The Great Ormond Street Hospital Top Child and Adolescent Health Study
Conditions: Adolescent Behavior, Child Behavior, Parents
Sponsor: Institute of Child Health

 
 
 
 
 
 
The GOSH Top Child & Adolescent Health 
Problems Study 
 
Research Proposal 
IRAS ID: 238932 
Document Version 4.0 
Date: 04/06/2018 
 
 
 
Dr. Webby E. Phiri 
MSc. Paediatrics and Child Health | Global Child Health 
University College London (UCL) Great Ormond Street Institute of Child Health 
Honorary Contract – Great Ormond Street Hospital 
w.phiri.17@ucl.ac.uk  
 
Supervisors: 
Dr. Vikram Palit, UCL GOS ICH 
Dr. Lee Hudson, GOSH 
 
 
 

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Contents 
Item 
Page No. 
PART A 
 
Abstract 
2 
Rationale and Background 
3 
Study Objectives 
4 
Study Design 
4 
Methodology 
5 
Safety Considerations 
6 
Follow up 
6 
Sample Size 
6 
Management and Statistical Analysis & Data Storage 
7 
Quality Assurance 
9 
Expected Outcomes of Study 
9 
Dissemination of Results & Publication 
9 
Duration of the Project 
9 
Problems Anticipated 
10 
Project Management 
10 
Ethics 
10 
PART B 
 
Other Considerations 
11 
References 
12 
 
 
Abbreviations 
CASC 
Centre for Applied Research Courses 
CRAC 
Clinical Research Adoptions Committee 
GOSH 
Great Ormond Street Hospital 
HRA 
Health Research Authority 
ICH 
Institute of Child Health 
NHS 
National Health Service 
RCPCH 
Royal College of Paediatrics and Child Health 
SoCH 
State of Child Health Report 
SPSS 
Statistical Package for the Social Sciences 
UCL 
University College London 
 
 
 
 
 
 
 

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ABSTRACT 
 
Rationale: There is a spectrum of child and adolescent health problems that may not 
be routinely discussed between clinicians and parents that affect management, or 
pose future risk to health of children and adolescents. Only a few surveys outside the 
UK have listed perception burdens. The National Health Service (NHS) England would 
require information on what the public and healthcare providers thinks are major child 
health concerns for policy decisions and identification of potential intervention areas 
likely to be well received. 
Objectives. The objective of this survey is to determine what the top child and 
adolescent health problems as perceived by parents and paediatricians in a tertiary 
hospital. This study will also investigate their perceptions about NHS England, identify 
influential information sources, and investigate the effect of demographics and 
socioeconomic status on parental concerns. 
Methods: This is a quantitative cross sectional, self-reported questionnaire based 
study that will ask respondents about demographics and review of a list of thirty 
common child and adolescent health problems. The study will be based at the Great 
Ormond Street Hospital (GOSH). 
Populations: Parents/guardians will be selected through convenience sampling, to a 
target sample size of 1,100 parents and 300 paediatricians giving a confidence interval 
of 95% and power of 0.86. This sample will be generalizable to a parents in a year’s 
attendance and consultants based at GOSH. These will be identified through a 
feasibility consensus with supervisors. All participants will be primarily based at the 
GOSH, London. 
Time Frame: The study will run from May 2018 to June 2019.  
Expected Outcomes: Improvement in clinical and health systems management of 
child and adolescent health problems tertiary hospitals, after considering input from 
public. Results will inform policy decisions and guide the focus of resources for child 
and adolescent health. The information can also provide foundation for prospects of 
establishing a national poll for child and adolescent health in the UK that would provide 
timely information. 
 
