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Jones R, O'Loughlin R, Xiong X, Bahrampour M, Devlin N, Hiscock H, Chen G, Mulhern B, Dalziel K. Comparative Psychometric Performance of Common Generic Paediatric Health-Related Quality of Life Instrument Descriptive Systems: Results from the Australian Paediatric Multi-Instrument Comparison Study. PHARMACOECONOMICS 2024; 42:39-55. [PMID: 37955799 PMCID: PMC11169028 DOI: 10.1007/s40273-023-01330-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/11/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE The aim of this study was to compare the psychometric performance of common generic paediatric health-related quality-of-life instrument descriptive systems (PedsQL generic core 4.0, EQ-5D-Y-3L, EQ-5D-Y-5L, Child Health Utility 9D [CHU9D], Assessment of Quality of Life 6D [AQoL-6D], and Health Utilities Index Mark 3 [HUI3]) by child age, report type, and health status. METHODS Data for children aged 5-18 years were from the Australian Paediatric Multi-Instrument Comparison study. Ceiling effects, test-retest reliability, known-group validity, convergent and divergent validity, and responsiveness were assessed in the total sample and by child age (5-12 years vs 13-18 years), report type (self- vs proxy report), and health status. Instruments were scored using an exploratory level sum score (LSS) approach. RESULTS Survey data were available for 5945 children, with follow-up data available for 2346 children. The EQ-5D-Y-3L demonstrated ceiling effects. The PedsQL, EQ-5D-Y-3L, EQ-5D-Y-5L, and CHU9D demonstrated acceptable test-retest reliability. All instruments demonstrated known-group, convergent, and divergent validity. The EQ-5D-Y-3L, EQ-5D-Y-5L, and CHU9D demonstrated responsiveness to improvements in health and the PedsQL, EQ-5D-Y-3L, EQ-5D-Y-5L, and CHU9D to worsening health. The AQoL-6D and HUI3 had inconclusive test-retest reliability and responsiveness evidence due to small sample size. Importantly, ceiling effects, test-retest reliability and responsiveness varied by subgroup. CONCLUSION Results reflect instrument performance using LSSs, which may differ to utility scores. In the total sample, the EQ-5D-Y-5L and CHU9D descriptive systems demonstrated evidence of good performance (i.e., meeting prespecified criteria) across all psychometric attributes tested. Performance varied by child age and report type, indicating room for considerations by population and study.
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Affiliation(s)
- Renee Jones
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia.
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia.
| | - Rachel O'Loughlin
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Xiuqin Xiong
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Mina Bahrampour
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Nancy Devlin
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
| | - Harriet Hiscock
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
- Health Services Research Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, VIC, Australia
| | - Gang Chen
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Ultimo, NSW, Australia
| | - Kim Dalziel
- Health Economics Unit, Centre for Health Policy, The University of Melbourne, Melbourne, VIC, Australia
- Health Services and Economics, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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van Heusden A, Rivero-Arias O, Herdman M, Hiscock H, Devlin N, Dalziel K. Psychometric Performance Comparison of the Adapted versus Original Versions of the EQ-5D-Y-3L and -Y-5L in Proxy Respondents for 2- to 4-Year-Olds. PHARMACOECONOMICS 2024; 42:129-145. [PMID: 38238604 PMCID: PMC11169041 DOI: 10.1007/s40273-024-01350-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/02/2024] [Indexed: 06/13/2024]
Abstract
INTRODUCTION Few preference-weighted instruments are available to measure health-related quality of life in young children (2-4 years of age). The EQ-5D-Y-3L and EQ-5D-Y-5L were recently modified for this purpose. OBJECTIVE The aim of this study was to test the psychometric properties of these adapted versions for use with parent proxies of children aged 2-4 years and to compare their performance with the original versions. It was hypothesised that the adapted instrument wording would result in improved psychometric performance. METHODS Survey data of children aged 2-4 years were obtained from the Australian Paediatric Multi-Instrument Comparison study. Distributional and psychometric properties tested included feasibility, convergence, distribution of level scores, ceiling effects, known-group validity (Cohen's D effect sizes for prespecified groups defined by the presence/absence of special healthcare needs [SHCNs]), test-retest reliability (intraclass correlation coefficients [ICCs]), and responsiveness (standardised response