title: Behavioral interactions in the perioperative environment: a new conceptual framework and the development of the perioperative child-adult medical procedure interaction scale.
abstract: BACKGROUND
  The authors suggest that research in the area of parental presence during induction of anesthesia should shift to emphasize what parents actually do during induction, rather than focusing simply on their presence. As a first step, the authors aimed to develop a behavioral coding system that would measure child and adult interactions in the perioperative environment.
  
  
  METHODS
  The authors enrolled 45 parents and children (aged 2-12 yr) undergoing elective surgery and general anesthesia. A multidisciplinary team examined videotapes and transcriptions of interactions between children, parents, and medical personnel in the holding room and operating room. The team used an existing scale, the Child-Adult Medical Procedure Interaction Scale, as the prototype for the development of a new perioperative behavioral coding system. The research team conducted extensive revisions to the original scale and added multiple codes to the original scale, including nonverbal codes. Interrater reliability was assessed using weighted kappa statistics. Construct validity was also examined.
  
  
  RESULTS
  The final Perioperative Child-Adult Medical Procedure Interaction Scale contains 40 codes in four domains. Analyses showed excellent reliability overall for verbal and nonverbal codes. Kappa values averaged 0.87 for verbal codes characterizing adult vocalizations, 0.92 for verbal codes characterizing child vocalizations, and 0.88 for nonverbal codes. Construct validity was demonstrated by finding the hypothesized associations between certain scale codes and children's anxiety (P = 0.0001).
  
  
  CONCLUSIONS
  Showing excellent reliability, the Perioperative Child-Adult Medical Procedure Interaction Scale is an appropriate tool for assessing child-adult behavioral interaction during the perioperative period. When sequential analyses are conducted and target behaviors are identified, empirically based parent preparation programs can be developed.
authors.affiliation: Department of Anesthesiology, Yale University School of Medicine, 333 Cedar Street, New Haven, CT 06510, USA.
authors.forename: Alison A
authors.initials: AA
authors.lastname: Caldwell-Andrews
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Blount
authors.forename: Linda C
authors.initials: LC
authors.lastname: Mayes
authors.forename: Zeev N
authors.initials: ZN
authors.lastname: Kain
mesh_terms: D000758:Anesthesia; D001007:Anxiety / Q000523:psychology; D002648:Child; D002652:Child Behavior; D002675:Child, Preschool; D005006:Ethnicity; D005260:Female; D006801:Humans; D008297:Male; D010290:Parents / Q000523:psychology*; D017060:Patient Satisfaction; D019990:Perioperative Care / Q000523:psychology*; D011594:Psychometrics; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014705:Verbal Behavior