Background
Recent systematic reviews show varying methods for eliciting, modelling, and reporting preference-based values for child health-related quality-of-life (HRQoL) outcomes, thus producing ...value sets with different characteristics. Reporting in many of the reviewed studies was found to be incomplete and inconsistent, making them difficult to assess. Checklists can help to improve standards of reporting; however, existing checklists do not address methodological issues for valuing child HRQoL. Existing checklists also focus on reporting methods and processes used in developing HRQoL values, with less focus on reporting of the values’ key characteristics and properties. We aimed to develop a checklist for studies generating values for child HRQoL, including for disease-specific states and value sets for generic child HRQoL instruments.
Development
A conceptual model provided a structure for grouping items into five modules. Potential items were sourced from an adult HRQoL checklist review, with additional items specific to children developed using recent reviews. Checklist items were reduced by eliminating duplication and overlap, then refined for relevance and clarity via an iterative process. Long and short checklist versions were produced for different user needs. The resulting long RETRIEVE contains 83 items, with modules for reporting methods (A–D) and characteristics of values (E), for researchers planning and reporting child health valuation studies. The short RETRIEVE contains 14 items for decision makers or researchers choosing value sets.
Conclusion
Applying the RETRIEVE checklists to relevant studies suggests feasibility. RETRIEVE has the potential to improve completeness in the reporting of preference-based values for child HRQOL outcomes and to improve assessment of preference-based value sets.
Background and Aims
Patient-reported outcome measures (PROMs) for children (aged ≤ 18 years) present methodological challenges. PROMs can be categorised by their diverse underlying conceptual bases, ...including functional, disability and health (FDH) status; quality of life (QoL); and health-related quality of life (HRQoL). Some PROMs are designed to be accompanied by preference weights. PROMs should account for childhood developmental differences by incorporating age-appropriate health/QoL domains, guidance on respondent type(s) and design. This systematic review aims to identify generic multidimensional childhood PROMs and synthesise their characteristics by conceptual basis, target age, measurement considerations, and the preference-based value sets that accompany them.
Methods
The study protocol was registered in the Prospective Register of Systematic Reviews (CRD42021230833), and reporting followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We conducted systematic database searches for generic multidimensional childhood PROMs covering the period 2012–2020, which we combined with published PROMs identified by an earlier systematic review that covered the period 1992–2011. A second systematic database search identified preference-based value sets for generic multidimensional PROMs. The PROMs were categorised by conceptual basis (FDH status, QoL and HRQoL) and by target age (namely infants and pre-schoolers aged < 5 years, pre-adolescents aged 5–11, adolescents aged 12–18 and multi-age group coverage). Descriptive statistics assessed how PROM characteristics (domain coverage, respondent type and design) varied by conceptual basis and age categories. Involvement of children in PROM development and testing was assessed to understand content validity. Characteristics of value sets available for the childhood generic multidimensional PROMs were identified and compared.
Results
We identified 89 PROMs, including 110 versions: 52 FDH, 29 QoL, 12 HRQoL, nine QoL-FDH and eight HRQoL-FDH measures; 20 targeted infants and pre-schoolers, 29 pre-adolescents, 24 adolescents and 37 for multiple age groups. Domain coverage demonstrated development trajectories from observable FDH aspects in infancy through to personal independence and relationships during adolescence. PROMs targeting younger children relied more on informant report, were shorter and had fewer ordinal scale points. One-third of PROMs were developed following qualitative research or surveys with children or parents for concept elicitation. There were 21 preference-based value sets developed by 19 studies of ten generic multidimensional childhood PROMs: seven were based on adolescents’ stated preferences, seven were from adults from the perspective of or on behalf of the child, and seven were from adults adopting an adult’s perspective. Diverse preference elicitation methods were used to elicit values. Practices with respect to anchoring values on the utility scale also varied considerably. The range and distribution of values reflect these differences, resulting in value sets with notably different properties.
Conclusion
Identification and categorisation of generic multidimensional childhood PROMs and value sets by this review can aid the development, selection and interpretation of appropriate measures for clinical and population research and cost-effectiveness-based decision-making.