mean [SRM] effect sizes for changes in health). Level sum scores were used to provide summary outcomes. Supplementary analysis using utility scores (from the Swedish EQ-5D-Y-3L value set) were conducted for the adapted and original EQ-5D-Y-3L, and no value sets were available for the EQ-5D-Y-5L. RESULTS A total of 842 parents of children aged 2-4 years completed the survey. All instruments were easy to complete. There was strong convergence between the adapted and original EQ-5D-Y-3L and EQ-5D-Y-5L. The adapted EQ-5D-Y-3L and adapted EQ-5D-Y-5L showed more responses in the severe levels of the five EQ-5D-Y dimensions, particularly in the usual activity and mobility dimensions (EQ-5D-Y-5L: mobility level 1: adapted n = 478 [83%], original n = 253 [94%]; mobility level 4/5: adapted n = 17 [2.9%], original n = 4 [1.5%)]). The difference in the distribution of responses was more evident in children with SHCNs. Assessment of known-group validity showed a greater effect size for the adapted EQ-5D-Y-3L and adapted EQ-5D-Y-5L compared with the original instruments (EQ-5D-Y-5L: adapted Cohen's D = 1.01, original Cohen's D = 0.83) between children with and without SHCNs. The adapted EQ-5D-Y-3L and adapted EQ-5D-Y-5L showed improved reliability at 4-week follow-up, with improved ICCs (EQ-5D-Y-5L: adapted ICC = 0.83, original ICC = 0.44). The responsiveness of all instruments moved in the hypothesised direction for better or worse health at follow-up. Probability of superiority analysis showed little/no differences between the adapted and original EQ-5D-Y-3L and EQ-5D-Y-5L. Supplementary psychometric analysis of the adapted and original EQ-5D-Y-3L using utilities showed comparable findings with analyses using level sum scores. CONCLUSIONS The findings suggest improved psychometric performance of the adapted version of the EQ-5D-Y-3L and EQ-5D-Y-5L in children aged 2-4 years compared with the original versions.
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Affiliation(s)
- Alexander van Heusden
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 4/207 Bouverie Street, Carlton, VIC, 3053, Australia.
| | - Oliver Rivero-Arias
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Harriet Hiscock
- Health Services Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
| | - Nancy Devlin
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 4/207 Bouverie Street, Carlton, VIC, 3053, Australia
| | - Kim Dalziel
- Health Economics Unit, Melbourne School of Population and Global Health, University of Melbourne, 4/207 Bouverie Street, Carlton, VIC, 3053, Australia
- Health Services Group, Murdoch Children's Research Institute, Melbourne, VIC, Australia
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Pérez-Ardanaz B, Peláez-Cantero MJ, Morales-Asencio JM, Vellido-González C, Gómez-González A, León-Campos Á, Gutiérrez-Rodríguez L. Socioeconomic Factors and Quality of Life Perceived by Parents and Children with Complex Chronic Conditions in Spain. CHILDREN 2021; 8:children8100931. [PMID: 34682195 PMCID: PMC8534789 DOI: 10.3390/children8100931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/20/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Health-related quality of life of children with complex chronic conditions could be affected by sociodemographic factors. Most studies focus exclusively on the parents’ perceptions of quality of life. This study aimed to determine the health-related quality of life of these children, according to their parents and the children themselves. A cross-sectional study was developed on children aged over five years with complex chronic conditions. Health-related quality of life, educational attainment, and social status were evaluated. A total of 101 children were included with a mean age of 10.48 years, and 35.6% were female. The most frequent disease was oncological (28.7%). Children perceived a better health-related quality of life, compared to their parents’ assessment: median difference −8.4 (95%CI: −9.2 to −3.8). Moreover, differences were observed by socioeconomic factors. Parents and children with complex chronic conditions perceive differently the health-related quality of life. Social determinants associate with an uneven perceived quality of life.
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Affiliation(s)
- Bibiana Pérez-Ardanaz
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
| | | | - José Miguel Morales-Asencio
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
- Correspondence: ; Tel.: +34-951952833
| | | | - Alberto Gómez-González
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
| | - Álvaro León-Campos
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
- Instituto de Investigación Biomédica de Málaga (IBIMA), 29010 Málaga, Spain
| | - Laura Gutiérrez-Rodríguez
- Faculty of Health Sciences, Universidad de Málaga, 29071 Málaga, Spain; (B.P.-A.); (A.G.-G.); (Á.L.-C.); (L.G.-R.)
