Abstract
BackgroundSeveral instruments are available to assess children's health-related quality of life (HRQoL) based on self reports as well as proxy reports from parents. Previous studies have found only low-to-moderate agreement between self and proxy reports, but few studies have explicitly compared the psychometric qualities of both. This study compares the reliability, factorial validity and convergent and known group validity of the self-report and parent-report versions of the HRQoL KINDL-R questionnaire for children and adolescents.MethodsWithin the nationally representative cross-sectional German Health Interview and Examination Survey for Children and Adolescents (KiGGS), 6,813 children and adolescents aged 11 to 17 years completed the KINDL-R generic HRQoL instrument while their parents answered the KINDL proxy version (both in paper-and-pencil versions). Cronbach's alpha and confirmatory factor-analysis models (linear structural equation model) were obtained. Convergent and discriminant validity were assessed by calculating the Pearson's correlation coefficient for the Strengths and Difficulties Questionnaire. Known-groups differences were examined (ANOVA) for obese children and children with a lower familial socio-economic status.ResultsThe parent reports achieved slightly higher Cronbach's alpha values for the total score (0.86 vs. 0.83) and most sub-scores. Confirmatory factor analysis revealed an acceptable fit of the six-dimensional measurement model of the KINDL for the parent (RMSEA = 0.07) and child reports (RMSEA = 0.06). Factorial invariance across the two versions did not hold with regards to the pattern of loadings, the item errors and the covariation between latent concepts. However the magnitude of the differences was rather small. The parent report version achieved slightly higher convergent validity (r = 0.44 – 0.63 vs. r = 0.33 – 0.59) in the Strengths and Difficulties Questionnaire. No clear differences were observed for known-groups validity.ConclusionOur study showed that parent proxy reports and child self reports on the child's HRQoL slightly differ with regards to how the perceptions, evaluations and possibly the affective resonance of each group are structured and internally consistent. Overall, the parent reports achieved slightly higher reliability and thus are favoured for the examination of small samples. No version was universally superior with regards to the validity of the measurements. Whenever possible, children's HRQoL should be measured via both sources of information.
Highlights
Several instruments are available to assess children's health-related quality of life (HRQoL) based on self reports as well as proxy reports from parents
According to the Winkler Index, 25.3% of the families could be classified as having a low socio-economic status, 47.2% as having a medium socio-economic status and 27.4 as having a high socio-economic status
Our study showed that parent proxy reports and children's self reports on the children's HRQoL differ with regards to how the perceptions, evaluations and possibly the affective resonance are structured and internally consistent
Summary
Several instruments are available to assess children's health-related quality of life (HRQoL) based on self reports as well as proxy reports from parents. This study compares the reliability, factorial validity and convergent and known group validity of the selfreport and parent-report versions of the HRQoL KINDL-R questionnaire for children and adolescents. Self-report questionnaires are regarded as the primary method for assessing health-related quality of life (HRQoL) in adults [1] as well as in children once they have reached a certain age and level of cognitive development [2]. There are numerous proxy report measures available to assess the HRQoL of children and adolescents. Several reviews and studies have examined the agreement between mental health and well-being reports made by parents and those made by the children themselves [3,4]. The level of agreement between proxy reports and children's self reports has been found to vary between different aspects of HRQoL [3,4,6]
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