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Bilingual asthma scale can help clinicians assess symptoms in Latino children

A new Spanish-English scale for measuring the control of asthma symptoms in Latino children from low-income families has been developed, tested, and found reliable in a study supported in part by the Agency for Healthcare Research and Quality. The eight-item scale will allow health care workers to obtain information from Latino parents about the degree of control of their child's asthma despite language and educational barriers.

Asthma is increasing rapidly among children. Between 1980 and 1994, for example, asthma among U.S. children 5 to 14 years of age increased by 74 percent; the disease is the most common chronic illness affecting Latino children. But there are few reliable instruments for measuring the severity and frequency of asthma's symptoms in non-English-speaking and low-literacy populations, in spite of findings that language and literacy levels can affect the reliability and validity of survey measures.

The eight-item instrument developed in this study asks parents, in English and Spanish, to indicate the frequency of their child's symptoms on a scale ranging from "every day" to "never," and it includes a "don't know" response. The symptoms listed are coughing, wheezing, shortness of breath, asthma attacks, and chest pain. The instrument also asks parents about the number of times their child has awakened at night during the previous 4 weeks because of asthma, and it asks parents to provide an overall rating of the severity of their child's asthma.

The symptom scale was tested by interviewing parents of 234 inner-city children treated for asthma in an emergency department at the time of their initial visit and 1 month later. About 69 percent of the children, whose average age was 9 years, were identified by their parents as being Latino. Just over half (54 percent) of interviews with parents about their children's symptoms were conducted in Spanish; the rest were conducted in English. There were no major differences in the reliability and validity of the responses between the Spanish- and English-speaking parents. However, larger studies will be required to confirm language equivalence in the bilingual scale, the researchers note. The study was led by Marielena Lara, M.D., M.P.H., of the UCLA/RAND Program on Latino Children with Asthma. Peter Gergen, M.D., of the Agency for Healthcare Research and Quality's Center for Primary Care Research, is a co-author of the study.

For more information, see "An English and Spanish pediatric asthma symptom scale," by Dr. Lara, Cathy Sherbourne, Ph.D., Naihua Duan, Ph.D., and others, in the March 2000 issue of Medical Care 38(3), pp. 342-350. Reprints (AHRQ Publication No. 00-R021) are available from the AHRQ Publications Clearinghouse.

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