Children’s family experiences: development of the PROMIS^® pediatric family relationships measures

Purpose: To describe the development of pediatric family relationships measures, with versions for child self-report (8–17 years) and parent-report for children 5–17 years old. Measures were created for integration into the Patient Reported Outcomes Measurement Information System (PROMIS^®). Methods: Semi-structured interviews with 10 experts, 24 children, and 8 parents were conducted to elicit and clarify essential elements of family relationships. A systematic literature review was conducted to identify item concepts representative of each element. The concepts were transformed into items that were iteratively revised based on cognitive interviews (n = 43 children) and item translatability review. Psychometric studies involving 2846 children and 2262 parents were conducted to further refine and validate the instruments. Results: Qualitative procedures supported the development of content valid Family Relationships item banks. Final child- and parent-report item banks each contain 47 items. Unidimensional item banks were calibrated using IRT-modeling to estimate item parameters representative of the US population and to enable computerized adaptive test administration. Four- and eight-item short forms were constructed for standard fixed format administration. All instruments have strong internal consistency, retest-reliability, and provide precise estimates of various levels of family relationship quality. Preliminary evidence of the instruments’ validity was provided by known-group comparisons and convergence with legacy measures. Conclusion: The PROMIS pediatric Family Relationships measures can be applied in research focused on determinants, outcomes, and the protective effects of children’s subjective family relationship experiences.