title: Assessing readiness for transition from paediatric to adult health care: Revision and psychometric evaluation of the Am I ON TRAC for Adult Care questionnaire.
abstract: OBJECTIVE
  To refine and psychometrically test the Am I ON TRAC for Adult Care questionnaire.
  
  
  BACKGROUND
  Inadequate transition to adult care for adolescents with special healthcare needs has been associated with greater risk of treatment non-adherence, lack of medical follow-up, increased morbidity and mortality. Presently, there are no well-validated measures assessing adolescents' readiness to transition from paediatric to adult medical care.
  
  
  METHODS
  Descriptive cross-sectional study.
  
  
  METHODS
  The Am I ON TRAC for Adult Care questionnaire was refined to improve the instrument's methodological soundness. A literature review informed the revisions. A convenience sample of 200 adolescents, 12-19 years, was recruited from four outpatient clinics at a paediatric hospital in Western Canada between April-June 2012. Construct validity was evaluated by Exploratory Factory Analysis; concurrent validity was assessed using the Psychosocial Maturity Index. Internal consistency was evaluated by computing Cronbach's alpha estimates.
  
  
  RESULTS
  Factor analysis of the knowledge items identified a 14-item unidimensional scale. Knowledge and behaviour sub-scale scores increased with age, with a stronger relationship between knowledge and age. Psychosocial maturity correlated with both sub-scale scores, but had a stronger association with behaviour. Psychosocial maturity and age had a weak but significant correlation suggesting age is a loose proxy for maturity. Only 27% of 17-year olds, but 62% 18-year olds, scored above the behaviour cut-off for transition readiness.
  
  
  CONCLUSIONS
  The revised Am I ON TRAC for Adult Care questionnaire is a psychometrically sound measure that has potential to be used as a readiness assessment tool in both clinical practice and research.
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Melissa
authors.initials: M
authors.lastname: Moynihan
authors.affiliation: School of Nursing and Division of Adolescent Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Saewyc
authors.affiliation: Department of Paediatrics, Division of Adolescent Medicine, University of British Columbia, Vancouver, British Columbia, Canada.|Youth Transitions Initiative, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Whitehouse
authors.affiliation: Division of Adolescent Health, BC Children's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Mary
authors.initials: M
authors.lastname: Paone
authors.affiliation: School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Gladys
authors.initials: G
authors.lastname: McPherson
mesh_terms: D000328:Adult; D002648:Child; D003266:Continuity of Patient Care; D006801:Humans; D010372:Pediatrics; D011320:Primary Health Care; D011594:Psychometrics; D011795:Surveys and Questionnaires
keywords: adolescent health; chronic illness; factor analysis; instrument development; psychosocial nursing