Psychometric properties and predictive validity of the PP-ACT

James A. Shepperd, Gregory D. Webster, Gabrielle C. Pogge, David Fedele, Sreekala Prabhakaran, Jean Hunleth, Erika A. Waters

Research output: Contribution to journalArticlepeer-review

4 Scopus citations


Objective: The Parent Proxy Asthma Control Test (PP-ACT) is a self-report measure of asthma control completed by caregivers on behalf of a child. We examined the psychometric properties and the reliability and predictive validity of the PP-ACT. Methods: We conducted two studies (one cross-sectional, one longitudinal over three months) that surveyed caregivers (N = 1622) of children with asthma. Caregivers completed the PP-ACT and a variety of other measures, including child health outcomes. Results: We found clear evidence that the five-item PP-ACT assesses two distinct constructs: Items 1–4 (which we call the PP-ACT4) assess symptoms, impairment, and use of a short acting beta-2 blocker (albuterol); Item 5 assesses caregivers’ global subjective assessment of their child’s asthma control. In addition, the two constructs function as unique predictors of asthma outcomes. Both the PP-ACT4 and Item 5 predicted unique variance in ED visits, the number of symptom-free days, and child quality of life. Only the PP-ACT4 predicted frequency of ICS use and only at Time 1 in Study 1. Conversely, Item 5 predicted exacerbation frequency whereas the PP-ACT4 did not. Conclusion: Our findings suggest that researchers and clinicians should treat the PP-ACT4 and Item 5 as distinct indicators of asthma control because they differentially predict asthma outcomes and likely have distinct meanings to caregivers. Supplemental data for this article is available online at

Original languageEnglish
Pages (from-to)174-184
Number of pages11
JournalJournal of Asthma
Issue number1
StatePublished - 2023


  • Pediatric asthma
  • asthma control test
  • caregivers
  • reliability
  • validity


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