THU0604 Juvenile inflammatory arthritis: the development and validation of an illustrated questionnaire to measure children’s motivation
Authors: Y. El Miedany, H. Lotfy, N. El Aroussy, D. Mekkawy, S.I. Nasef, W. Hassan, M. Eissa, G. El Deriny, S. Almedany, Y. Farag, M. El Gaafary
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Self-determination theory (SDT) is a macro theory of human motivation and personality that concerns people's inherent growth tendencies and innate psychological needs. SDT is concerned with the motivation behind choices people make without external influence and interference. JIA disrupts a child's sense of normality and impairs his or her motivation capacity. Children with JIA have a sense of being misunderstood and stigmatised, and they feel perpetually caught between having hope and control over their bodies and overwhelming pain and despair. To increase their confidence and the ability to manage pain, children need ongoing information about treatments, lifestyle management, and active involvement in their own health decision making. <h3>Objectives</h3> To develop a questionnaire for evaluating the ''motivation'' amongst children living with inflammatory arthritic conditions and assess the psychometric properties of that measure. <h3>Methods</h3> Based on content analysis and semi structured group discussion as well as Rasch analysis, ten domains were identified and used as a frame for an expert consensus and patient focus groups. The questionnaire was developed including: 10-items scale (0–10 on VAS scale). A mean score is calculated across all items. The total score ranged from 0–10. Each item was supported by illustrations explaining both ends of the measure. The questionnaire was formatted, one copy for adolescents and another copy was directed for the parents of younger children. Construct validity was assessed by correlating the score of the questionnaire to disease activity scores (JADAS-27, SLEDAI-2K, ASDAS-CRP); measures of functional disability, quality of life, patient self-helplessness measure as well as the patients' adherence to therapy. Reliability and comprehensibility and sensitivity to change were also assessed. <h3>Results</h3> The questionnaire was assessed in 71 children with JIA, 32 with enthesitis related arthritis and 34 with cSLE. Results revealed that the developed illustrated questionnaire mean score correlated significantly with disease activity measures: JADAS-27: r=−0.87; ASDAS-CRP: r=−0.85, SLEDAI-2K: r=−0.86 reflecting its validity. It also correlated significantly with the scores of functional disability: r=−0.89, QoL: r=−0.88 as well as patient self-helplessness r=−0.91. The questionnaire was reliable (Cronbach's alpha 0.926 and had no misfitting items. The illustrations were well received and this was reflected on the questionnaire comprehensibility (9.5) and sensitivity to change (p&lt;0.01). The patient motivation score showed significant (p&lt;0.01) correlation with adherence to therapy. <h3>Conclusions</h3> The illustrated children motivation measure, is a patient-centred unidimensional scale that is valid, reliable and comprehensible. The measure has good psychometric properties indicating that it can be used at the individual child's level to tailor management and monitor changes in response to therapy. The illustrations enhanced the questionnaire perception by the children as well as the parents. <h3>Disclosure of Interest</h3> None declared