 
 
 
 
 
 

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PART A 
 
Rationale & background information 
The GOSH Top child and adolescent health problems study aims to identify the top 
health concerns that parents/guardians and paediatricians in a tertiary hospital have 
for young people in England. The study will be surveying parents/guardians and 
paediatricians at GOSH, asking them to review and give their impressions from a list 
of thirty common child and adolescent health issues. Analysis of responses will provide 
a list of problems that are most important and determine if respondents feel that the 
NHS England is adequately addressing these problems. 
The project was designed with public partnership. We conducted literature reviews, 
and adopted with permission, a survey instrument used by the C.S. Mott Children’s 
Hospital National Poll in Michigan, USA. We asked some parents to list child and 
adolescent health problems that they deem most important. A consensus meeting with 
experts was held, to select the thirty most common and important public health issues 
for young people in England, from which the study will identify problems with the 
highest concern. This project and its intended outcomes will span medical, nursing, 
research and voluntary services that will improve child and adolescent healthcare 
provision the UK. 
The SoCH 2017 highlights indicators of child health problems across the four nations 
of the United Kingdom. There are some polls that were conducted in Australia and 
USA, investigating the top concerns for child health problems and thus providing a 
framework onto which to find solutions. The Royal Children’s Hospital  Melbourne 
through its National Child Health Poll established that that excessive screen time was 
the greatest parental concern, and that the top ten concerns related to modern 
lifestyle, mental health and child safety (Rhodes, 2015). Similarly, the C.S. Mott 
Children’s Hospital National Poll on children’s health selected a national sample of 
adults to identify health topics that are a “big problem” for children and teenagers. The 
2017 report identified bullying/cyberbullying as the greatest concern (C.S. Mott 
Children's Hospital, 2017). However there is no available evidence about studies being 
conducted in the United Kingdom to find out what parents/guardians and 
paediatricians report as the top child and adolescent health problems. 
The information would be valuable to the health professionals at the point of care, as 
well as the national healthcare system. This study analyses information from groups 
on both the supply and demand side of child and adolescent healthcare. 
Understanding the different perceptions of child and adolescent health problems 
between healthcare professionals and parents/guardians can lead to improved follow-
up care and compliance with advice (Crone et al., 2016). Information from this study 
can be used as a basis for the establishment of a UK national poll that would further 
investigate public concerns for child health. 
 
 

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Study goals and objectives 
 
Primary Research Question 
What are the top child and adolescent health concerns amongst parents and 
paediatricians at the Great Ormond Street Hospital? 
 
Secondary Research Questions 
o How do the top child and adolescent health concerns differ between 
parents/guardians and paediatricians. 
o What are the perceptions on the NHS addressing child and adolescent health? 
o What are the important information sources influencing perceptions on child 
and adolescent health? 
o What is the effect of age, gender, education, socioeconomic status, ethnicity 
and age of children under care, on perception of top child and adolescent 
health problems? 
o Is there any effect of paediatrician`s specialty or years of practice on perception 
of top child and adolescent health problems?  
 
 
Study Design 
This is a quantitative cross sectional, self-reported questionnaire based study that will 
ask respondents about demographics as well as child and adolescent health 
problems. It will not involve retrospective or prospective follow up of patients. 
Inclusion Criteria 
 Parents/Guardians attending GOSH NHS Foundation Trust Outpatients 
 Paediatricians practicing at GOSH  
 
Exclusion Criteria 
 Parents/Guardians and Paediatricians outside the GOSH or NHS England 
 Children aged under 18 years old 
 Inpatients 
 Parents/Guardians who cannot communicate in English and do not have an 
interpreter 
 Participants who have previously responded to the questionnaire 
 
 
 

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Methodology 
The questionnaire interviews will be conducted in the GOSH outpatient waiting areas. 
Implied consent model will be used, where participants will be informed both verbally 
and in writing on the participant information sheet that by filling in a questionnaire, 
consent will be implied. There will be a separate room for the administration of the 
questionnaire. 
The researcher will approach the Nurse-in-Charge of the clinic to identify eligible 
participants. The research will also recruit via a poster in outpatients. These will have 
to meet eligibility criteria and taking part in the study would not interrupt their hospital 
visit process. Being a short questionnaire, with implied consent, participation will 
unlikely cause any interruptions to the hospital operations. 
Over a 12 month study period, 400 Participants will be selected in the Six OPD Areas: 
Cheetah, Manta ray, Rhino, Zebra, Hare and Hippo between May 2018 and June 
2019.  
200 Consultant paediatricians will be identified through convenient sampling. 
Presentations about the full project will be given at clinical meetings to engage the 
clinicians.  
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Fig 1. Participant Contact time in the GOSH Parental and Paediatrician Concerns for Child 
and Adolescent Health 
 