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Fan X, Linder S, D’Amico LK, White KM, Pawloski T. Identifying the Needs of Prekindergarten Children: A Focus on Health, Wellbeing, and Family Environment. EARLY CHILDHOOD EDUCATION JOURNAL 2021; 50:823-840. [PMID: 34025106 PMCID: PMC8130793 DOI: 10.1007/s10643-021-01206-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/30/2021] [Indexed: 06/12/2023]
Abstract
The impact of children's health, wellbeing, and family environment on their learning and development is evident. Identifying the needs of children and their families is the first step to effectively developing and implementing programs that promote child development. This research employed a convergent mixed methods design and incorporated multiple data collection and analysis techniques to explore the needs of prekindergarten children related to their health, wellbeing, and family environment. A large-scale survey, regional meetings, and focus groups were conducted among a total of 4615 parents/caregivers, organizational representatives, and community members in the state of South Carolina, in the United States. Understanding child development, getting services for children and families, making childcare accessible and affordable, having enough family time, building strong relationships with children, and community support for families were identified as priorities. Parents/caregivers of different socio-demographic backgrounds prioritized different needs.
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Affiliation(s)
- Xumei Fan
- Department of Educational Studies, University of South Carolina, 004 Wardlaw, Columbia, SC 29208 USA
| | - Sandra Linder
- Early Childhood Mathematics Education, Clemson University, 407-F Tillman Hall, Clemson, SC 29634 USA
| | - Leigh Kale D’Amico
- Research, Evaluation, and Measurement Center, University of South Carolina, 820 South Main Street, Columbia, SC 29208 USA
| | - Kelley Mayer White
- Department of Teacher Education, College of Charleston, 66 George Street, Charleston, SC 29424 USA
| | - Tammy Pawloski
- FMU Center of Excellence to Prepare Teachers of Children of Poverty, Francis Marion University, PO Box 100547, Florence, SC 29501 USA
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Wolf ZR, Bailey DN. Nursing center-Health Intervention Program in Philadelphia: Program evaluation and outcomes. Nurs Forum 2017; 53:161-172. [PMID: 29165828 DOI: 10.1111/nuf.12238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The La Salle Neighborhood Nursing Center provided the Health Intervention Program (HIP) for vulnerable children with special needs, and families in Philadelphia challenged by chronic physical, developmental, behavioral, and emotional conditions and low incomes. AIMS We evaluated the effectiveness of HIP for a 5-year period and the consistency of quarterly and annual reports as a quality improvement initiative. METHODS Using program evaluation, secondary analysis design, the effect of a city-wide, family support home visiting program was assessed. Consistency of documentation of program outcomes on annual reports was described. Data were obtained from reports, framed by program objectives submitted via the ETO® database to the Department of Public Health. Components of the HIP consisted of case management, supportive services, information, and referrals provided by a multidisciplinary healthcare team. RESULTS Family services, program outcomes, referrals, community meetings, and themes demonstrated program complexity and effectiveness. Reports showed inconsistent documentation on 19 outcomes for program objectives. CONCLUSIONS Children with special needs and their families shared challenges and barriers to their health. The institution staff should create a table to report outcomes on program objectives to evaluate trends across funding years and establish interrater reliability on quarterly and annual reports.
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Abstract
OBJECTIVES To examine the relationship between adverse childhood experiences (ACE), access to a medical home and a global measure of well-being among children ages 6-17 using the 2011-2012 National Survey of Children's Health. METHODS Multivariate linear regressions assessed the associations between each adverse experience and an index of child well-being with and without the impact of other events. The number of ACE was summed for each respondent and the analyses were repeated with the cumulative score as a continuous variable. The cumulative model was repeated with the addition of an interaction term between ACE score and medical home access. All analyses were conducted separately for children ages 6-11 and adolescents 12-17. RESULTS Over half (53 %) of US children ages 6-17 have experienced some adverse experience during childhood. Over a quarter (28 %) has experienced at least two adverse experiences, while 15 % have experienced three or more hardships. Results suggest that the accumulation of ACE reduces well-being in children. The associations remained significant after controlling for gender, race/ethnicity, age, parental education, special health condition, and medical home access. Medical home access was consistently associated with higher levels of child well-being and was a significant moderator of the relationship between the total ACE and child well-being among children ages 6-11. Children with ACE exposure and access to a medical home have higher levels of well-being than comparable children without access to a medical home. CONCLUSIONS FOR PRACTICE Children exposed to adverse experiences have measurably lower levels of well-being, although younger children with access to a medical home are protected at increasing exposure.
