title: Refinement of an instrument to evaluate parental attitudes about follow-up care after an acute emergency department visit for asthma.
abstract: BACKGROUND
  Prompt follow-up after emergency department (ED) care for asthma allows the primary care provider (PCP) and family to review factors that led to the ED visit, update current care plans, and plan for prevention of future exacerbations.
  
  
  METHODS
  The Initial Questionnaire to assess parental impressions of Pros and Cons of follow-up was administered to parents who brought their children to the ED for treatment of an acute asthma exacerbation (N = 309). After a planned interim analysis, 19 new items were generated, and this Expanded Questionnaire was given to 198 parents. Principal Component Analysis (PCA) was used to identify well-defined items and discard ambiguous and confusing items.
  
  
  RESULTS
  PCA of the Expanded Questionnaire revealed 18 of 43 items related to four dimensions of parents' Pros and Cons for obtaining follow-up care. Four distinct categories were identified: two Pros and two Cons. Pro items related to practical things parents get from a follow-up visit and to positive parental beliefs about follow-up care. Con items emphasized practical considerations that make it difficult to go to a follow-up visit and identified the misconception that follow-up is not necessary for asymptomatic children. In addition, two distinct clusters of parents were identified: those that value and those that do not value follow-up care.
  
  
  CONCLUSIONS
  We developed an 18-item measure that assesses Pros and Cons of follow-up care for asthma following emergency care, which has four reliable factors: Pro Practical, Pro Attitude, Con Practical, and Con Attitude. This questionnaire may help guide interventions to change perceptions of the need for follow-up. Attention to increasing Pros among those who are reluctant to attend follow-up care may be especially effective.
authors.affiliation: Division of Emergency Medicine, St. Louis Children's Hospital, Washington University School of Medicine, St. Louis, Missouri, USA. srsmith@ccmckids.org
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Smith
authors.forename: Gabrielle R
authors.initials: GR
authors.lastname: Highstein
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.forename: Edwin B
authors.initials: EB
authors.lastname: Fisher
authors.forename: Robert C
authors.initials: RC
authors.lastname: Strunk
mesh_terms: D000208:Acute Disease; D001249:Asthma / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy; D001294:Attitude to Health; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005069:Evaluation Studies as Topic; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D010353:Patient Education as Topic; D010359:Patient Readmission; D010817:Physician-Patient Relations; D011320:Primary Health Care; D011368:Professional-Family Relations; D011594:Psychometrics; D011779:Q-Sort; D015203:Reproducibility of Results; D012307:Risk Factors; D011795:Surveys and Questionnaires