RESEARCH METHODS:TRANSITION READINESS ASSESSMENT QUESTIONNAIRE The Transition Readiness Assessment Questionnaire (TRAQ): Its Factor Structure, Reliability, and Validity David L. Wood, MD, MPH; Gregory S. Sawicki, MD, MPH; M. David Miller, PhD; Carmen Smotherman, MS; Katryne Lukens-Bull, MPH; William C. Livingood, PhD; Maria Ferris, MD, MPH, PhD; Dale F. Kraemer, PhD From the Department of Pediatrics (Dr Wood), Department of Neurology (Dr Kraemer), College of Medicine-Jacksonville, University of Florida, Jacksonville, Fla; Center for Health Equity and Quality Research (Drs Wood, Kraemer, and Livingood, and Ms Smotherman), University of Florida, Jacksonville, Fla; Boston Children’s Hospital, Harvard Medical School, Boston, Mass (Dr Sawicki); School of Human Development and Organizational Studies, University of Florida, Gainesville, Fla (Dr Miller); Duval County Health Department, Florida Department of Health, Jacksonville, Fla (Ms Lukens-Bull); and University of North Carolina Kidney Center at Chapel Hill, NC (Dr Ferris) The authors declare that they have no conflict of interest. Address correspondence to David Wood, MD, MPH, 580 W 8th St, Tower II, Suite 6015, Jacksonville, FL 32209 (e-mail: david.wood@jax.ufl. edu). Received for publication December 21, 2012; accepted March 12, 2014. ABSTRACT OBJECTIVE: National consensus statements recommend that providers regularly assess the transition readiness skills of adolescent and young adults (AYA). In 2010 we developed a 29-item version of Transition Readiness Assessment Question- naire (TRAQ). We reevaluated item performance and factor structure, and reassessed the TRAQ’s reliability and validity. METHODS: We surveyed youth from 3 academic clinics in Jacksonville, Florida; Chapel Hill, North Carolina; and Boston, Massachusetts. Participants were AYAwith special health care needs aged 14 to 21 years. From a convenience sample of 306 patients, we conducted item reduction strategies and explor- atory factor analysis (EFA). On a second convenience sample of 221 patients, we conducted confirmatory factor analysis (CFA). Internal reliability was assessed by Cronbach’s alpha and criterion validity. Analyses were conducted by the Wil- coxon rank sum test and mixed linear models. RESULTS: The item reduction and EFA resulted in a 20-item scale with 5 identified subscales. The CFA conducted on a sec- ond sample provided a good fit to the data. The overall scale has high reliability overall (Cronbach’s alpha ¼ .94) and good reli- ability for 4 of the 5 subscales (Cronbach’s alpha ranging from .90 to .77 in the pooled sample). Each of the 5 subscale scores were significantly higher for adolescents aged 18 years and older versus those younger than 18 (P < .0001) in both univar- iate and multivariate analyses. CONCLUSIONS: The 20-item, 5-factor structure for the TRAQ is supported by EFA and CFA on independent samples and has good internal reliability and criterion validity. Additional work is needed to expand or revise the TRAQ subscales and test their predictive validity. KEYWORDS: health care transition readiness; self-assessment questionnaire; youth with special health care needs ACADEMIC PEDIATRICS 2014;14:415–422 WHAT’S NEW The Transition Readiness Assessment Questionnaire (TRAQ; http://hscj.ufl.edu/jaxhats/traq/) is a validated 20-item, 5-domain patient-reported assessment of health and health care self-management skills that can be used in preparation for transition to adult care. ACCORDING TO THE 2009–2010 National Survey of Children With Special Health Care Needs, the prevalence of special health care needs (SHCN) among adolescents (ages 12 to 17 years) is 19.8%. 1 Advances in health care have led to improvements in the survival of children with SHCN, enabling over 90% to transition to adulthood. 2,3 The process of health care transition (HCT) is defined as “purposeful, planned movement of adolescents and young adults with chronic physical and medical condi- tions from child-centered care to an adult-oriented care system.” 2 The fact that Healthy People 2020 included mea- surements of successful HCT as one of the national health objectives indicates the growing importance of HCT. 4 In addition, the Maternal Child Health Bureau includes HCT as a key indicator of measures of health. 5 However, for a number of reasons, many adolescents and young adults (AYA) have a difficult time during transition, experiencing lapses in insurance and gaps in care. 6,7 In addition, many AYA struggle to adjust to the increased level of autonomy expected of patients in the adult service system. 8,9 Studies ACADEMIC PEDIATRICS Volume 14, Number 4 Copyright ª 2014 by Academic Pediatric Association 415 July–August 2014