UBC Theses and Dissertations
Assessing adolescents with special health care needs : readiness to transition from paediatric to adult medical care Moynihan, Melissa Mary
Successful transition to adult care is critical for adolescents with special health care needs (SHCN), but there are no well-validated measures to assess transition readiness. This study evaluated the Transition Readiness Assessment Questionnaire (TRAQ) with a younger population and validated the updated Am I ON TRAC for Adult Care questionnaire. During routine clinic appointments 200 youth, ages 12-19 years, from four outpatient clinics at BC Children’s Hospital, Vancouver participated in the study. The instruments included a demographics information page, the TRAQ, the ON TRAC questionnaire, and two Psychosocial Maturity Inventory (PMI) subscales. Psychometric properties of the PMI, TRAQ and ON TRAC knowledge items were evaluated using principal components analysis (PCA) with parallel analysis and scree plots. ON TRAC behaviour items were summed as an index to measure consistent patterns of behaviour; theorized cut-off scores for behaviour items were set at minimally accepted frequency of behaviours required for successful transition to adult care. Relationships between participant age, psychosocial maturity and ON TRAC scores were examined. Youth were from the diabetes (36%), cardiology (27%), gastroenterology (27%), and neurology (10%) clinics, and 57.5% were male. The PCA of the TRAQ yielded a markedly different factor structure from the original validation study and consequently could not be compared with the ON TRAC for convergent validity. The PCA of ON TRAC knowledge items identified a 14-item unidimensional scale with a Cronbach’s α=.84. ON TRAC knowledge and behaviour scores increased with age, with a stronger relationship for knowledge (r=.43, p<.01), while psychosocial maturity correlated with both ON TRAC scores, with a stronger association to behaviour (r=.39, p<.01). Psychosocial maturity and age had a weak but significant correlation (r=.16, p<.05) suggesting age is a loose proxy for maturity. Only 27% of 17-year-olds, but 62% 18-year-olds scored above the behaviour cut-off for transition readiness. The ON TRAC questionnaire is a psychometrically sound measure with strong internal consistency, and has potential to be used as a readiness assessment tool in clinical practice. Results of the TRAQ psychometric evaluation raise questions about whether it is a suitable measure to evaluate transition readiness among younger adolescents.
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