Pediatric Health-Related Quality of Life: A Structural Equation Modeling Approach

Abstract

ObjectivesOne of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children.MethodsThe contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3–5 years old) participating in a follow-up study that investigates pediatric health outcomes.ResultsModel fit was χ2 = 5.5; df = 6; p = 0.48; SRMR = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model.ConclusionsThe goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.

Association between social capital, health-related quality of life, and mental health: a structural-equation modeling approach

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Community-based pediatric palliative care for health related quality of life, hospital utilization and costs lessons learned from a pilot study

“…The scientific literature on HRQoL for pediatrics is extensive including articles on HRQoL developed and/or tested for specific conditions [ 29 , 30 ], more generic HRQoLs for children in general [ 30 – 32 ], and pediatric HRQoL adapted from adult instruments [ 33 ]. These instruments tend to have similar constructs such as physical, social, emotional and overall functioning and tend to rely on child self-report and parental proxy report.…”

Measuring health-related quality of life in young children: how far have we come?

“…In 2008, Valderas and Alonso propose a classification system of measures, linked to a conceptual model [47] that is also based on Wilson and Cleary's model, integrated into the ICF. Villalonga-Olives [48] tested Wilson and Cleary's model in the paediatric population in 2014 and found a conceptual gap between adults' and children's HRQoL, again encouraging researchers to concentrate on working towards conceptualizing HRQoL in the paediatric population.…”