Reliability and validity of the KIDSCREEN-52 health-related quality of life questionnaire in a Greek adolescent population

Identifying candidate items for a health-related quality of life measure in young children with respiratory illness: A scoping review of generic and disease-specific measures

BACKGROUND

Health-related quality of life (HRQoL) in young children affected by respiratory illnesses remains understudied, particularly in low- and middle-income countries (LMICs), where the burden of these diseases is disproportionately high. Existing HRQoL measures, including both generic and respiratory disease-specific measures, have been reviewed to identify key components that can guide the development of a novel HRQoL tool for young children (0-5-years) with respiratory illnesses. The study aimed to identify candidate items from existing HRQoL measures to inform the development of a new HRQoL tool for young children (0-5 years-old) with respiratory illnesses in a LMIC setting.

METHODS

A scoping review was conducted using PubMed, EBSCOhost, and PsycArticles databases Keywords included variations of the following terms 'quality of life', 'health-related quality of life', 'wellbeing', 'questionnaire', 'instrument', 'measure', 'children', 'toddler', 'paediatric', 'child*', 'develop' or 'validation'. The search was limited to English-language articles published between January 2000 and November 2023. Deductive thematic analysis was used to organise the measures and synthesise cross-cutting components.

RESULTS

Out of 1823 articles, data were extracted from 72 articles reporting on 41 measures. Of these, 20 were generic, and 21 were specific to respiratory diseases. The measures' key dimensions included physical and emotional health, social support, and school functioning. However, few measures, targeted children 0-5-years, and none incorporated child-specific methods for assessing HRQoL. Existing tools varied widely in their domains and definitions, often lacking consistency and not adequately considering the developmental milestones. Furthermore, most tools were developed in high-income settings (HIC), with limited adaption to the socio-economic burden and disease burden contexts in LMICs.

CONCLUSION

There is an urgent need for a comprehensive HRQoL measure tailored to young children with respiratory illnesses, particularly one designed for use in LMICs. Such a tool should address developmental milestones, cultural sensitivity, and the unique socio-economic challenges faced in these settings.

The science of child and adolescent mental health in Greece: a nationwide systematic review

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [ https://rpubs.com/camhi/sysrev_table ]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries.

Diagnostic intervention improved health-related quality of life among teenagers with food allergy

OBJECTIVES

The aim was to examine if a diagnostic intervention set up to assess current food allergy to cow's milk, hen's egg, fish, or wheat among teenagers had an impact on generic and disease specific health-related quality of life (HRQL). The study compared HRQL scoring before and two years after the intervention, and in relation to age matched controls without reported food allergy.

METHODS

The study was performed within the Obstructive Lung Disease in Northern Sweden (OLIN) studies where a cohort study on asthma and allergic diseases among 8-year-old schoolchildren was initiated in 2006. At age 12 years, the 125/2612 (5%) children who reported allergy to cow's milk, hen's egg, fish, or wheat were invited to a diagnostic intervention including clinical examination, blood tests and evaluation by a pediatric allergist. Of 94 participants, 79 completed generic and disease specific HRQL questionnaires. Additionally, a random sample of 200 (62% of invited) children without food allergy from the OLIN cohort answered the generic HRQL questionnaire. The respondents of the HRQL questionnaires were re-examined two years later and 57 teenagers with and 154 without reported allergy participated.

RESULTS

There were no significant differences in generic HRQL scores between teenagers with and without reported food allergy at study entry, or after the intervention. Among those with reported food allergy, we found a significant improvement in disease specific HRQL after the intervention (mean values: 3.41 vs 2.80, p<0.001). Teenagers with only food allergy had better disease specific HRQL compared to those with one, two or three concomitant allergic diseases, both before and after the intervention. Children with only food allergy significantly improved their HRQL after the intervention, 1.84 vs. 2.87 (p<0.001) but this association was not seen in children with one other allergic disorder (3.16 vs. 3.65, p = 0.121) or those with two or more allergic disorders (3.72 vs. 3.90, p = 0.148).

CONCLUSION

The diagnostic intervention showed a long-term improvement of disease specific HRQL but not generic HRQL.

Anthropometric, Lifestyle Characteristics, Adherence to the Mediterranean Diet, and COVID-19 Have a High Impact on the Greek Adolescents' Health-Related Quality of Life

OBJECTIVE

The study aimed at analyzing the relationship between anthropometric characteristics, lifestyle, and dietary habits, as well as the burden of the pandemic on the health-related quality of life among Greek pupils.

