Healthcare Professionals' Understanding of Children's Rights: Development and Psychometric Testing of the Children's Rights Questionnaire

Abstract

The United Nations Convention on the Rights of the Child (UNCRC) emphasises the active participation of children in matters related to their well-being. While numerous studies highlight the significance of understanding children’s rights, there is a notable lack of validated and reliable tools to assess healthcare professionals' (HCPs) comprehension of these rights. This gap poses challenges for consistent evaluation and progress tracking in both research and clinical practice. To date, studies have relied on invalid and unreliable measures, limiting their generalisability and underscoring the urgent need for the development of robust assessment tools. HCPs play a crucial role in advocating for and implementing children’s rights; however, their understanding of these rights vary significantly. Addressing this gap is essential for enhancing advocacy efforts among HCPs. Aim: This study aimed to develop and psychometrically test the Children’s Rights for Healthcare Professionals Questionnaire (CRHPQ) to assess HCPs’ understanding of children’s rights. The study pursued four key objectives: (a) to establish and test the CRHPQ for face and content validity, (b) to determine its construct validity and internal consistency, (c) to examine its test-retest reliability, and (d) to utilise the CRHPQ in comparing the understanding of children's rights between HCPs in the Kingdom of Saudi Arabia (KSA) and the United Kingdom (UK). Methods: A systematic review was conducted to critically appraise and synthesise the existing literature on HCPs’ understanding of children’s rights. The questionnaire was developed following a rigorous multi-phase process, including expert validation, pilot testing, and ii psychometric evaluation with a diverse sample of HCPs. The scale development methodology comprised two phases. Phase 1: focused on the development of the CRHPQ, detailing the steps involved in constructing the scale, including item generation, format selection, expert review for content validity, and pilot testing. The role of both the Children’s Project Advisory Group (CPAG) and the Adult Project Advisory Group (APAG) in refining the scale was also highlighted. The research team collaborated with advisory groups to assess the clarity, importance, and relevance of the questionnaire items, ensuring alignment with the World Health Organization’s (WHO) seven standards of children’s rights based on the UNCRC. The CRHPQ was piloted with 26 students to evaluate content validity. Phase 2: addressed the validation of the CRHPQ, involving scale administration and Exploratory Factor Analysis (EFA) to examine its construct validity. Reliability assessment, including internal consistency and test-retest reliability, was conducted to evaluate the scale’s stability and consistency. To test the psychometric properties of the CRHPQ, an exploratory factor analysis and internal consistency tests were performed. A cross-sectional study was conducted with 272 HCPs to assess the construct validity of the CRHPQ. Participants were recruited from three major hospitals using a convenience sampling strategy. Data were analysed using descriptive and inferential statistics, including reliability testing and factor analysis. Test-retest reliability was assessed with postgraduate healthcare students at Queen’s University Belfast. Participants completed the questionnaire twice, with a two-week interval. Recruitment was conducted via module coordinators, and data were collected online. A minimum of 30 paired responses was required, but 40 participants were recruited to ensure sufficient data. iii A cross-sectional online questionnaire study compared HCPs’ understanding of children’s rights in KSA and the UK. Primary data from 40 randomly selected HCPs in KSA were compared with responses from 40 postgraduate healthcare students in the UK. In KSA, participants were drawn from the larger sample of 272 HCPs, while in the UK, postgraduate students were recruited for accessibility and relevant clinical training. Results: The systematic review identified three main themes: (1) barriers to implementing children’s rights in healthcare, (2) factors facilitating implementation, and (3) study instruments used to measure outcomes. Several barriers hindered the implementation of children’s rights, including limited knowledge, misconceptions about legal and ethical principles, time constraints, resource shortages, and workforce pressures. Parental dominance in decision-making and a lack of formal training further exacerbated these challenges. Despite these challenges, certain factors facilitated the implementation of children’s rights. HCPs with specialist training demonstrated a stronger understanding and application of these rights. Effective communication strategies, such as age-appropriate explanations and trust-building, were crucial in encouraging children’s participation in decision-making. Institutional policies and legal frameworks also played a role in promoting consistent rights- based practices. Statistical analyses confirmed the CRHPQ’s validity and reliability, establishing it as a robust tool for measuring HCPs' awareness and comprehension of children’s rights. The EFA revealed a seven-factor solution consisting of 53 items. Internal consistency, assessed using Cronbach’s alpha, demonstrated excellent reliability (α = 0.979). Test-retest reliability analysis, completed by 40 HCPs, indicated moderate reliability, with four out of seven subscales exhibiting poor test-retest reliability. In its first application, iv the CRHPQ was employed to compare HCPs' understanding of children’s rights in the UK and KSA. An independent t-test revealed a statistically significant difference in total scores between the two groups, t(50.529) = 2.034, p = .047 (two-tailed), suggesting that HCPs in the UK had a higher understanding of children’s rights than those in KSA. Conclusions: The CRHPQ is a valid and reliable tool for assessing HCPs’ understanding of children’s rights. This research underscores the importance of equipping HCPs with the knowledge necessary to provide rights-respecting care in line with global frameworks such as the UNCRC. Findings indicate significant variations in understanding across different contexts, highlighting the need for targeted interventions to enhance HCPs’ awareness of children’s rights. The CRHPQ not only identifies understanding gaps but can also be utilised to support the development of educational programmes to improve HCPs’ understanding and application of children’s rights. Integrating rights-based approaches into healthcare is crucial, necessitating training, policy development, and practical application. Ultimately, the CRHPQ has the potential to drive systemic change in healthcare practices globally, ensuring that children’s rights are consistently upheld.