Quality of Life Research

, Volume 14, Issue 1, pp 243–252

Development, reliability and validity of a new measure of overall health for pre-school children

  • S. Saigal
  • P. Rosenbaum
  • B. Stoskopf
  • L. Hoult
  • W. Furlong
  • D. Feeny
  • R. Hagan

DOI: 10.1007/s11136-004-4228-7

Cite this article as:
Saigal, S., Rosenbaum, P., Stoskopf, B. et al. Qual Life Res (2005) 14: 243. doi:10.1007/s11136-004-4228-7


Background: Few comprehensive systems are available for assessing and reporting the overall health of pre-school children.Objectives: (i) To develop a multi-dimension health status classification system (HSCS) to describe pre-school (PS) children 2.5–5 years of age; (ii) to report reliability and validity of the newly developed measure. Design: Existing systems (Health Utilities Index, Mark 2 and 3) were adapted for application to a pre-school population. The new system was tested for acceptability, validity and reliability. Participants: Three cohorts of children and their parents from Canada and Australia were utilized: Cohort 1 (MAC)-101 3-years old very low birthweight (VLBW, < 1500 g) and 50 same age term children from Canada; Cohort 2 (AUS)-150 VLBW 3-years old from Australia; Cohort 3 (OMG)-222 3-years old with cerebral palsy (CP) from Ontario. Methods: Parental intra-rater reliability was evaluated by completion of the HSCS-PS Parent questionnaire (MAC) at the clinic visit and again 14 days later. Health professionals (MAC) completed the HSCS-PS Clinician questionnaire. Percent agreement and Kappa values were used to assess parent-clinician agreement. Concurrent validity was tested in two populations of VLBW children (MAC and AUS) and a reference group of term children (MAC) by exploring the relationships between dimensions of the HSCS-PS and well-recognized norm-referenced measures: the Bayley Scales of Infant Development (BSID-II), the Vineland Adaptive Behavior Scales (VABS) and the Stanford-Binet (SB). Construct validity was tested by comparing ratings on both the HSCS-PS and the Gross Motor Function classification system (GMFCS) using a population of pre-school children with CP. Analyses were done using χ2, ANOVA and correlations with tau-b statistic. Results: The HSCS-PS has 12 dimensions and 3–5 levels per dimension. Response rate for parental intra-rater reliabilitywas 95%, with percent agreement ranging between 86 and 100%. Kappa values for various dimensions ranged from 0.38 to 1.00. Inter-rater reliability between parents and clinicians showed agreement ranging from 72 to 100%. Kappa values ranged from 0.30 to 1.00. Concurrent Validity: There was a statistically significant gradient between HSCS-PS Mobility levels and motor scale scores of the BSID-II and VABS. A significant gradient also occurred when comparing HSCS-PS cognition levels to psychometric scores on the BSID-II and SB, as well as HSCS-PS self-care levels compared to VABS Daily Living scores. Discriminative and Construct validity: Birthweight category was shown to be a significant determinant of proportion of children with multiple HSCS-PS dimensions affected. In addition, HSCS-PS dimension levels were congruent with GMFCS levels where expected: mobility had excellent correlation; self-care, dexterity, speech and cognitive dimensions had moderate correlations. Conclusions: The HSCS-PS is readily accepted, quick to complete, widely applicable and provides a multi-dimensional description of health status. Preliminary assessments of reliability and validity are promising. The HSCS-PS can discriminate across populations by birthweight and shows strong relationships with standardized psychometric measures in comparable domains. It can provide a summary profile of functional limitations in various populations of pre-school children in a consistent manner across programs and in different settings.


Concurrent validity Construct validity Health-related quality of life Health status Health Utilities Index Multi-attribute Reliability Very low birth weight 



Bayley Scales of Infant Development II (revised)


cerebral palsy


Gross Motor Function Classification System


health-related quality of life


health status classification system–pre-school


Health Utilities Index

HUI 2/3

Health Utilities Index Mark 2 and Mark 3


Bayley Mental Development Index


Bayley Psychomotor Development Index


quality adjusted life years




Vineland Adaptive Behaviour Scales


very low birth weight

Copyright information

© Springer 2005

Authors and Affiliations

  • S. Saigal
    • 1
  • P. Rosenbaum
    • 1
  • B. Stoskopf
    • 1
  • L. Hoult
    • 1
  • W. Furlong
    • 2
    • 4
  • D. Feeny
    • 3
    • 4
  • R. Hagan
    • 5
  1. 1.Department of PediatricsMcMaster UniversityHamiltonCanada
  2. 2.Department of Clinical Epidemiology and BiostatisticsMcMaster UniversityHamilton
  3. 3.University of Alberta and Institute of Health EconomicsEdmonton
  4. 4.Health Utilities Inc., Dundas
  5. 5.Department of Neonatal Paediatrics, Centre for Women and Infants HealthPrincess Margaret Hospital, University of Western AustraliaPerth