The IBHQ© was designed to allow the standardized assessment of the impact on parents of the hospitalization of their infant for bronchiolitis. It was developed in accordance with up-to-date reference methods , and it was shown to be well accepted by parents and clinicians. Even if some minor measurement issues were detected in our study, the validity and reliability of the IBHQ were overall satisfactory in a population of parents of infants hospitalized for bronchiolitis, including a significant number of infants with features specific to those that are generally hospitalized for bronchiolitis within their first year of life (i.e. preterm infants; infants issued from multiple pregnancies; infants with CHD).
The development and validation of the IBHQ highlights the multifaceted nature of the impact of hospitalization for bronchiolitis. Previous studies have shown that the impact of an infant’s illness on parents can be cognitive, psychological, social, physical and financial; hospitalization can also affect marital relationships, parenting roles, daily life and work activities [5–14]. The infant’s illness could also impact siblings and extended family. The psychometric analyses performed in our study strengthened this conclusion: the PCA clearly supported the multidimensionality of the IBHQ structure, and the low inter-score correlations indicated that IBHQ domain scores were exploring distinct aspects. This study emphasizes that the impact of the bronchiolitis hospitalization cannot be restricted to a single facet and should be considered in a comprehensive approach that encompasses a variety of factors. Moreover, this multidimensional measurement model preserved its validity 3 months after the hospitalization.
Our study showed that the great majority of the investigated aspects were impacted. The financial impact score was the only one distributed toward the lower end of the 0–100 range; all the others were distributed around the medium values of the scale or above. In particular, emotional, physical, and daily organization aspects were clearly impacted during the hospitalization. In addition, the impact on various aspects (emotional, parenting roles, and reactions of siblings) remained 3 months after hospital discharge, even if overall, the scores at follow-up were consistently lower than at discharge. These results confirmed the relevance of a questionnaire measuring all the aspects covered by the IBHQ and enabling the measurement not only at hospital discharge but also a few months later.
A previous study showed that the strong parental emotional distress associated with the infant’s hospitalization for bronchiolitis persists several weeks after discharge . This previous study showed that parents and caregivers of children hospitalized for severe RSV infection exhibited remarkably high levels of anxiety during their child’s hospitalization compared to a control group (i.e. children not hospitalized for severe RSV infection and their parents/caregivers) and that these levels of anxiety were still significantly higher two months later. Of note, this previous study focused mainly on the psychological distress, and did not cover all aspects of the impact of the bronchiolitis hospitalization on parents’ life. In addition, it did not use a questionnaire to assess the impact of bronchiolitis hospitalization in a standardized manner. The results of our study are highly consistent with these data, showing the importance of scores that concern the emotional aspects (i.e. distress generated by the infant’s pain and uncertainty of his or her future, helplessness, etc.), both during hospitalization and three months after hospital discharge. But our results also enable a more complete picture of the impact on parents of the bronchiolitis hospitalization to be drawn. Further in-depth analyses of the impact on the parents of infants hospitalized for bronchiolitis as measured by the IBHQ in our study sample are reported elsewhere .
The demonstration of the IBHQ psychometric properties in the present study has some limitations. First, even if the IBHQ fits perfectly with the picture of a multifaceted impact on parents of the hospitalization for bronchiolitis, which was consistently shown by all research on this question, and its content validity is underpinned by the involvement of clinicians and parents throughout its development, the amount of evidence on its construct validity is still limited and should be confirmed in future research. Second, given the small number of fathers having completed the questionnaires, no reliable analysis could be performed to evaluate neither the validity of the IBHQ in fathers nor the potential differences in the impact of hospitalization depending on parent’s gender. Third, parents were required to be able to complete the questionnaire in French without help to be included in the study. This may have led to underrepresentation of parents with a lower level of education, despite this population being of particular interest since low parental education level is a documented risk factor of hospitalization for bronchiolitis . The validity of the IBHQ in this specific population should be further explored. However, the validity of the self-administered version of the IBHQ may be challenging to ascertain in this population, which might benefit from having the questionnaire administered by an interviewer. Finally, the IBHQ has been developed and validated in France; as for any questionnaire, its validity in other countries with different cultures, health care, and health insurance systems, remains to be studied. To allow such studies to be conducted, a linguistic validation has been performed to make the IBHQ available in US English.
Yet the IBHQ is already a promising tool that could be used in several contexts: (i) in epidemiological studies, to explore the impact of bronchiolitis hospitalization in different populations; (ii) to identify the risk factors of strong impact, thus helping clinicians to focus on those parents who could benefit from maximal support during this stressful experience; (iii) to evaluate innovative health care strategies for bronchiolitis in light of their benefit for the parents.