Importance Structured antenatal diet and physical activity interventions have been shown to be associated with reduced adverse pregnancy outcomes and recommended to be routinely offered to all ...pregnant women. The health cost implications of population-level implementation are unclear. Objective To estimate the budget impact associated with integrating structured diet and physical activity interventions into routine antenatal care. Design, Setting, and Participants This economic evaluation was conducted from the perspective of Australian health funders. An open-source decision-tree model was constructed to compare the projected budget outcomes of implementing lifestyle intervention vs usual care. Scenario, deterministic, and probabilistic sensitivity analysis were completed. The study setting was Australian health services, and the study population was all Australian women projected to give birth in the years 2022 to 2026 (approximately 330 000 per year). Interventions Structured diet and physical activity intervention provided by trained health professionals, integrated into routine antenatal care. Comparator was usual care, which currently in Australia does not include routine structured lifestyle interventions. Main Outcomes and Measures Return on investment (ROI) ratio for lifestyle intervention (cost of intervention divided by cost savings attributable to reduced maternal and infant adverse events) from the perspective of Australian health care funders. Adverse events were obtained from a published meta-analysis and population data. Costs were estimated from aggregate trial data and clinical pathways and valued at the year incurred. Results Intervention offered an ROI ratio of 4.75 over the 5-year program; hence every Australian dollar spent on implementation produced an estimated return of A$4.75. The projected total 5-year intervention cost was A$205 million ($151 million), with cost offsets (from reduced incidence of adverse pregnancy outcomes) of A$1022 million ($755 million), and health budget savings of A$807 million (95% CI, A$129 million to A$1639 million) ($596 million 95% CI, $95 million to $1211 million); 93.3% of the 10 000 iterations were within cost saving, and results were robust to scenario and sensitivity analyses. Conclusions and Relevance This economic evaluation found that providing access to structured diet and physical activity lifestyle interventions for all pregnant Australian women was estimated to provide strong return on investment for health funders. The open-source model developed can be used by other jurisdictions and health services to explore cost implications of implementation within their patient population.
Many children start school developmentally vulnerable and struggle to keep up with their peers. Children experiencing socioeconomic-disadvantage are at higher risk of poor developmental outcomes. A ...high-quality education and wrap-around community-service model, such as the Doveton Model, at Doveton College, Australia, may improve outcomes for families experiencing entrenched disadvantage. This study focussed on the effect of this model on early-learning (pre-formal schooling) for school entry readiness and academic achievement over the subsequent four years. Students who did/did not attend the Doveton Model Early-Learning-Centre were compared using standard reading, oral-language, writing and numeracy tests from school-entry to Year 3. There was a trend towards higher academic achievement for students who attended Doveton early-learning compared to students who had not. Many tests showed statistically significant differences, despite low sample sizes. This study provides preliminary evidence that attending early-learning within a high-quality, wrap-around service model may have significant academic benefits for disadvantaged children.
Home‐visiting interventions are used to improve outcomes for families experiencing disadvantage. As scarce resources must be allocated carefully, appropriate methods are required to provide accurate ...information on the effect of these programmes. We aimed to investigate: economic evaluation/analysis methods used in home‐visiting programmes for children, young people and families, study designs and methods suitable in situations where randomised‐controlled‐trials are not feasible, and type of costs included in analyses, including any implementation costs stated. A systematic search and review was conducted of existing full economic evaluation/analysis methods in home‐visiting programmes for children, young people and/or families. We included studies published in English between January 2000 and mid‐November 2020. Of the 4,742 papers sourced, 60 were retained for full‐text review, and 21 included. Economic‐analysis methods found in the included studies were: within trial economic evaluation, economic evaluation using decision analytic modelling (i.e. cost‐utility, cost‐benefit analysis), cost comparison and cost‐consequence. Studies incorporating return on investment and budget impact analysis were also found. Study designs suitable when randomisation was not feasible included parallel cluster randomised trials and using pre‐post intervention data. Costs depended mainly on study context and only one study reported implementation costs. We hope this information will help guide future economic evaluations of home‐visiting interventions.
