Purpose: The Transition Readiness Assessment Questionnaire (TRAQ) is a 29-item measure of readiness for transition from pediatric to adult health care for youth with special health care needs and was initially validated with 192 youth ages 16-26 years in the United States. The purpose of this study was to evaluate the applicability of the TRAQ for a younger adolescent population in Canada.
Methods: Two hundred adolescents ages 12-19 years were recruited from the waiting rooms of four outpatient clinics (Diabetes, Neurology, Gastrointestinal, Cardiology) at BC Children’s Hospital, Vancouver for a study of transition measures. During routine clinic appointments participants completed a study package that included a demographics information page, and the TRAQ, the Am I ON TRAC for Adult Care index, two subscales of the Psychosocial Maturity Inventory (PMI) and the Child’s Report of Parental Behavior Inventory (CRPBI). This analysis focuses on the psychometric validation of the TRAQ before its possible inclusion within the overall study. A principle components analysis (PCA) with a forced two-factor solution and oblique rotation was performed to confirm the performance of the TRAQ, based on the published conceptual development and its original validation with older adolescents. The same criteria were used to identify significant factors from the original study of the TRAQ: eigenvalues1, the number of factors at which a clear elbow appears in the scree plot, the loading of items within each factor, and the percentage of variance explained by the factors.
Results: The mean age of our participants was 15.3 (SD1.9), 57.5% were male, and they were distributed across the clinics, with 36% from diabetes, 27% cardiology, 27% gastroenterology, and 10% neurology. The PCA with a forced two-factor oblique rotation (n 161) yielded a markedly different factor structure from the original TRAQ validation study. The two factors accounted for only 34.1% of the total variance explained, compared to 68% in the original study. The two TRAQ domains, self-management (items 1-16) and self-advocacy (items 17-29) were not reproduced in this sample. Instead, this PCA resulted in 18 items loading on factor one (10-25, 27-29) and eight items loading on factor two (2-9). Item one cross-loaded, and item 26 did not load on either factor. Factor two contained items related to medications and medical equipment, while items in factor one related to general self-care practices. An alternate unconstrained factor analysis generated an eight factor solution, none of which appeared to match the original theorized factors, and which still only explained 63% of the total variance in response.
Conclusions: Given the inability to reproduce the factor structure, the results of this psychometric evaluation raise questions about whether the TRAQ is a suitable measure to evaluate readiness to transition among younger adolescents.