Currently submitted to: JMIR Human Factors
Date Submitted: Dec 17, 2025
Open Peer Review Period: Jan 6, 2026 - Mar 3, 2026
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“To choose a band-aid” – a Q-methodology study of childrens' preferences for participation in healthcare situations
ABSTRACT
Background:
Child-centered care (CCC) is standard practice in pediatrics, emphasizing the child as an individual with rights while acknowledging the child's role within the family. A key aspect of CCC is the involvement of the child in health care decisions alongside parents and professionals. Although this is a right recognized by the United Nations Convention on the Rights of the Child (UNCRC) it may not always be applied in practice.
Objective:
The aim of this study is to explore the preferences of 3- to 5-year-old children for participation in health care from both the child's perspective as well as the child perspective, i.e., to ask their parents and health professionals about their understanding of children's preferences.
Methods:
Preferences were studied using Q-methodology, comparing responses from twelve children, fourteen parents, and twelve health professionals who ranked twenty-five statements. Factor analysis identified shared perspectives on participation preferences. Children’s rankings were also analyzed separately for comparison.
Results:
Three perspectives presenting different preferences were identified: direct communication between the child and healthcare professionals; understanding and shared decision-making; and responsive and child-led participation. A separate analysis of children’s rankings resulted in three perspectives: included in and setting their own terms for participation; small choices, meaningful outcomes; and trust through familiarity and shared decision-making.
Conclusions:
This study suggests that children value shared decision-making and situational control but prefer to leave major decisions to adults. It affirms that pre-school-aged children can meaningfully participate in healthcare when given age-appropriate choices, support, and tools. Children’s perspectives must be acknowledged directly rather than adults assuming their views. The findings support child-centered care (CCC) principles and reinforce the UNCRC mandate to respect children’s views regarding all issues relevant to them.
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