1. Implied Consent (10 Minutes) 
Selected parent or paediatrician will be approached and offered to participate in the 
study. They will be offered a participant information sheet explaining that by filling 
and returning the questionnaire, consent to participate would have been implied. 
2. Filling in Questionnaire (10 minutes) 
The participant will then fill in the questionnaire, by ticking responses. A limited 
space is provided for optional further comments at the end of each of the three 
research questions. 
3. Collection of completed questionnaire (1 minute) 
The completed questionnaire is collected, and participant offered an option to ask 
any questions or give comments about the process. The participant is thereafter 
thanked for their participation in the study. 

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Safety Considerations 
The research carries no foreseeable risk to the participants. The questionnaire is 
anonymous, and focuses mainly on their perception of child and adolescent health 
problems in the public, rather than self-reflecting personal effect of the issues. The 
research therefore carries no foreseeable risk to the researchers and participants. 
The questionnaire may carry a very unlikely risk of disruption of hospital processes. In 
the event that the questionnaire is likely to cause, or causes any disruption to service 
and processes, the data collection process will be withheld at that moment. 
Follow-Up 
This study will have no further follow up with participants after completion of the 
questionnaire. There will be no retrospective follow-up of any participant data. 
Sample Size  
This is an initial exploratory study that will be conducted 3 days a week, aim at 
interviewing about 25 – 30 parents/guardians and 10 paediatricians weekly. The 
sample participants will be proportionately distributed a sample across the six OPD 
department areas as practically possible. Sample size calculation was not required, 
due to the nature of the study, but used as a guide. 
 
 
 
 
 
 
Parents/guardians attending GOSH OPD (nA) 
o Target Population = Yearly OPD attendance = 308,457 
o Confidence Level is 95% 
o Margin of error = 5% 
o Target Sample Size = 384, approximately 400 
o Sampling will be matched to attendance proportions in the six OPD 
areas – Cheetah, Manta ray, Rhino, Zebra, Hare and Hippo. 
Paediatricians (nB) 
o Target population = 400 Paediatricians at GOSH 
o Confidence Level is 95% 
o Margin of error = 5% 
o Target Sample Size = 197, approximately 200 
o There will be no power calculation done. No statistical testing will be 
conducted 
Child & Adolescent 
Health Concerns 
Supply side group 
(nB = 200) 
Paediatricians 
Demand side group 
(nA = 400) 
Parents/guardians 

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Statistical Analysis & Data Management 
Data collection will be anonymous, without use of any personal identifiers. Data will be 
inputted into an excel sheet, updated daily by the researcher as filled in questionnaires 
are collected.  
 
Collected Variables 
No. Variable 
Variable/Data Format 
A 
Demographics 
 
1 
Age 
Categorical (6 age bands, 18-24 --- 65 and older) 
2 
Gender 
Binary (Female or Male) 
3 
No. of children under care 
Categorical ordinal (0 --- 4 or more) 
4 
Age of eldest child under care Categorical ordinal (0-4 --- 19 or older) 
5 
Level of education 
Categorical ordinal (None --- Post Graduate) 
6 
Ethnicity 
Categorical nominal (White, Black, …, Mixed, Asian) 
7 
Household Average Annual 
Income (£) 
Categorical ordinal (< 15,000 --- 70,000 or More)   
8 
Paediatrician Specialty 
Categorical nominal (Neonatal Medicine, …, Oncology) 
9 
Paediatrician years of 
experience 
Categorical ordinal (<5 --- >30) 
B 
Child Health Issues 
 
