Development and preliminary validation of the ‘Mind the Gap’ scale to assess satisfaction with transitional health care among adolescents with juvenile idiopathic arthritis


  • Contributors: Eileen Baildam, Jeremy Camelleri, Diane Coulson, Joyce Davidson, Sue Ferguson, Helen Foster, Paul Galea, Janet Gardner-Medwin, Janine Hackett, Ann Hall, Gill Jackson, Jane Kelly, Sue Kemp, Nicki Kennedy, Ruth McGowan, Steph Phillips, Clarissa Pilkington, Alison Swift, Helen Venning, Tracey Whitely, Jane Wilby, Sue Wyatt, Helena Wythe.

Dr Janet E McDonagh, MD, FRCP, Institute of Child Health, Diana, Princess of Wales Children’s Hospital, Steelhouse Lane, Birmingham B4 6NH, UK


Background  To develop a scale to assess satisfaction with transitional health care among adolescents with a chronic illness and their parents.

Methods  The ‘Mind the Gap’ scale was developed using evidence from a previous needs assessment, in three stages: (1) definition of the construct; (2) design of the scale items, response options and instructions; (3) full administration of the scale, item analysis and dimensionality analysis. The scale was administered to 308 adolescents with juvenile idiopathic arthritis (JIA) and 303 parents/guardians, prior to and 12 months after the implementation of an evaluation of a structured and co-ordinated programme of transitional care. The patient population involved adolescents with JIA and their parents recruited from 10 major UK rheumatology centres.

Results  A total of 301 (97.7%) adolescents and 286 (95.0%) parents chose to complete the questionnaire, with median item completion rates of 100.0% (0–100%) for both adolescents and parents thus confirming feasibility. Face and content validity were confirmed. Factor analyses revealed a three-factor structure which explained 49.5% and 56.1% of the variation in adolescent and parent scores respectively. The internal consistency of each subscale (‘management of environment’, ‘provider characteristics’ and ‘process issues’) was indicated by Cronbach’s alphas of 0.71, 0.89 and 0.89 for adolescents, respectively, and 0.83, 0.91 and 0.92 for parents respectively. Cronbach’s alphas for the entire scales were 0.91 and 0.94 for the adolescent and parent forms respectively.

Conclusion  These preliminary results report the potential of the ‘Mind the Gap’ scale in evaluating transitional care for adolescents with JIA. In view of the generic nature of transitional care reflected in the scale, this scale has wider potential for use with adolescents with other chronic illness in view of the generic nature of transition. This development is particularly timely in the context of transitional care developments in the UK and further validation of the scale is in progress.