RESEARCH METHODS AND PROCEDURES

On the whole, 2088 adolescents aged 12-18 years from Attica, Greece, were enlisted in this school-based cross-sectional study that took place in May-December 2021. Health-related quality of life was estimated through the KIDSCREEN-27 questionnaire, adherence to the Mediterranean diet-through the KIDMED test. For the empirical and econometric analyses, the Mann-Whitney U and Kruskal-Wallis means comparison tests were utilized; multiple linear regression was used accordingly.

RESULTS

The present study provides evidence to the fact that boys, younger adolescents, adolescents living with both parents and with highly educated mothers had a better health-related quality of life. Concerning their eating practices, positive predictors were consuming a better-quality breakfast, having all five meals daily, consuming lunch and dinner with parents, and higher adherence to the Mediterranean diet. Moreover, sufficient night sleep time, fewer hours spent on screen viewing, more frequent walks, and having hobbies were linked to the health-related quality of life with a positive sign. In contrast, negative predictors were higher body mass index and everyday life difficulties due to the COVID-19 pandemic crisis.

CONCLUSIONS

Greek adolescents' anthropometric characteristics, BMI, lifestyle and sedentary habits, eating habits, and adherence to the Mediterranean diet were significantly related to their perceived health-related quality of life during the pandemic.

Health-related quality of life, Mediterranean diet, physical activity and socioeconomic factors of Greek adolescents during COVID-19: A cross sectional study

BACKGROUND: Health related quality of life of the adolescents during quarantine and social isolation potentially decreases, with significant alteration on physical activities and nutrition behaviour. OBJECTIVE: The present study investigates the relationship between Greek adolescents’ health related quality of life and socioeconomic factors, lifestyle and dietary characteristics, along with their adherence to the Mediterranean Diet immediately after the lockdown period in Greece. METHODS: A total sample of 459 students aged 12–16 years old were recruited from secondary schools in the area of Athens. The KIDSCREEN-27 questionnaire for children and adolescents, the KIDMED test, the Godin and Shephard Leisure Time Physical Activity Questionnaire and the Family Affluence Scale III, were used for the statistical analysis. T-tests, Kruskal Wallis, Chi-square, Anova tests and multiple regression analyses were employed. RESULTS: Econometric analysis reveals that adolescents’ health related quality of life is higher among boys, adolescents who live with both parents, tend to sleep more during night and do not spend many hours on screen viewing. Also, adolescents with higher family affluence level, being physically active and with a high adherence to the Mediterranean Diet have higher health related quality of life. CONCLUSIONS: Adolescents’ adherence to the Mediterranean Diet, physical activity, socioeconomic characteristics and life style behaviors are highly correlated with perceived health related quality of life during COVID-19 period.

"Greek KOOS-Child: a valid, disease specific, diagnostically accurate and responsive PROM in children with knee-related pathology"

PURPOSE

The Knee Injury Osteoarthritis Outcome Score (KOOS)-Child questionnaire is one of the frequently child-friendly measures used in pediatric studies. The aim of this study was to transculturally adapt the Greek version of KOOS-Child and evaluate its clinimetric properties in children with knee disorders.

METHODS

Children visiting the Outpatients Orthopaedic Clinic of a Greek Paediatric General Hospital were considered eligible if they were aged 8-14 years, had a knee soft tissue injury and associated physical limitations. The transcultural adaptation was based on a multistage backward translation approach. Participants completed the KOOS-Child at their first visit to the orthopedic specialist (baseline), 2 weeks and 3 months after baseline. Content validity of the KOOS-Child was evaluated using general QoL measures (KIDSCREEN and Kid-KINDL) and construct validity was explored by correlating relevant items. Responsiveness was evaluated according to the children's response on the given orthopeadic treatment.

RESULTS

Sample consisted of 59 children (30 males), aged: 11 ± 1.8 years. The KOOS-Child showed high internal consistency (Cronbach's a: 0.80-0.96). Adequate convergent validity with > 75% relevant a priori hypotheses was confirmed. Construct validity was moderate to strong (Pearson's r correlations between related KOOS and Kid-KINDL subdimensions: 0.54-0.62). KOOS and KIDSCREEN subdimensions correlations were fair (Pearson's r correlations: 0.32-0.65). KOOS-Child's diagnostic accuracy was high. Factor analysis extracted height factors accounting for 76.15% of the total variance, confirmed by the scree plot. Responsiveness was moderate to high with Cohen's d from 0.6 to 1.4.

CONCLUSION

The Greek version of the KOOS-Child demonstrated excellent internal consistency, good construct validity, diagnostic accuracy and interpretability as well as good responsiveness. The measure could be used across Greek children with orthopaedic knee problems. Generalisability of findings is limited due to the relatively limited cohort.