1 
Ranking Child Health Issues 
Obesity, Autism, …, Bullying 
[List of issues = 30] 
Categorical ordinal (Not a problem, small, moderate, 
large problem) 
2 
Adequacy of NHS in 
addressing child and 
adolescent health issues 
Categorical ordinal 5 bands (Strongly Disagree --- 
Strongly agree) 
3 
Top information sources 
Categorical nominal (Personal experience, …, Media) 
 
Analysis Plan 
No 
Investigation & variable 
Analysis Plan for child and 
adolescent health issues  
1 
Identify top child health concerns by 
parents/guardians and paediatricians. 
Summary frequency scores by sub 
group parents/guardians and 
paediatricians as percentages  
           Description of effect 
 
Age 
  Younger than 35 
  35 or older 
Ranking &frequencies of by age 
category 
Gender 
  Female 
  Male 
Ranking & frequencies by gender 

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No. Of children under care 
  No children under care 
  1 or more children under care 
Ranking & frequencies by no. Of 
children under care 
Age of eldest child under care 
  < 5 
  5-14 
  15 or older 
Ranking & frequencies by age of 
eldest child under care 
Level of education 
  Low (none, high school) 
  Medium (Diploma,  Undergraduate) 
  Higher (Postgraduate) 
Ranking & frequencies by level of 
education 
Ethnicity 
  White 
  Asian 
  Black 
  Mixed 
  Other 
Ranking & frequencies by ethnicity 
Household average annual income (£): 
  Low (< 15,000) 
  Medium (15,000 – 69,999) 
  High (70,000 or more) 
Ranking and frequencies by 
household average annual income 
(£) 
Paediatrician specialty 
Ranking and describe frequencies  
Paediatrician years of experience 
  Less Experience < 5 
  High experience 5 or more 
Ranking & frequencies by 
paediatrician years of experience 
2 
Perception of adequacy by NHS 
  Overall perception by sub group of  
parents and paediatricians 
  Disagree (Strongly Disagree, Disagree) 
  Agree (Strongly Agree, Agree) 
Ranking & frequencies by 
perception of adequacy of the NHS 
3 
Top information sources 
  Rank top three by sub group parents and 
paediatricians 
Ranking and describe frequencies 
 
 
Data Storage and Protection 
No personal data will be collected for this study. Research Data will be managed 
according to the UCL Data Protection Policy following the data protection principles. 
Data will be stored on a password-protected institutional database of the UCL 
Information Services Division. It will be accessed securely by the Principal Investigator 
and the research team only.  
Research data will be stored for 15 years. This data will not have any personal 
identifiers. It may further processed for other research purposes, without any risk of 
identifying the participants. 
 

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Quality Assurance 
The project will be constantly monitored by two supervisors, both professional and 
academic on the subject. 
The Clinical Supervisor is a Consultant Paediatrician at the Great Ormond Street 
Hospital. The Academic Supervisor is based at the University College London (UCL). 
There will be regular weekly reporting meetings with the supervisors. 
Statistical assessment and support will be provided by the UCL Centre for Applied 
Statistics Courses (CASC), through the scheduled academic support and drop in 
sessions.  
 
Expected Outcomes of the Study 
Immediate outcomes of the study will be information that can be readily used by 
hospital psychosocial support units, in designing programs and supports that address 
major child and adolescent health problems among those adolescents and parents 
/guardians attending OPD in a quaternary hospital.  
The information will also be used by policy makers and clinicians paediatricians, to 
understand how much patients’ concerns about adolescent health problems may vary 
from their own. Paediatricians and associated healthcare workers can then anticipate 
issues that may be presented for discussions from patient perspectives, being on the 
healthcare supply side. 
This study would form the foundation for the NHS to design a national poll for 
adolescent health problems, which will have more reporting based on patient 
perspectives. Examples are the Royal Children’s Hospital National Poll in Melbourne 
Australia, and the Mott Poll in Michigan, United States of America (USA). Such an 
informative poll will increase the sensitivity of the NHS to adolescent health Problems 
currently does not exist in the United Kingdom. 
 
