Table 5

Overview of results of the 9-step process

Dimension
(original terminology)
Step 1Step 2Steps 3, 4 and 5Steps 6 and 7
Belongs to healthReasonsSuggested modificationsModifications made after consulting with the multidisciplinary research team
My body
(Bodily functions)
YesSupporting quote: ‘Well, it is like, you feel whether you are healthy or not and you exercise and that is all related to your body. And your food is also your body, in fact everything is your body. Everything you do, you do with your body.’ Healthy girl, 8–11 year age group.Adding ‘physical appearance’ as an aspect, because this was frequently mentioned in the first part of the interviews.
  • ‘Physical appearance’ was added as an aspect.

  • A new aspect, ‘having energy’, was defined and added as this was also frequently mentioned in the first part of the interviews.

  • Adding ‘sexuality’ as an aspect was considered and discussed. However, it was never spontaneously mentioned by children during the interviews. Therefore, it was decided not to include this as an aspect.

My feelings and thoughts
(Mental well-being)
YesChildren discussed how thinking about your health and talking about your health are important aspects of health itself.The aspect ‘coping with stress and disappointment’ (also frequently mentioned during the first part of the interviews) was originally suggested as an aspect for the ‘Feeling good about yourself’ dimension. However, it seemed that other aspects were more fitting for that dimension (step 3). Therefore, it was suggested to include this aspect in the ‘My feelings and thoughts’ dimension instead.
  • ‘Coping with stress and disappointment’ was added as an aspect.

  • Marking the aspects ‘feeling positive about life’, ‘knowing your limitations’ and coping with disappointments and bad situations’ as applicable to children aged 12 and older.

Who am I and what do I want
(Meaningfulness)
NoDifficult to understand for the younger children (aged 8–11), as they related ‘Who am I’ to their name and ‘What do I want’ to future professions.After clarifying the meaning of this dimension by presenting the corresponding aspects (eg, looking at the future), most children felt that the aspect ‘dreams and goals for the future’ was the most important. Therefore, the researcher proposed to rename the dimension to ‘Now and in the future’.
  • Dimension rephrased to ‘Now and in the future’.

  • Marking the aspects ‘making choices’, ‘self-knowledge’ and ‘role models’ as applicable to children aged 12 and older.

My happiness and enjoyment/ Feeling good
(Quality of life)
Yes’Feeling good about yourself’ was essential according to children, as the results of the first part of the interviews show. In addition, during step 2, the majority of children in both age groups agreed that ‘Feeling good about yourself’ belongs to their concept of health and they emphasised the importance of enjoyment, stating it is unhealthy not to enjoy life.Leaving out ‘My happiness and enjoyment’ as part of the dimension title, as both the younger and the older children had difficulty understanding this phrase.
Receiving support and being understood by your environment were frequently mentioned during the first part of the interviews. Therefore, two new aspects for this dimension were suggested: ‘receiving support from others’ and ‘experiencing a pleasant environment’.
  • Dimension rephrased to ‘Feeling good in your own skin’.

  • ‘Receiving support from others’ and ‘experiencing a pleasant environment’ were added as aspects.

  • Marking the aspects ‘a pleasant environment’, ‘taking pleasure in doing things’ and ‘receiving support and understanding from others’ as applicable to children aged 12 and older.

Participation
(Participation)
YesSupporting quote: ‘Yes if you are healthy then, you are always able to participate anyway, you can, maybe you won’t, but it is possible. You can decide that for yourself. But if you are unhealthy then you are not always able to participate, maybe you want to, but sometimes it’s not possible.’ Boy with muscular disease, 12–15 year age group.‘Wanting to participate’ and ‘doing what you want’ were frequently mentioned by the children and it was therefore suggested they be added as one aspect (namely: ‘self-determination’) for this dimension.
  • ‘Self-determination’ was added as an aspect.

  • A new aspect ‘personal contribution’ was defined and added, to connect to the original focus of this dimension.

  • Marking the aspects ’self-determination’, ’keeping up with others’ and ‘personal contribution’ as applicable to children aged 12 and older.

What can I do and what do I do?
(Daily functioning)
NoWas interpreted literally and, therefore, usually not considered connected to health. Terminology caused confusion with regards to ‘participation’, while this dimension is intended to focus on daily functioning.To clarify the meaning of this dimension and prevent confusion by its duality, it was suggested to rephrase it to ‘Daily life’, a phrase that seemed to properly cover all aspects.
  • Dimension rephrased to ‘Daily life’.

  • Marking the aspect ‘smoking, alcohol and drugs use’ as applicable to children aged 12 and older.