LEVEL OF EVIDENCE

II.

Psychometric properties of the Mandarin Chinese version of the KIDSCREEN-52 health-related quality of life questionnaire in adolescents: a cross-sectional study

PURPOSE

To evaluate the psychometric properties of the Mandarin Chinese version of KIDSCREEN-52 health-related quality of life (HRQOL) questionnaire.

METHODS

We conducted a cross-sectional study with two cohorts of school-based data in the urban areas of Weifang, China. 4385 and 841 representative adolescents aged 11-17 years have recruited into the baseline and test-retest group, respectively. Psychometric analyses included feasibility, item and dimension properties, reliability, construct validity, measurement invariance, convergent and discriminant validity, and known-group validity.

RESULTS

The response rates of both baseline and test-retest surveys were more than 90%. Low missing values were found (0.02-1.92%) across ten dimensions. The measurement properties of items were satisfactory. Noteworthy ceiling effects were observed for ten dimensions (6.75-31.84%), while the observed floor effects were negligible (0.02-1.37%). Internal consistency was robust with Cronbach's alpha (0.819-0.959), while the test-retest reliability was acceptable with the ICCs (0.724-0.849). Confirmatory factor analysis confirmed the ten-dimensional structure and supported the configural and metric invariance across gender and age groups. The Pearson correlation coefficients between the KIDSCREEN-52 and the PedsQL™ 4.0 were stronger in comparable dimensions than those in less comparable dimensions, demonstrating the convergent and discriminant validity. In most dimensions, statistically significant and medium or large effect size differences were found across socioeconomic and mental health status, supporting the known-group validity.

CONCLUSION

These findings demonstrate that the Mandarin Chinese version of KIDSCREEN-52 seems to work well in a Chinese context, and is a psychometrically valid and reliable HRQOL instrument.

Children's and parents' perspectives of health-related quality of life in newly diagnosed adolescent idiopathic scoliosis

The aim of this study is to compare child and parent perceptions of health-related quality of life in Adolescent Idiopathic Scoliosis. The scoliosis-specific SRS-22 and the generic KIDSCREEN-52 were administered to newly diagnosed patients and the latter also to a parent. Strong correlations (r > 0.5, p < 0.001) were revealed between conceptually similar dimensions of the instruments. Parents' assessments of their child's HRQoL were generally higher than the children/adolescents; however score differences were small and insignificant. The significance of parents' perceptions was also confirmed with OLS regressions. In conclusion, HRQoL is thoroughly investigated when both generic and disease-specific instruments are used.

Quality of life in children with chronic kidney disease

BACKGROUND

Progressive chronic kidney disease (CKD), irrespective of the underlying etiology, affects the quality of life (QoL) of children due to the need for regular follow-up visits, a strict medication program and diet intake.

METHODS

The Greek version of the KIDSCREEN-52 multidimensional questionnaire was used in children with CKD, renal transplantation (RT) and in a control group (CG) of healthy children.

RESULTS

Fifty-five patients between 8 and 18 years, with CKD (n = 25), RT (n = 16) and with end-stage renal disease (ESRD) on peritoneal dialysis (PD) (n = 14) were included. Each group of studied children was compared with the CG (n = 55), the validation sample (VS) (n = 1200) and the parent proxy scores. Physical well-being of all studied children was significantly lower compared to CG (p = 0.004). In contrast, all studied children between 8 and 11 years showed better social acceptance compared to VS (p = 0.0001). When QoL of children with CKD was compared with parent proxy QoL, conflicting opinions were observed in several dimensions, such as self-perception (p = 0.023), autonomy (p = 0.012), school environment (p = 0.012) and financial resources (p = 0.03).

CONCLUSIONS

QoL and mainly the dimension of physical well-being, may be affected dramatically in children with CKD unrelated to disease stage. In early school years children with CKD seem to feel higher social acceptance than the healthy controls, exhibiting better score in this dimension. Optimal care requires attention not only to medical management, but also to an assessment of QoL factors, that may help promote pediatric patient's health.

Exploratory factor analysis of a 16D Health-Related Quality of Life instrument with adolescents seeking help for early psychiatric symptoms

BACKGROUND

Health-related quality of life (HRQoL) is a widely studied phenomenon in health care. This study aimed to identify which factors can be extracted from a generic 16-dimension (16D) HRQoL instrument in a sample of adolescents seeking help for early psychiatric symptoms.

