Table 2 Qualitative criteria considered in the focus groups when considering to items in the candidate item pool

Redundancy

Items were eliminated if participants expressed that the concept was better encapsulated in another item

Participants reported that, “I talk to my doctor” was represented by “healthcare team,” and did not need to be addressed separately

Variance in interpretation

Items were eliminated for having connotations to participants that weren’t intended by our team or outlined by the conceptual model

Regarding, “I lead a healthy sex life,” one participant expressed that the term meant, “f*%$ing a lot in my generation.” Items were also eliminated if there could be varying interpretations as to why the question is being asked. For the item “I do my taxes,” one participant noted that if this item would make them think “are you [the health provider] going to audit us now?”

Youth friendliness and meaningfulness

Item wording did not appeal to youth

For the item, “I do the things I want to do”, beyond issues regarding clarity, a participant expressed that the item was “lame” and not meaningful

Clarity of relationship to function

The quality or frequency of the items needed to be modified to more clearly depict function

For the item, “I participate in meaningful activities,” a participant noted, “meaningful to who?” As such, we qualified this to be “activities that are meaningful to me.”

Several items were also revised to substitute “access” for a more active verb such as “use”; for example, “I use health services when I need to,” since access may also allude to ability to, while use clearly denotes doing

Participants expressed concepts underlying items were conducive to function depending on how and when they occurred; as such, adverbs of frequency were modified in some items to depict a functional relationship. For the item, “I spend time with my family when I want to and/or need too,” one participant expressed that interaction should be when “it’s convenient for both parties,” and as such, we utilized the participant’s suggestion of, “I maintain healthy relationships.” In this instance, meeting mutual expectations was expressed as key to function

Meeting expectations was also deemed important in items relating to school and work. One participant highlighted that “just saying I go to school or I go to work doesn’t capture function very well,” and that you could still be “failing your classes miserably.” For other items, engagement needed to be balanced with other demands and personal values for it to denote function. For example, in regard to, “I exercise enough each day,” it was noted that some people “may be busy and not want to,” so a participant’s suggestions of “as much as I want to,” was used to qualify the item instead

Inclusivity

Items were modified to be more inclusive of those in different life circumstances and cultural backgrounds

In regards to saving money, one participant expressed, “you …only get enough money to pay rent and buy food, then that’s it and you’re done,” while in regards to preparing healthy meals a participant noted, “it’s not something everyone has access to.” As such, we utilized a participant’s suggestion and qualified these items with “when I can.”

Participants discussed that not everyone uses transit to get about, so we added the item “I get to where I need to go.” Likewise, participants suggested that showering, bathing and brushing your teeth could be consolidated into “one question,” of “I maintain my personal hygiene,” to include those without access to a shower

Conceptual completeness

Items that may not have been included in the conceptual model, but could be considered

Many participants felt that social connection to both friends and family were important, and that the two items could not be consolidated. As such, we added “My communication with my friends is healthy,” as well as the item pertaining to family