Feasibility and Psychometric Properties of the Infant Toddler Quality of Life (ITQOL) Questionnaire in a Community-Based Sample of Healthy Infants in China

Abstract

Objective Evaluate the feasibility and psychometric properties of the Infant Toddler Quality of Life (ITQOL) questionnaire as a measure of health-related quality of life (HRQOL) in a sample of Chinese infants. Methods The linguistically validated Simplified Chinese version of the ITQOL was used in a multicenter, observational study of healthy, term infants (N = 427), age 6 weeks at enrollment, in China. At Days 1 and 48, parents/guardians completed the ITQOL, the Short Form Health Survey (SF-12v2) and the Infant Gastrointestinal Symptom Questionnaire (IGSQ). ITQOL feasibility, reliability, ceiling/floor effects, concurrent validity and discriminatory validity were evaluated. Results Feasibility of administering the ITQOL was supported by strong response rates (> 97%) with < 1% missing items for all scales except physical abilities. Reliability was acceptable (Cronbach’s alpha > 0.70) for all scales except Day 1 General Health (0.67). Floor effects were minimal (< 2%), except Day 1 physical abilities (7%). Ceiling effects increased from Days 1 to 48 across all scales. Concurrent validity was demonstrated by correlations between ITQOL infant-focused scales and IGSQ score (r = −0.20 to − 0.34, p < 0.001) and between parent-focused scales and SF-12v2 mental health composite (MCS) scores (r = 0.29–0.46, p < 0.001). ITQOL scales discriminated between infant subgroups based on illness-related outcomes (sick visits, adverse events) and between parent subgroups based on SF-12v2 MCS scores. Conclusion The Simplified Chinese version of the ITQOL performed well in a community-based sample of Chinese infants, with evidence supporting the instrument’s feasibility, reliability, and validity. These data support the ITQOL as a valuable tool to assess HRQOL in Chinese infants.

Review of Valuation Methods of Preference-Based Measures of Health for Economic Evaluation in Child and Adolescent Populations: Where are We Now and Where are We Going?

“…There are added complications of generating utilities for children below age 4, where none of the generic preference-based measures are recommended for use, meaning that there is little scope for the measurement and valuation of health and quality of life for children of this age as reported by carers/parents. There is a quality of life measure for infants and toddlers [77][78][79], the infant and toddler quality of life questionnaire (ITQOL), but it is not preference-based. Valuation for health and quality of life for this age group would also present new challenges, since what is within a normal developmental range widely varies within the 0-4 age range, and any generated utilities may need to capture impairment in comparison to the normal developmental range, rather than the normal developmental stage.…”

Infant feeding and health-related quality of life in healthy Chinese infants: results from a prospective, observational cohort study

“…Strengths of our study include use of the ITQOL, which was chosen based on extensive review of alternative measures. We chose the ITQOL over other measures [ 9 , 15 ] because it has been most extensively used, is appropriate for measurement of HRQOL in healthy infants [ 20 ], and provides clearly defined concept scores. The inclusion of a mixed-fed group is an additional strength; most studies exclude this group despite widespread use of mixed feeding regimens and practitioner encouragement of partial breastfeeding when exclusive breastfeeding is not possible [ 33 ].…”

“…Infant HRQOL was assessed using a standardized validated questionnaire, the Infant and Toddler Quality of Life Questionnaire (ITQOL), at clinic visit 1 and clinic visit 3. The ITQOL was translated for this study into Simplified Chinese using a standardized linguistic validation process, and the translated tool has been shown to perform well, have good reliability, and discriminate across illness-related categories in this population of very young infants [ 20 ].…”

Validation of a Quality of Life Assessment Questionnaire for Patients with Infantile Hemangioma and Their Families – the IH-QOL-RO

“…Generic measures include the ITQOL and ITQOL-SF47, instruments which measure items which generate a health profile (10). ITQOL was validated in other countries such as China (11), whereas part of the measure has also been included in a respiratory disease specific QoL measure which was validated in the Netherlands (12).…”