Nurs Admin Q Vol. 33, No. 1, pp. 26–31 Copyright c  2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Children’s Perceptions of Healthcare Survey Linda Lindeke, PhD, RN, CPNP; Jayne Fulkerson, PhD; Mary Chesney, MS, RN, CNP; Lauren Johnson, MS, RN, CNS; Kay Savik, MS Background: Few validated pediatric tools exist to directly gather data about children’s per- ceptions of their own healthcare; parent surveys are typically used as proxies. A psychometri- cally sound, child-focused survey captures children’s unique perceptions for quality improvement. Objectives: This study developed and evaluated reliability of a survey, assessed score differences by children’s age, and compared the responses of children and parents. Method: The Children’s Perceptions of Healthcare Survey was developed for inpatient and outpatient quality improvement. Following expert review, the tool was administered to 237 parent-child dyads at the time of dis- charge from an inpatient pediatric unit (n = 121) and after outpatient clinic visits (n = 116). Responses were analyzed and compared. Results: Internal consistency reliability for the tool was high (child/adolescents: α = .84; parents: α = .86), with no significant differences by child age or child gender. Parent and child scores were significantly correlated (r = 0.29, P < .001). About half of parents’ scores were higher than their children’s scores. Discussion: This tool worked well to collect data from a wide age range of children across healthcare settings. Children’s per- ceptions were unique; involving children in care assessment is worthwhile and captures insights missed when only parents are surveyed. The Children’s Perceptions of Healthcare Survey is a valid, psychometrically sound tool to capture children’s unique perspectives regarding their healthcare and may be useful for system quality improvement. Key words: adolescents, children, healthcare questionnaire, quality improvement F EW TOOLS are in use to gather reliable data directly from children and youth re- garding their impressions of their healthcare experiences. Generally, parents’responses are presumed to be sufficient to improve chil- From the School of Nursing, University of Minnesota, Minneapolis (Drs Lindeke, Fulkerson, Chesney, and Savik); and University of Minnesota Children’s Hospital, Fairview (Dr Johnson). The authors thank Joanne Disch, PhD, RN, FAAN, and the Katherine J. Densford Center for Interna- tional Nursing Leadership for funding Lauren John- son and Linda Lindeke as Densford clinical scholars for this research. Research assistants Angela Jukkala and Angelynn Grabau provided excellent work on the manuscript. We also thank Mary Hauck, PhD, RN, who provided inspiration and continuous support. Corresponding author: Linda Lindeke, PhD, RN, CPNP, School of Nursing, University of Minnesota, 5-160 WDH, 308 Harvard St SE, Minneapolis, MN 55455 (e-mail: linde001@umn.edu). dren’s healthcare 1 and minor children are not typically queried directly for quality improve- ment processes. In addition, surveys used for systems improvement are often site specific and not face valid or psychometrically sound. STUDIES OF CHILDREN’S PERCEPTIONS OF HEALTHCARE Quality improvement activities attempt to close the gap between desired processes/ outcomes and what are actually delivered. 2 For example, Margaret et al 3 surveyed pedi- atric patients and their parents to improve emergency department care. They modified the Wong-Baker FACES Pain Rating Scale 4 to inquire about waiting time, information pro- vided, pain management, and communication and found that their study demonstrated the usefulness of measuring children’s satisfac- tion with care. Their tool performed well with 26