Introduction
Methods
Concept elicitation
Item generation
Cognitive debriefing interviews
Results
Concept elicitation
Sample description
Spain (n = 11) | US (n = 25) | Total (n = 36) | |
---|---|---|---|
Age, mean(SD) | 40.4(3.1) | 42.0(7.6) | 41.5(6.6) |
(Range) | (35–43) | (32–68) | (32–68) |
Relationship to child, n(%) | |||
Mother | 8(73) | 23(92) | 31(86) |
Father | 3(27) | 2(8) | 5(14) |
Marital status, n(%) | |||
Single | 2(18) | 0 | 2(6) |
Married | 6(55) | 23(92) | 29(81) |
Partnered | 3(27) | 0 | 3(8) |
Divorced | 0 | 2(8) | 2(6) |
Race/ethnicity, n(%)a | |||
Black/African American | – | 3(12) | – |
Latino/Hispanic | – | 1(4) | – |
White/Caucasian | – | 23(92) | – |
Education, n(%) | |||
Less than high school | 2(18) | 1(4) | 3(8) |
High school or equivalent | 4(36) | 2(8) | 6(17) |
College degree | 5(46) | 12(48) | 17(47) |
Post-graduate school | 0 | 10(40) | 10(28) |
Work status, n(%) | |||
Full-time | 6(55) | 10(40) | 16(44) |
Part-time | 3(27) | 3(12) | 6(17) |
Student | 0 | 2(8) | 2(6) |
Retired | 0 | 1(4) | 1(3) |
Not working (other) | 2(18) | 9(36) | 11(31) |
Household income, n(%)b | |||
< 20,000 | 3(27) | 1(4) | – |
20,001 to 40,000 | 5(46) | 2(8) | – |
40,001 to 60,000 | 1(9) | 1(4) | – |
60,001 to 80,000 | 1(9) | 3(12) | – |
80,001 to 100,000 | 0 | 1(4) | – |
> 100,000 | 0 | 15(60) | – |
Decline to answer | 1(9) | 2(8) | – |
Spain (n = 11) | US (n = 25) | Total (n = 36) | |
---|---|---|---|
Child age, n(%) | |||
2 to < 5 years | 5(46) | 6(24) | 11(31) |
5 to < 9 years | 4(36) | 9(36) | 13(36) |
9 to < 12 years | 2(18) | 10(40) | 12(33) |
Child gender, n(%) | |||
Female | 7(64) | 12(48) | 19(53) |
Male | 4(36) | 13(52) | 17(47) |
Child’s race/ethnicity, n(%)a | |||
Asian-American | – | 2(8) | – |
Black/African-American | – | 4(16) | – |
Latino/Hispanic | – | 2(8) | – |
White/Caucasian | – | 20(80) | – |
Age/time diagnosed with achondroplasia, n(%) | |||
In utero | 9(82) | 12(48) | 21(58) |
At birth | 1(9) | 4(16) | 5(14) |
< 2 months of age | 1(9) | 2(8) | 3(8) |
2–6 months of age | 0 | 5(20) | 5(14) |
Unknown (adopted) | 0 | 2(8) | 2(6) |
Child has parent(s) with achondroplasia, n(%) yes | 0 | 7(28) | 7(19) |
Health status (parent-reported), n(%) | |||
Excellent | 3(27) | 9(36) | 12(33) |
Very good | 3(27) | 11(44) | 14(39) |
Good | 3(27) | 4(16) | 7(19) |
Fair | 2(18) | 1(4) | 3(8) |
Height (cm) | |||
Mean(SD) | 89.5(10.4) | 93.2(15.2) | 92.1(13.9) |
(Range) | (75.0–104.0) | (63.5–121.0) | (63.5–121.0) |
Weight (kg) | |||
Mean(SD) | 17.3(5.6) | 20.4(8.4) | 19.4(7.7) |
(Range) | (10.0–28.0) | (8.3–43.9) | (8.3–43.9) |
BMI | |||
Mean(SD) | 18.9(4.2) | 21.4(7.0) | 20.6(6.3) |
(Range) | (13.3–27.5) | (12.6–44.7) | (12.6–44.7) |
Planned limb lengthening surgery for the future, n(%) yes | 5(46) | 0 | 5(14) |