The recently developed EQ Health and Wellbeing Instrument (EQ-HWB) is a broad, generic measure of quality-of-life designed to be suitable for caregivers. The aim of this study was to investigate ...performance and validity of the 9-item version (EQ-HWB-S) for caregivers where families had experienced adverse-life-events.
Using survey data from caregivers of children aged 0-8 years attending a community-health centre in 2021-2022, the general performance, feasibility, convergent and known-group validity, responsiveness-to-change, and test-retest reliability of the EQ-HWB-S was assessed. Twelve semi-structured interviews were conducted with survey respondents to assess acceptability and content validity.
The sample included 234 caregivers at baseline (81% female, mean age 36-years, 38% Australian-born) and 190 at 6-months follow-up. Most EQ-HWB-S item responses were evenly spread, except for 'Mobility'. The instrument showed good convergent validity with psychological distress (Kessler 6 (K6)) and personal-wellbeing (PWI-A) scales. EQ-HWB-S level sum-scores and preference-weighted scores were significantly different in all known-group analyses, in expected directions, and the instrument was responsive to change. For test-retest reliability, Intraclass Correlation Coefficients were excellent and individual item Kappa scores were moderate. The instrument was well received by interviewees who found the questions clear and relevant. The items were appropriate for parents experiencing adversity and carers of children with additional needs.
The EQ-HWB-S appeared valid, responsive to change, feasible, and well accepted by caregivers. By demonstrating the validity of the EQ-HWB-S in this hard-to-reach population of caregivers in families experiencing adverse events, this study adds to existing international evidence supporting its use.
Abstract Child sexual abuse is a significant problem in many Indigenous communities; there is also evidence of chronic under-reporting of this crime. This study aimed to compare reporting rates ...between Indigenous and non-Indigenous cases of child sexual abuse across two Australian jurisdictions. Datasets comprising child sexual abuse reports from the Police Information Management Systems of the two jurisdictions were used to calculate reporting rates, and to compare case characteristics and case progression. Results indicated that the reporting rate for child sexual abuse of Indigenous children was between two and four times that of non-Indigenous children. In the Indigenous cases, the second jurisdiction had lower reporting rates than the first jurisdiction. Further analysis of the Indigenous cases only found that cases in the second jurisdiction were more severe, more likely to have a forensic interview, and more likely for the suspect to be charged, than in the first jurisdiction. However, there were no significant differences in conviction rates between the two jurisdictions. Differences observed in severity and case progression suggest that the lower reporting rates observed in the second jurisdiction may be due to comparatively high levels of under-reporting, rather than lower actual levels of child sexual abuse. In conclusion, reporting rates of child sexual abuse can be better understood when further information, such as case characteristics and case progression rates, is available.
Objective
The aim of this study was to examine the level of agreement between self- and proxy-reporting of health-related quality of life (HRQoL) in children (under 18 years of age) using generic ...preference-based measures.
Methods
A systematic review of primary studies that reported agreement statistics for self and proxy assessments of overall and/or dimension-level paediatric HRQoL using generic preference-based measures was conducted. Where available, data on intraclass correlation coefficients (ICCs) were extracted to summarise overall agreement levels, and Cohen’s kappa was used to describe agreement across domains. A meta-analysis was also performed to synthesise studies and estimate the level of agreement between self- and proxy-reported paediatric overall and domain-level HRQoL.
Results
Of the 30 studies included, 25 reported inter-rater agreement for overall utilities, while 17 reported domain-specific agreement. Seven generic preference-based measures were identified as having been applied: Health Utilities Index (HUI) Mark 2 and 3, EQ-5D measures, Child Health Utility 9 Dimensions (CHU9D), and the Quality of Well-Being (QWB) scale. A total of 45 dyad samples were included, with a total pooled sample of 3084 children and 3300 proxies. Most of the identified studies reported a poor inter-rater agreement for the overall HRQoL using ICCs. In contrast to more observable HRQoL domains relating to physical health and functioning, the inter-rater agreement was low for psychosocial-related domains, e.g., ‘emotion’ and ‘cognition’ attributes of both HUI2 and HUI3, and ‘feeling worried, sad, or unhappy’ and ‘having pain or discomfort’ domains of the EQ-5D. Parents demonstrated a higher level of agreement with children relative to health professionals. Child self- and proxy-reports of HRQoL showed lower agreement in cancer-related studies than in non-cancer-related studies. The overall ICC from the meta-analysis was estimated to be 0.49 (95% confidence interval 0.34–0.61) with poor inter-rater agreement.