Dissemination of Results and Publication Policy 
The results of the study will be primarily presented to the UCL Institute of Child Health 
in fulfilment of the Masters of Science in Paediatrics and Child Health – Global Child 
Health, by the MSc Research Student. 
The study results will thereafter be presented to the GOSH, the site of the study, as 
well as applications made for publication of results in the Health Journals, as well as 
presentations at local, regional or international meetings. This study will be registered 
on a clinical database, on www.clinicaltrials.gov.  
 
Duration of the Project 
The study is expected to run from May 2018 to June 2019. 

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Problems Anticipated 
The project has a low likelihood of the following potential problems. 
Incomplete Questionnaires – participants will be encouraged to fill out the 
questionnaire as complete as they can. The questions offer ‘opt-out’ and ‘neutral’ 
options that will be highlighted during the verbal brief by the researcher. 
Non response – this may likely occur with the professionals engaged in the study. A 
reminder and follow-up of any incomplete questionnaires from paediatricians will be 
made. 
 
Project Management 
The research project will be organised at the following levels: 
Course Directors at UCL ICH - Paediatrics and Child Health – will give oversight of the 
research project. 
Principal Investigator and Academic Supervisor at UCL ICH – will give academic 
guidance and weekly monitoring of the research process. 
Clinical & Academic Supervisor at GOSH – will provide oversight of project 
management regarding operations within the hospital. 
Centre for Applied Statics Courses at UCL – providing statistical support through the 
drop in sessions. 
MSc. Student – primarily responsible for conduction of research, through the stages 
of seeking consent, administering questionnaires, coding and entering data into 
database, analysis of data and presentation of findings.  
 
Ethics 
Ethics Application will be made with the Health Research Authority (HRA), United 
Kingdom, before commencement of the study. Procession of study will depend on 
approval from HRA. 
The research will also undergo assessment by the Clinical Research Adoptions 
Committee (CRAC) at GOSH. CRAC is an internal peer review committee that meets 
to review and endorse any clinical research projects taking place within GOSH. 
The study will only be conducted after full ethical approval. The researcher will ensure 
that they introduce the study in basic lay language, explaining objectives and aims, 
what the study will be investigating, explaining that participation is voluntary, and that 
consent may be withdrawn at any time without providing reasons. 
 
 
 

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PART TWO 
Budget 
No funding has been sought for this project. 
 
Collaboration with other scientists or research institutions 
The research will be based at the GOSH linked to the UCL Institute of Child Health, 
and only staff in these institutions will form part of the core research team. 
 
Links to other projects 
This research project is not linked to other past or ongoing projects. 
 
Other research activities of the investigators 
The Principal Investigator is not currently engaged in any other research project. 
 
Financing and Insurance 
The research project will not need funding to commence. 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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References 
C.S. MOTT CHILDREN'S HOSPITAL. 2017. Mott Poll Report: Bullying and Internet Safety Are Top 
Health Concerns for Parents [Online]. Michigan, United States of America: C.S. Mott 
Children's Hospital National Pool on Child Health. Available: 
https://mottpoll.org/sites/default/files/documents/082117_TopParentConcerns.pdf 
[Accessed 20th November 2017]. 
CRONE, M. R., ZEIJL, E. & REIJNEVELD, S. A. 2016. When do parents and child health professionals 
agree on child's psychosocial problems? Cross-sectional study on parent-child health 
professional dyads. BMC Psychiatry, 16, 151. 
RHODES, A. 2015. What the Public Thinks: Top Ten Child Health Problems. Australian Child Health 
Poll [Online]. Available: https://www.rchpoll.org.au/wp-
content/uploads/2015/12/ACHP_Detailed-report_Dec2015-poll-1.pdf [Accessed 20th 
November 2017].