Using Animation to Self-report Health: a Randomized Experiment with Children

The Child Health Utility-9D (CHU-9D) is the only generic preference based measure specifically developed to elicit health-related quality of life directly from children aged 7 to 11 years. The aim of this study was to investigate whether the use of animation on a touch screen device (tablet) is a better way of collecting health status information from children aged 4 to 14 years compared to a traditional paper questionnaire. The specific research questions were firstly, do young children (4 to 7 years) find an animated questionnaire easier to understand; secondly, independent of the child’s age, is completion of an animated questionnaire easier for sick children in hospital settings; and thirdly, do children’s preferences for the different versions of the questionnaire vary by the age of the child. Using a balanced cross-over trial we administered different versions of the CHU-9D to 221 healthy children in a school setting and 217 children with health problems in a hospital setting. The study tested five versions of the CHU-9D questionnaire: paper text, tablet text, tablet image, paper image and tablet animation. Our results indicate that the majority of the youngest children aged 4-7 years found the CHU-9D questions easy to answer independent of the type of questionnaire administered. Amongst children aged 7-14 with health problems the type of questionnaire was found to influence understanding. Children aged 7 to 11 years found tablet image and animation easier compared to text questionnaires while the oldest children in hospital found text based questionnaires easier compared to image and animation. Children in all three age groups preferred animation on a tablet to other methods of assessment. Our results highlight the potential for using an Animated Preference Based Measure to the health of children as young as 4 years.