METHODS

Data were collected at the Helsinki University Central Hospital (HUCH), Finland, by an early intervention team. In total, 394 help-seeking adolescents (mean age 15.3 years, SD 2.14 years, 183 boys and 211 girls) completed a 16D HRQoL questionnaire.

RESULTS

Exploratory factor analysis (generalized least squares method, promax rotation) identified four factors in the 16D instrument. The first factor of "psychophysiological health" included the dimensions of vitality, breathing, distress, sleeping, physical appearance, mental functioning and depression. The second factor, "physical and social health", consisted of the items discomfort and symptoms, friends and elimination. The items hearing, eating and speech were loaded on factor three, "health in somatosensory functioning". Moreover, the single item of school and hobbies was loaded on factor four, "health in functioning ability". However, the items of vision and mobility were not loaded on any factor. Since the 16D instrument was originally designed for 11-15-year-old adolescents, analysis was repeated using a subsample of this age group (n = 245).

CONCLUSIONS

The results here suggest that the 16D instrument consists of four factors and forms its own latent variable structure in this specific sample of adolescents seeking help for early psychiatric symptoms. However, items such as vision, mobility and school and hobbies should be interpreted with caution as a part of the factor structure of a 16D instrument among this population.

Perseverative thoughts and subjective health complaints in adolescence: Mediating effects of perceived stress and negative affects

Stable tendency to perseverative thoughts such as trait rumination and worry can influence somatic health. The purpose of the study was to investigate the relationship between perseverative thoughts and somatic complaints, and the possible mediating effects of perceived stress, negative and positive affectivity in adolescence. Having an acute or a chronic condition was also assessed to be controlled for and to reveal their effects on symptom reporting. Three hundred and six adolescents from 7th to 12th grade with mean age of 16.33 (SD = 1.29) participated in the study. Mediation analysis suggested that impact of trait-like perseverative thoughts on complaints were mediated by perceived stress and negative affectivity. Having an acute condition had also an effect on symptom reporting through increased negative affectivity. Our results highlight that ruminations or worry as stable intrapersonal characteristics are relevant processes in health and can be potential targets in prevention programmes in adolescence.

Comparative study of the health-related quality of life of children with epilepsy and their parents

PURPOSE

We aimed to evaluate the health-related quality of life (HRQoL) of schoolchildren with epilepsy and its determinants and the HRQoL of their parents in comparison with those of healthy children and their parents.

MATERIALS AND METHODS

The study sample comprised 100 children with epilepsy (58 males), 8-16 years of age, diagnosed at least 6 months earlier. The children with epilepsy were divided into two subgroups: A, with well controlled idiopathic epilepsy, and B, with drug-resistant or symptomatic epilepsy and with concomitant neurodevelopmental problems. A control group consisted of 100 healthy age- and gender-matched children. One parent in each family completed two questionnaires standardized for use in Greece: KIDSCREEN-27 (version for parents) to assess the HRQoL of the children and SF-12 to assess the parental HRQoL. For each of the five dimensions of KIDSCREEN-27 and for the physical and mental component scales of the SF-12 tool, the standardized mean difference (SMD) was used for comparison between the various groups and subgroups. Linear regression analysis was used to explore the effect of specific illness-related factors on the five dimensions of KIDSCREEN-27 in the children with epilepsy.

RESULTS

The parent-reported scores on KIDSCREEN-27 of the children with epilepsy were worse overall than those of healthy children, but the difference reached statistical significance only for the dimensions of "physical well-being" (p = 0.001) and "school environment" (p < 0.001). The differences were greater in adolescents (age group: 13.5-16years). The worst scores were recorded in subgroup B, the children with severe epilepsy, in the dimensions "physical well-being" (p < 0.001), "school environment" (p < 0.0001), and "peers and social support" (p = 0.044). The factors found to have a significant effect on all dimensions were mental retardation, physical disability, abnormal brain imaging findings, learning problems, and, to a lesser degree, administration of a large number of antiepileptic drugs and prolonged treatment. The parents of children with resistant epilepsy and accompanying neurodevelopmental problems scored significantly worse on the SF-12 mental health scale than those of healthy children (p < 0.001).

CONCLUSIONS

Epilepsy, particularly severe epilepsy with concomitant neurodevelopmental problems, adversely affects the HRQoL of both schoolchildren and their parents.

