Psychometric Evaluation of the Turkish Version of the Induction Compliance Checklist in Children Undergoing Mask Anesthesia
Yesim Andiran Senayli, Nida Kiyici, Sevgi Ulusoy Tangul, Cevdet Yardimci, Mehmet Kara, Atilla Senayli, Zeev N. KainABSTRACT
Background
Many children undergoing anesthesia commonly exhibit distress behaviors such as anxiety, crying, and physical resistance. Assessment of this behavior is important as it could lead to postoperative behavioral changes and delayed recovery.
Aim
The aim of this study was to evaluate the content validity, construct validity, internal consistency, and inter‐observer reliability of the Turkish version of the Induction Compliance Checklist (ICC), which was developed to assess compliance behaviors in children during anesthesia induction.
Methods
The study was planned as a prospective observational study. Following translation of the original ICC, content validity was examined using the Davis technique with the opinions of 10 experts. Next, Turkish ICC was applied simultaneously and independently by three independent observers during mask induction to 184 children (ASA I‐III) aged 1–7 years undergoing anesthesia and surgery. Inter‐observer reliability was evaluated with Intraclass Correlation Coefficient (ICC) and Fleiss Kappa/Gwet's AC1; internal consistency with KR‐20 and McDonald's omega; and construct validity with single‐factor confirmatory factor analysis (WLSMV). Item analysis was performed with a tetrachoric correlation matrix, floor and ceiling effects.
Results
Content validity was excellent (I‐CVI 0.90–1.00, S‐CVI≈0.99). Inter‐observer reliability for the total score was excellent: InCC (1, 2) = 0.92 (95% CI: 0.90–0.94), InCC (2, 3) = 0.97 (95% CI: 0.96–0.98). At the item level, Gwet's AC1 values ranged from 0.81 to 0.97, while Kappa values were generally 0.75–0.90 except for M11. Internal consistency was at an acceptable level with KR‐20 0.49–0.52 and McDonald's omega 0.66–0.82. These results are low due to the floor effect caused by premedication. Confirmatory factor analysis moderately supported the single‐factor structure (best fit in Observer Surgeon: CFI = 0.927, TLI = 0.907). High floor effect was prominent especially in rarely observed severe behaviors (M7‐M11); strong correlation was observed between M9‐M10 (0.89–0.94).
Conclusions
Following rigorous analysis, we found that the Turkish ICC is a reliable and valid tool that can assess children's compliance behaviors during pediatric anesthesia induction. Excellent inter‐observer agreement and high content validity support its suitability for clinical and research use. The Turkish Induction Compliance Checklist is a reliable and valid measurement tool in the Turkish pediatric population. It can contribute to standardized evaluation of child behaviors during anesthesia induction and help improve the quality of perioperative care.