Conclusion
This study provides evidence from a systematic review of studies reporting dyad assessments to demonstrate the discrepancies in inter-rater agreement between child and proxy reporting of overall and domain-level paediatric HRQoL using generic preference-based measures. Further research to drive the inclusion of children in self-reporting their own HRQoL wherever possible and limiting the reliance on proxy reporting of children’s HRQoL is warranted.
•Pregnancy diet is a risk factor implicated in the prevention of postpartum depressive symptoms.•Antenatal fruit and vegetable intake were not associated with depressive symptoms 12 months ...post-birth.•Antenatal fish intake was not associated with depressive symptoms 12 months post-birth.•Future research should explore diet quality via adherence to dietary guidelines.
Postnatal depression is a critical public health concern, and gaining a better understanding of possible causes is paramount. Recently, diet quality during pregnancy has emerged as a possible preventative measure in ameliorating postnatal depression, however the evidence-base exploring this association is immature. The aim of this study was to examine the association between consumption of food groups characteristic of a quality diet during pregnancy (that is fruit, vegetable and fish intake) and postnatal depressive symptoms at 12 months postpartum. Pregnant women were recruited at 10–18 weeks gestation via advertising on online pregnancy forums, pregnancy and parenting magazines, and two Australian maternity clinics. Participants (n = 253) completed self-report questionnaires assessing fruit, vegetable and fish intake as well as depressive symptoms at early- to mid- pregnancy. Path analyses were conducted to examine whether fruit, vegetable and fish intake during pregnancy were associated with depressive symptom scores at 12 months postpartum. There were no associations between fruit, vegetable or fish intake in pregnancy and postnatal depressive symptoms. Antenatal diet quality as measured by intake of food groups associated with a healthy diet was not associated with postpartum depressive symptoms at 12 months postpartum. Future research should consider the exploration of dietary quality as a measure of overall adherence to evidence-based dietary guidelines.
Australian breastfeeding rates are low, and strategies to increase them have been inadequate. New approaches for supporting breastfeeding are required.
Preliminary data suggested that Australian ...Breastfeeding Association members had higher exclusive breastfeeding rates than the general Australian population. The Engaging Mothers: Breastfeeding Experiences Recounted project provided an opportunity to determine which practices were influencing better breastfeeding outcomes.
(1) To determine whether Australian Breastfeeding Association volunteer trainees were positive deviants regarding breastfeeding practices, (2) to explore characteristics or behaviours underpinning beneficial breastfeeding practices and (3) to identify modifiable characteristics to inform breastfeeding promotion.
A cross-sectional, one-group survey design was used. Breastfeeding-related quantitative and qualitative data were obtained from lactation history questionnaires collected on application to train as volunteers with the Australian Breastfeeding Association (N=174), and analysed using descriptive statistics.
Participants in this project had higher levels of exclusive breastfeeding to around 6 months (64%) and longer duration of breastfeeding (80% to one year) than the general Australian population, going beyond World Health Organization targets. Identified modifiable factors were knowledge and motivation to breastfeed, partner and peer support, birthing outcomes, immediate skin-to-skin contact, formula supplementation and positive attitudes to breastfeeding at work and breastfeeding in public.
Participants could be defined as positive deviants with positive attitudes towards breastfeeding. The personal behaviours and practices of this group may help inform future breastfeeding interventions.
Identifying positive deviants and supporting the broader community to adopt behaviours that explain improved breastfeeding outcomes could be powerful methods to produce change.
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