR. We compared how the psychometric properties (i.e. internal consistency) applied to lower and higher educated adolescents. We assessed whether the five-factor structure of the SDQ is invariant across different educational levels. Moreover, we interviewed 24 adolescents from pre-vocational secondary education schools, and performed online focus group interviews with 17 PCH professionals. Results The internal consistencies (Cronbach's alphas) per SDQ scale were comparable for lower and higher educated adolescents. On most subscales the lower educated adolescents had higher mean scores than the higher educated adolescents. Findings on differences by educational level for the other psychometric properties, i.e. multi-group invariance and single group (CFA) analyses, were inconsistent, with some measures showing unequal factor loadings but others not. Although professionals and lower educated adolescents reported that the SDQ includes many outdated and difficult words, professionals nevertheless perceived the SDQ-SR as a valid instrument. Conclusions The psychometric properties of the SDQ-SR are sufficient for use among lower educated adolescents. However, for optimal implementation in PCH there is a need for improvement in the wording of the SDQ, as expressed by both professionals and adolescents. Key messages The psychometric properties of the SDQ are sufficient for use among lower educated adolescents. For optimal implementation the SDQ needs to be updated in more understandable language.

Triage in Preventive Child Healthcare: A novel triage protocol to identify health problems

Background A triage approach to routine health assessments was introduced to improve the efficiency of Preventive Child Healthcare (PCH): PCH assistants carry out pre-assessments of all children and send the children with suspected health problems to follow-up assessments conducted by a physician or nurse. Each PCH service use their own protocol (with health themes such as visuals disorders, sleeping- and psychosocial problems) to determine whether a follow-up assessment is needed. In this study a novel standardized triage protocol was developed. The aim was to improve the quality of detection of health problems in primary school children by PCH by investigating the quality of detection of health problems and satisfaction of this novel triage protocol. Methods We included 459 primary school children undergoing routine health assessments in 2 PCH services across the Netherlands. We used parent-reported child problems and PCH registry data. After each assessment PCH professionals reported whether they had identified any problems and carried out any additional actions (e.g., additional assessments, referral). The validity of the protocol is assessed, with problems identified by PCH professionals and performing additional actions as criteria. Results Results showed that the psychometric properties of the novel triage protocol were moderate to good. Sensitivity (true positives) and specificity (true negatives) for the novel triage protocol were 0.73 and 0.62, respectively for the identification of any problems, and were 0.91 and 0.41, respectively, for additional PCH actions. Conclusions The novel triage protocol is a valid tool for the detection of health problem in primary school children by PCH. Few children with health problems were missed. Professionals and parents were very satisfied with the novel protocol. Professionals made specific recommendations about adaptations of the protocol to improve efficiency and facilitate implementation in daily PCH practice. Key messages The novel triage protocol is a valid tool for the detection of health problem in primary school children. For optimal implementation in preventive child healthcare the novel triage protocol needs some minor adaptations.

Physical activity around the clock: objectively measured activity patterns in young children of the GECKO Drenthe cohort

Background Given the widespread problem of physical inactivity, and the continued growth in prevalence of childhood and adolescent obesity, promotion of regular physical activity (PA) among young people has become a public priority. A greater understanding of children’s PA patterns throughout the day is needed to effectively encourage children to be more physically active. Hence this study looking at the distribution of PA in young children throughout the day and its relevance to overweight. Methods Accelerometers (ActiGraph GT3X, weartime > 600 min/day, ≥3 days) were used to measure the PA of 958 children (aged 5.7 ± 0.8 years, 52% boys) enrolled in the GECKO Drenthe cohort. Levels of sedentary time (ST), light PA (LPA) and moderate-to-vigorous PA (MVPA) were recorded throughout the day and analysed in segments (07:00–09:00, 09:00–12:00, 12:00–15:00, 15:00–18:00, 18:00–21:00). Body mass index was measured by Preventive Child Healthcare nurses and Cole’s (2012) definition of overweight was used. General linear mixed models, adjusted for age, sex and season, were used to analyse patterns of PA and ST throughout the day. Results Children were most sedentary in the early morning (07:00–09:00) and evening (18:00–21:00), and exhibited the most time spent engaged in LPA and MVPA in the afternoon (12:00–15:00) and late afternoon (15:00–18:00). The greatest inter-individual variation in ST, LPA and MVPA among the children occurred in the late afternoon and evening (approximately 40, 30 and 15 min difference per time segment between 25th and 75th percentile, respectively). The most active children (highest quartile of MVPA) were found to be more active and less sedentary throughout the entire day than the least active children (lowest quartile of MVPA). Furthermore, children with overweight were no less active than children without overweight. Conclusions At this young age, the relevance of different PA patterns to childhood overweight was minimal. Children were most active in the afternoon and late afternoon. To encourage PA in general, ST can be reduced and PA increased in the early morning and evening. Targeted PA interventions to specifically stimulate the least active children could take place in the late afternoon or evening.