Expert interviews
n, % reporting impact/issue | Parent reports by child age | Experts (n = 7)a | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
2 to < 5 years (n = 11) | 5 to < 9 years (n = 13) | 9 to < 12 years (n = 12) | Total (n = 36) | |||||||
Managing child's medical care/treatment | 11 | 100% | 12 | 92% | 10 | 83% | 33 | 92% | 6 | 86% |
Help with self-care | 8 | 73% | 10 | 77% | 6 | 50% | 24 | 67% | 2 | 29% |
Advocating for child | 4 | 36% | 10 | 77% | 9 | 75% | 23 | 64% | 5 | 71% |
General advocacy | 3 | 27% | 9 | 69% | 6 | 50% | 18 | 50% | 5 | 71% |
Educating others | 1 | 9% | 7 | 54% | 6 | 50% | 14 | 39% | 2 | 29% |
Assisting child with tasks (e.g., reaching objects) | 8 | 73% | 6 | 46% | 6 | 50% | 20 | 56% | 2 | 29% |
Support/guidance (e.g., for living with/managing achondroplasia) | 4 | 36% | 5 | 38% | 8 | 67% | 17 | 47% | 6 | 86% |
Monitoring child (e.g., for safety) | 8 | 73% | 6 | 46% | 3 | 25% | 17 | 47% | 2 | 29% |
Obtaining adaptations for child | 2 | 18% | 6 | 46% | 1 | 8% | 9 | 25% | 3 | 43% |
Finding childcare/school | 4 | 36% | 3 | 23% | 0 | 0% | 7 | 19% | 1 | 14% |
n, % reporting impact | Parent reports by child age | Experts (n = 7)a | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
2 to < 5 years (n = 11) | 5 to < 9 years (n = 13) | 9 to < 12 years (n = 12) | Total (n = 36) | |||||||
Impacts on parent emotional well-being | 11 | 100% | 13 | 100% | 12 | 100% | 36 | 100% | 7 | 100% |
Worried/concerned | 10 | 91% | 12 | 92% | 10 | 83% | 32 | 89% | 6 | 86% |
Worry about the future | 6 | 55% | 12 | 92% | 9 | 75% | 27 | 75% | 1 | 14% |
Worry about child’s physical health | 6 | 55% | 9 | 69% | 9 | 75% | 24 | 67% | 3 | 43% |
Safety concerns | 7 | 64% | 6 | 46% | 5 | 42% | 18 | 50% | 2 | 29% |
Worry about child’s social well-being | 3 | 27% | 7 | 54% | 5 | 42% | 15 | 42% | 1 | 14% |
Concern about child’s ability to function independently | 4 | 36% | 6 | 46% | 2 | 17% | 12 | 33% | 2 | 29% |
Worry about child’s emotional well-being | 0 | 0% | 8 | 62% | 3 | 25% | 11 | 31% | 0 | 0% |
Stressed/overwhelmed | 6 | 55% | 4 | 31% | 6 | 50% | 16 | 44% | 3 | 43% |
Initial shock/grief | 5 | 45% | 7 | 54% | 3 | 25% | 15 | 42% | 6 | 86% |
Putting things in perspective | 2 | 18% | 5 | 38% | 4 | 33% | 11 | 31% | 1 | 14% |
Happy | 4 | 36% | 4 | 31% | 2 | 17% | 10 | 28% | 0 | 0% |
Acceptance | 3 | 27% | 2 | 15% | 3 | 25% | 8 | 22% | 3 | 43% |
Positive | 3 | 27% | 2 | 15% | 3 | 25% | 8 | 22% | 0 | 0% |
Fortunate/lucky | 2 | 18% | 3 | 23% | 2 | 17% | 7 | 19% | 0 | 0% |
Increased knowledge | 2 | 18% | 4 | 31% | 1 | 8% | 7 | 19% | 5 | 71% |
Proud | 3 | 27% | 2 | 15% | 2 | 17% | 7 | 19% | 1 | 14% |
Normal | 2 | 18% | 1 | 8% | 3 | 25% | 6 | 17% | 1 | 14% |
