title: Development of a comprehensive health-related needs assessment for adult survivors of childhood cancer.
abstract: OBJECTIVE
  Examine the construct validity, stability, internal consistency, and item-response performance of a self-report health needs assessment for adult survivors of childhood cancer.
  
  
  METHODS
  A 190-item mailed survey was completed by 1,178 randomly selected (stratified on age, diagnosis, time since diagnosis) Childhood Cancer Survivor Study participants (mean age, 39.66 [SD 7.71] years; time since diagnosis, 31.60 [SD 4.71] years). Minorities and rural residents were oversampled at a 2:1 ratio.
  
  
  RESULTS
  The final instrument included 135 items comprising nine unidimensional subscales (Psycho-emotional, Health System Concerns, Cancer-Related Health Information, General Health, Survivor Care and Support, Surveillance, Coping, Fiscal Concerns, and Relationships). Confirmatory factor analysis (n = 1,178; RMSEA = 0.020; 90 % CI = 0.019-0.020; CFI = 0.956; TLI = 0.955) and person-item fit variable maps established construct validity. Across subscales, Cronbach's alpha was 0.94-0.97, and the 4-week test-retest correlations were 0.52-0.91. In a Rasch analysis, item reliability was 0.97-0.99, person reliability was 0.80-0.90, and separation index scores were 2.00-3.01. Significant subscale covariates of higher need levels included demographics, diagnosis, and treatment exposures.
  
  
  CONCLUSIONS
  The Childhood Cancer Survivor Study Needs Assessment Questionnaire (CCSS-NAQ) is reliable and construct-valid, has strong item-response properties, and discriminates need levels.
  
  
  CONCLUSIONS
  The CCSS-NAQ potentially can be used to: (1) directly assess adult childhood cancer survivors' self-reported health-related needs, (2) identify individuals or subgroups with higher-level needs, (3) inform prevention and direct intervention strategies, and (4) facilitate prioritization of health-care resource allocation.
authors.affiliation: Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN 38105-3678, USA. cheryl.cox@stjude.org
authors.forename: Cheryl L
authors.initials: CL
authors.lastname: Cox
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Sherrill-Mittleman
authors.forename: Barth B
authors.initials: BB
authors.lastname: Riley
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Hudson
authors.forename: Lauren J
authors.initials: LJ
authors.lastname: Williams
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: Margie G
authors.initials: MG
authors.lastname: Zacher
authors.forename: Les L
authors.initials: LL
authors.lastname: Robison
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D020380:Needs Assessment; D009369:Neoplasms / Q000401:mortality / Q000523:psychology* / Q000628:therapy; D011594:Psychometrics; D011788:Quality of Life; D012944:Social Support; D011795:Surveys and Questionnaires; D015996:Survival Rate; D017741:Survivors / Q000523:psychology*; D055815:Young Adult