Alcohol segment-specific associations between the quality of the parent-child relationship and adolescent alcohol use

BACKGROUND

There is much evidence that parents have an influence on the alcohol use of their children. However, in general the relationship is rather weak. A reason for this small association may be due to the fact that adolescents are a heterogeneous group and that, consequently, the association between the quality of the parent-child relationship and alcohol use varies for diverse subgroups, resulting in an overall small effect. In an earlier study we found five different segments for adolescents regarding their attitude towards alcohol. This article reports on a study into the differences between these segments with respect to the quality of the parent-child relationship and parental attitudes to alcohol. Moreover, we examined segment-specific associations of the quality of the parent-child relationship and alcohol use.

METHODS

This study used data from a survey held among adolescents aged 12 to 18. A random sample of 59,073 adolescents was drawn from 67 municipalities in the south of the Netherlands. To assign respondents into one of the five segments, a questionnaire of 28 items concerning alcohol and approval from others from the original segmenting study was included in the internet version. Therefore, only the results of the internet version (N = 12,375 adolescents) were analysed.

RESULTS

Both the quality of the parent-child relationship and the attitude of the parents towards the drinking behaviour of their children differed between the segments. Significant associations were found between the quality of the parent-child relationship and life-time and recent alcohol use and binge drinking. The interaction between the quality of the parent-child relationship and the segments was only significant for binge drinking.

CONCLUSIONS

The quality of the parent-child relationship seemed to be most strongly associated with life-time alcohol use, suggesting that parents appear to play the most important role in the prevention of alcohol use. Moreover, the results showed segment-specific associations between the quality of the parent-child relationship and binge drinking, indicating that the role of parents in heavy drinking is different for the various segments.

The role of perceived well-being in the family, school and peer context in adolescents' subjective health complaints: evidence from a Greek cross-sectional study

BACKGROUND

During adolescence children are usually confronted with an expanding social arena. Apart from families, schools and neighbourhoods, peers, classmates, teachers, and other adult figures gain increasing importance for adolescent socio-emotional adjustment. The aim of the present study was to investigate the extent to which Greek adolescents' perceived well-being in three main social contexts (family, school and peers) predicted self-reported Subjective Health Complaints.

METHODS

Questionnaires were administered to a Greek nation-wide, random, school-based sample of children aged 12-18 years in 2003. Data from 1.087 adolescents were analyzed. A hierarchical regression model with Subjective Health Complaints as the outcome variable was employed in order to i) control for the effects of previously well-established demographic factors (sex, age and subjective economic status) and ii) to identify the unique proportion of variance attributed to each context. Bivariate correlations and multicollinearity were also explored.

RESULTS

As hypothesized, adolescents' perceived well-being in each of the three social contexts appeared to hold unique proportions of variance in self-reported Subjective Health Complaints, after controlling for the effects of sex, age and subjective economic status. In addition, our final model confirmed that the explained variance in SHC was accumulated from each social context studied. The regression models were statistically significant and explained a total of approximately 24% of the variance in Subjective Health Complaints.

CONCLUSIONS

Our study delineated the unique and cumulative contributions of adolescents' perceived well-being in the family, school and peer setting in the explanation of Subjective Health Complaints. Apart from families, schools, teachers and peers appear to have a salient role in adolescent psychosomatic adjustment. A thorough understanding of the relationship between adolescents' Subjective Health Complaints and perceived well-being in their social contexts could not only lead to more effective tailored initiatives, but also to promote a multi- and inter-disciplinary culture in adolescent psychosomatic health.

Evaluating the Serbian version of the KIDSCREEN quality-of-life questionnaires: reliability, validity, and agreement between children's and parents' ratings

PURPOSE

To evaluate the psychometric properties of the Serbian set of the KIDSCREEN questionnaires: KIDSCREEN-52, KIDSCREEN-27, and KIDSCREEN-10 index.

METHODS

The study included 330 children (8-18 years) and 314 parents. All completed the KIDSCREEN and KINDL questionnaires. Psychometric analyses included internal consistency reliability (Cronbach's coefficient), criterion, convergent and discriminant validity, and agreement between children and parents (the intraclass correlation coefficient-ICC).

RESULTS

Cronbach's α of 0.7 and above was found for all except for the self-perception scale of the KIDSCREEN-52, being 0.58 for the child and 0.63 for the parent version. Correlations between similar scales in the KIDSCREEN and KINDL were substantial (ranging 0.45-65) and higher than correlations between theoretically different scales. Moderate to excellent agreement existed between children's and parents' ratings in all KIDSCREEN scales (ICC ranged 0.44-0.63), except for the moods and emotions from the longer (ICC = 0.34) and the social support and peers from the shorter version (ICC = 0.38).

CONCLUSIONS

Levels of internal consistency reliability and validity of all KIDSCREEN questionnaires in Serbian are appropriate, as well as agreement between children's and parents' ratings.