Protective of child | 2 | 18% | 3 | 23% | 1 | 8% | 6 | 17% | 3 | 43% |
Depressed/sad | 3 | 27% | 2 | 15% | 0 | 0% | 5 | 14% | 2 | 29% |
Empathy/understanding | 0 | 0% | 3 | 23% | 2 | 17% | 5 | 14% | 0 | 0% |
Overcoming challenges | 0 | 0% | 3 | 23% | 1 | 8% | 4 | 11% | 1 | 14% |
Hurt/bother | 1 | 9% | 2 | 15% | 0 | 0% | 3 | 8% | 1 | 14% |
Anxious/nervous | 1 | 9% | 1 | 8% | 1 | 8% | 3 | 8% | 0 | 0% |
Anger/frustration | 0 | 0% | 1 | 8% | 2 | 17% | 3 | 8% | 1 | 14% |
Grateful | 1 | 9% | 1 | 8% | 1 | 8% | 3 | 8% | 0 | 0% |
Strength/resilience | 1 | 9% | 1 | 8% | 1 | 8% | 3 | 8% | 0 | 0% |
Intense focus on child | 1 | 9% | 0 | 0% | 1 | 8% | 2 | 6% | 3 | 43% |
Self-conscious | 0 | 0% | 1 | 8% | 1 | 8% | 2 | 6% | 1 | 14% |
Alone/lonely | 1 | 9% | 0 | 0% | 0 | 0% | 1 | 3% | 0 | 0% |
Patience | 0 | 0% | 0 | 0% | 1 | 8% | 1 | 3% | 0 | 0% |
Confused | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 1 | 14% |
Denial | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 4 | 57% |
Guilty | 0 | 0% | 0 | 0% | 0 | 0% | 0 | 0% | 3 | 43% |
Impacts on parent physical well-being | 5 | 45% | 2 | 15% | 3 | 25% | 10 | 28% | 0 | 0% |
Being tired/sleep deprived | 5 | 45% | 1 | 8% | 2 | 17% | 8 | 22% | 0 | 0% |
General health | 4 | 36% | 1 | 8% | 2 | 17% | 7 | 19% | 0 | 0% |
n, % reporting impact/issue | Parent reports by child age | Experts (n = 7)a | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
2 to < 5 years (n = 11) | 5 to < 9 years (n = 13) | 9 to < 12 years (n = 12) | Total (n = 36) | |||||||
Support and friendships through a community of people with dwarfism | 7 | 64% | 9 | 69% | 9 | 75% | 25 | 69% | 2 | 29% |
Limit social/other activities | 4 | 36% | 3 | 23% | 3 | 25% | 10 | 28% | 1 | 14% |
Support from family/friends | 4 | 36% | 3 | 23% | 3 | 25% | 10 | 28% | 0 | 0% |
Strained relationships | 2 | 18% | 0 | 0% | 0 | 0% | 2 | 6% | 0 | 0% |
Stigma/ignorance | 0 | 0% | 0 | 0% | 1 | 8% | 1 | 3% | 1 | 14% |
n, % reporting impact/issue | Parent reports by child age | Experts (n = 7)a | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
2 to < 5 years (n = 11) | 5 to < 9 years (n = 13) | 9 to < 12 years (n = 12) | Total (n = 36) | |||||||
Impacts on families | ||||||||||
Strain on family | 5 | 45% | 8 | 62% | 7 | 58% | 20 | 56% | 6 | 86% |
Family travel or vacations | 5 | 45% | 6 | 46% | 8 | 67% | 19 | 53% | 2 | 29% |
Limit/adapt family activities | 5 | 45% | 8 | 62% | 2 | 17% | 15 | 42% | 2 | 29% |
Increased family closeness | 0 | 0% | 3 | 23% | 3 | 25% | 6 | 17% | 0 | 0% |
Impacts on siblings | ||||||||||
Strain on siblings | 4 | 36% | 5 | 38% | 4 | 33% | 13 | 36% | 3 | 43% |
Caretaking responsibilities | 2 | 18% | 5 | 38% | 4 | 33% | 11 | 31% | 2 | 29% |
Increased empathy | 0 | 0% | 2 | 15% | 3 | 25% | 5 | 14% | 1 | 14% |
