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Background: Children's activity level is commonly assessed in clinical research, but rigorous assessment tools for children are scarce. Our objectives were to improve pediatric activity self-report measures using qualitative methods to develop item pools that measure these concepts., Methods: On the basis of the items generated from our conceptual framework development, we applied cognitive interviews and comprehensibility reviews to ensure children readily understood the items., Results: Our methods resulted in 129 unique items-physical activities (80 items), sedentary behaviors (23 items), and strengthening activities (26 items)-that were comprehensible to children between the ages of 8 and 18 years. Comprehensibility review resulted in the deletion of 4 items., Conclusions: The resultant item pools reflect children's experiences and understanding of the concepts of physical activities, sedentary behaviors, and strengthening activities. The item pools will undergo calibration using item response theory to support computer-adaptive test administration of self- and proxy-reported outcomes.

Purpose: Children's physical activity (PA) levels are commonly assessed in pediatric clinical research, but rigorous self-report assessment tools for children are scarce, and computer adaptive test implementations are rare. Our objective was to improve pediatric self-report measures of activity using semistructured interviews with experts and children for conceptualization of a child-informed framework., Methods: Semistructured interviews were conducted to conceptualize PA, sedentary behaviors, and strengthening activities. We performed systematic literature reviews to identify item-level concepts used to assess these 3 domains., Results: We developed conceptual frameworks for each domain using words and phrases identified by children as relevant., Conclusions: Semistructured interview methods provide valuable information of children's perspectives and the ways children recall previous activities. Conceptualized domains of PA are based on the literature and expert views, which also reflect children's experiences and understanding, providing a basis for pediatric self-report instruments.