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Affiliation(s)
- Kelly Stamper Balistreri
- Center for Family and Demographic Research, Bowling Green State University, 218 Williams Hall, Bowling Green, OH, 43403, USA.
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Preskitt JK, Menear KS, Goldfarb SS, Menachemi N. Wellness among US adolescents ages 12-17 years. Child Care Health Dev 2015; 41:1207-15. [PMID: 25846725 DOI: 10.1111/cch.12248] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/07/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wellness is a multidimensional construct related to an individual's physical, emotional, intellectual and social well-being. We present estimates of wellness among US adolescents aged 12-17 years and explore how demographic characteristics are associated with wellness. METHODS All respondents aged 12 to 17 years (n = 34,601) from the 2011-2012 National Survey of Children's Health were included in the sample. Survey items were coded to operationalize an overall wellness score, comprised of four subdimensions (physical, intellectual, emotional and social). RESULTS The mean adjusted overall wellness score was 30.2 (out of 40). Mean raw subdimensions scores were: social = 3.14 (out of 4), emotional = 4.79 (out of 6), intellectual = 4.80 (out of 8) and physical = 6.57 (out of 8). Older adolescents, those with special health needs, those in lower income families and those whose mother or father report fair-poor mental health status had lower wellness scores. CONCLUSIONS US adolescents have wellness scores towards the upper or higher end of our scale. Several adolescent and family characteristics were associated with either lower overall wellness and/or lower wellness on multiple subdimensions. Assessing wellness during critical developmental periods of adolescence is a first step towards promoting behaviours that support increased wellness into adulthood.
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Affiliation(s)
- J K Preskitt
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - K S Menear
- Department of Human Studies, School of Education, University of Alabama at Birmingham, Birmingham, AL, USA
| | - S S Goldfarb
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - N Menachemi
- Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
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Menear KS, Preskitt JK, Goldfarb SS, Menachemi N. Correlates of wellness among youth with functional disabilities. Disabil Health J 2015; 8:223-30. [PMID: 25457291 DOI: 10.1016/j.dhjo.2014.10.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 10/03/2014] [Accepted: 10/06/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND The literature is more informative on the impediments to wellness among youth with functional limitations and less instructive on the state of wellness for this population. OBJECTIVE To explore overall wellness, and each sub-dimension of wellness, in a national sample of youth with functional limitations and to determine how demographic characteristics are associated with wellness. METHODS Using a previously validated screening instrument, we identify youth with functional limitations aged 12 to 17 represented in the 2011/12 National Survey of Children's Health. Survey items were coded to operationalize an overall wellness score comprised of four sub-dimensions of wellness (i.e., physical, intellectual, emotional, and social). RESULTS The mean overall wellness score was 26.7 (out of 40) and had an approximate normal distribution. Mean raw scores for each sub-dimension were as follows: social = 2.79 (out of 4; 69.7%); emotional = 4.09 (out of 6; 68.2%); intellectual = 3.79 (out of 8; 47.4%); and physical = 6.30 (out of 8; 78.7%). Lower wellness scores were associated with older age among youth, increasing number of chronic health conditions, lower income, single mother homes, and youth whose mother reported fair or poor mental health status (all p < 0.05). Higher wellness scores were positively associated with mother's education (p < 0.001). CONCLUSIONS Program planners should consider interventions that target youth with functional limitations shown to be at particular risk for lower overall wellness and promote family involvement and comprehensive supports, including maternal educational attainment, mental health screening, and referral.
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Affiliation(s)
- K S Menear
- Department of Human Studies, School of Education, University of Alabama at Birmingham, 1720 2nd Ave. S., EB 207, Birmingham, AL 35294-1250, USA.
| | - J K Preskitt
- Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, RPHB 330, 1720 2nd Ave. S., Birmingham AL 35294, USA
| | - S S Goldfarb
- Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, RPHB 330, 1720 2nd Ave. S., Birmingham AL 35294, USA
| | - N Menachemi
- Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, RPHB 330, 1720 2nd Ave. S., Birmingham AL 35294, USA
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Domellöf E, Hedlund L, Ödman P. Health-related quality of life of children and adolescents with functional disabilities in a northern Swedish county. Qual Life Res 2013; 23:1877-82. [DOI: 10.1007/s11136-013-0613-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 10/25/2022]
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