Development and Initial Validation of the Health-Related Quality of Life Pictorial Inventory for Children (HEALTH-PIC)

Abstract

Objective This 3-study paper aimed to develop and validate a self-reported health-related quality of life pictorial inventory for early childhood children. The scale was designed to overcome existing barriers of parent-proxy response styles and offers an alternative to age-suited literary questionnaires to assess self-reported health-related quality of life, including physical health, emotional health, social health and school health in early childhood. Methods Following an established protocol in the literature of pictorial scales, this 3-study paper leads to the development and validation of the Health-related Quality of Life Pictorial Inventory for Children (HEALTH-PIC). Study 1 involved item development/revision, which utilized a panel of 10 experts and 25 parents via the Delphi method to revise the scale and establish agreement. Study 2 invited a sample of 22 primary school students and 20 kindergarten students to establish face validity amongst primary respondents. Finally, Study 3 invited 342 parent and child dyads to complete the HEALTH-PIC and reference health-related quality of life (HRQoL) questionnaires to establish the questionnaire’s factorial, concurrent, discriminant and criterion validity in addition to internal consistency. Results In Study 1, scale items were developed alongside experts and parents with a strong theoretical and statistical support, ensuring that the items were clear, accurate and applicable for children (Aiken’s V p < .05). In Study 2, we ensured that primary respondents of different ages (kindergarten and primary school children) were able to accurately identify the pictorial images (Aiken’s V p < .05) and complete the questionnaire when the scripted instructions were read aloud. In Study 3, structural equation modelling of the HEALTH-PIC demonstrated a robust factor structure (CFI and TLI > .99; RMSEA and SRMR ≤ .08), concurrent validity (p < .001), discriminant validity (AVE < shared variance), criterion validity (p < .001) and an acceptable level of internal consistency (i.e., Cronbach’s α = .60 − .66). Conclusion Overall, the findings of the three studies provide preliminary evidence to support the content validity and construct validity of the HEALTH-PIC. This novel pictorial scale not only provides a reliable and valid assessment of the multidimensional aspects of health-related quality of life among children but can also overcome existing barriers of parent-proxy or age-suited questionnaires.