Cultural Adaptation and Content Validation of the Danish ‘Am I ON TRAC?‘ Questionnaire: A Qualitative Study
This qualitative study successfully culturally adapted and validated the Danish 'Am I ON TRAC?' Questionnaire, demonstrating its effectiveness as a dialogue support tool that enhances communication, promotes adolescent autonomy, and addresses non-clinical transition needs within a split-visit model for adolescents with chronic lung conditions.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Growing up with a chronic illness means navigating a world where medical care changes its shape. For children, doctors are often parents' partners, guiding every step with a protective hand. But as teenagers approach adulthood, the goal shifts. They must learn to steer their own health, making decisions about medication, appointments, and lifestyle without relying on their parents to manage the details. This shift, known as the transition from pediatric to adult care, is a critical period. If it is handled poorly, young people can feel lost, confused, or abandoned, leading to gaps in treatment that harm their long-term health. The challenge is not just medical; it is deeply personal. It requires a teenager to move from being a passive patient to an active manager of their own life, a process that demands confidence, knowledge, and a safe space to ask difficult questions.
In Denmark, a team of researchers set out to solve a specific problem in this transition: how to help teenagers talk openly about their readiness to take charge of their care. They focused on a tool called the "Am I ON TRAC?" questionnaire, originally developed in Canada. This is not a test with right or wrong answers, but a series of twenty-five questions designed to help young people reflect on what they know and what they still need to learn. The researchers wanted to see if this tool could work in a Danish hospital, where the language and culture are different. More importantly, they wanted to understand how it felt to use this tool during a special type of appointment called a "split-visit." In this model, a teenager meets with a nurse or doctor alone for part of the time, without their parents present, before the family joins back together. The goal was to see if combining the questionnaire with this private time could help teenagers speak more honestly and take more ownership of their health.
The study took place at a lung clinic in Aarhus, where twenty-two teenagers with chronic lung conditions and eleven healthcare workers shared their experiences. Before the interviews began, the team carefully translated the questionnaire into Danish. They did not just swap words; they tested the questions with young people to ensure the meaning was clear and the tone felt right for a Danish teenager. They added small explanations in parentheses for tricky medical terms, ensuring that a fourteen-year-old would understand what was being asked without feeling overwhelmed. Once the tool was ready, the researchers asked the participants to use it during their regular visits and then talked to them about how it felt.
The teenagers who used the tool described it as a way to find their own voice. Many said that filling out the questions at home, on their own computer, gave them time to think deeply about their situation without the pressure of a doctor looking over their shoulder. They felt that the questions helped them organize their thoughts, turning a vague sense of worry into specific topics they could discuss. One teenager noted that even if they could not answer "yes" to every question yet, seeing the list showed them exactly what they needed to learn before moving to an adult hospital. This process made them feel like active partners in their care rather than just patients being examined. They reported that the tool helped them identify what they did not know, giving them the confidence to ask questions they might otherwise have been too shy to ask.
A crucial part of the experience was the "split-visit" model, where the teenager spoke with the healthcare provider alone. The researchers found that this private time created a safe space for honest conversation. Without parents in the room, teenagers felt freer to discuss sensitive topics like mental health, relationships, and sexuality, which are often central to growing up but rarely come up in standard medical visits. The questionnaire acted as a bridge in these moments. When the screen showed the answers, it gave the doctor a clear starting point to ask, "Tell me more about this," rather than guessing what the teenager was worried about. The teenagers felt heard and respected, knowing that their concerns were the focus of the conversation.
The healthcare professionals, including nurses and doctors, also found the tool valuable, though they had to learn how to use it effectively. At first, some found it difficult to move beyond the standard medical questions and use the tool to guide a broader conversation about the teenager's life. However, as they gained experience, they saw that the questionnaire helped them spot issues they might have missed. It acted as a flexible guide rather than a rigid checklist, allowing them to tailor the conversation to the individual needs of the young person. The staff noted that the tool helped shift the responsibility onto the teenager, encouraging them to take the lead in the discussion. This change in dynamic was essential for preparing them for adult care, where they would be the ones making the decisions.
The study concluded that the Danish version of the questionnaire is a useful tool, but only when it is used as part of a supportive conversation. It is not a magic wand that fixes everything on its own, nor is it a test that teenagers must pass. Instead, it is a way to structure a dialogue, ensuring that the teenager's voice is central to the visit. The researchers found that when the tool is combined with the private time of a split-visit, it helps teenagers build the confidence and skills they need to manage their own health. The findings suggest that this approach improves communication and helps young people feel more in control of their future. While the study did not measure long-term medical outcomes, it provided strong evidence that this method makes the transition process more human, more personal, and more effective for the teenagers involved.
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