Other sibling impacts | 1 | 9% | 2 | 15% | 1 | 8% | 4 | 11% | 1 | 14% |
n, % reporting impact/issue | Parent reports by child age | Experts (n = 7)a | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
2 to < 5 years (n = 11) | 5 to < 9 years (n = 13) | 9 to < 12 years (n = 12) | Total (n = 36) | |||||||
Work/productivity issues | 8 | 73% | 11 | 85% | 9 | 75% | 28 | 78% | 4 | 57% |
Missed work time | 4 | 36% | 6 | 46% | 8 | 67% | 18 | 50% | 3 | 43% |
Changed work schedule | 3 | 27% | 2 | 15% | 2 | 17% | 7 | 19% | 0 | 0% |
Discontinued work | 2 | 18% | 3 | 23% | 0 | 0% | 5 | 14% | 2 | 29% |
Past time out of workforce | 0 | 0% | 1 | 8% | 1 | 8% | 2 | 6% | 0 | 0% |
Reduced work hours | 0 | 0% | 1 | 8% | 1 | 8% | 2 | 6% | 1 | 14% |
Difficult work/life balance | 0 | 0% | 0 | 0% | 1 | 8% | 1 | 3% | 0 | 0% |
Limited work opportunities | 0 | 0% | 1 | 8% | 0 | 0% | 1 | 3% | 0 | 0% |
Changed job/career | 1 | 9% | 0 | 0% | 0 | 0% | 1 | 3% | 0 | 0% |
Parent interviews
Preliminary theoretical model
Item generation
Cognitive debriefing
Parent participant demographics | Child demographic/health characteristics | ||
---|---|---|---|
Parent age, mean(SD) | 39.1(6.4) | Child age, n(%) | |
(Range) | (31–55) | 2 to < 5 years | 4(25) |
Relationship to child, n(%) | 5 to < 9 years | 6(38) | |
Mother | 16(100) | 9 to < 12 years | 6(38) |
Parent has achondroplasia, n(%) yes | 2(12.5) | Child gender, n(%) | |
Marital status, n(%) | Female | 12(75) | |
Single | 1(6) | Male | 4(25) |
Married | 14(88) | Age/time diagnosed with achondroplasia, n(%) | |
No response | 1(6) | In utero | 5(31) |
Parent race/ethnicity, n(%)a | At birth | 1(6) | |
Asian-American | 1(6) | < 2 months of age | 2(13) |
Latino/Hispanic | 1(6) | 2–6 months of age | 5(31) |
White/Caucasian | 14(88) | > 6 months of age | 1(6) |
Parent education, n(%) | Unknown (adopted) | 2(13) | |
High school or equivalent | 2(13) | Child’s race/ethnicity, n(%)a | |
Vocational/technical school | 1(6) | Asian-American | 4(25) |
College degree | 9(56) | Latino/Hispanic | 1(6) |
Post-graduate school | 4(25) | White/Caucasian | 11(69) |
Parent work status, n(%) | Child health status (parent-reported), n(%) | ||
Full-time | 7(44) | Excellent | 8(50) |
Part-time | 4(25) | Very good | 7(44) |
Retired/student | 0 | Good | 0 |
Not working (other) | 5(31) | Fair | 1(6) |
Household income, n(%) | Child height (cm) | ||
< $40,000 | 0 | Mean(SD) | 90.8(12.0) |
$40,001 to $60,000 | 1(6) | (Range) | (66.0–106.7) |
$60,001 to $80,000 | 1(6) | Child weight (kg) | |
$80,001 to $100,000 | 6(38) | Mean(SD) | 18.3(5.8) |
> $100,000 | 6(38) | (Range) | (10.9–31.7) |
Decline to answer | 2(13) | BMI | |
Mean(SD) | 19.8(4.5) | ||
(Range) | (14.8–32.0) |