Quality of Life Research

, Volume 15, Issue 2, pp 203–215 | Cite as

The PedsQLTM 4.0 as a School Population Health Measure: Feasibility, Reliability, and Validity

  • James W. VarniEmail author
  • Tasha M. Burwinkle
  • Michael Seid
Instrument Development and Evaluation


Background: The application of health-related quality of life (HRQOL) as a school population health measure may facilitate risk assessment and resource allocation, the tracking of student health at the school and district level, the identification of health disparities among schoolchildren, and the determination of health outcomes from interventions and policy decisions at the school, district, and county level. Objective:To determine the feasibility, reliability, and validity of the 23-item PedsQLTM 4.0 (Pediatric Quality of Life InventoryTM) Generic Core Scales as a school population health measure for children and adolescents. Design: Survey conducted in 304 classes at 18 elementary schools, 4 middle schools, and 3 high schools within a large metropolitan school district. Methods:The PedsQLTM 4.0 Generic Core Scales (Physical, Emotional, Social, School Functioning) were completed by 2437 children ages 8–18 and 4227 parents of children ages 5–18. Results:The PedsQLTM 4.0 evidenced minimal missing responses, achieved excellent reliability for the Total Scale Score (α = 0.89 child, 0.92, parent report), and distinguished between healthy children and children with chronic health conditions. The PedsQLTM 4.0 was related to indicators of socioeconomic status (SES) at the school and district level. The PedsQLTM School Functioning Scale was significantly correlated with standardized achievement scores based on the Stanford 9. Conclusion: The results demonstrate the feasibility, reliability and validity of the PedsQLTM 4.0 Generic Core Scales as a school population health measure. The implications of measuring HRQOL in schoolchildren at the school, district, and county level for identifying and ameliorating health disparities are discussed.


Health-related quality of life PedsQLTM Schools Socioeconomic status Health Children 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Matza, LS, Swensen, AR, Flood, EM, Secnik, K, Leidy, NK 2004Assessment of health-related quality of life in children: A review of conceptual, methodological, and regulatory issuesValue Health77992CrossRefPubMedGoogle Scholar
  2. 2.
    Drotar, D 2004Measuring child health: Scientific questions, challenges, and recommendationsAmbul Pediatr4353357PubMedGoogle Scholar
  3. 3.
    Eiser, C 2004Use of quality of life measures in clinical trialsAmbul Pediatr4395399CrossRefPubMedGoogle Scholar
  4. 4.
    Koot, HM, Wallander, JL 2001Quality of Life in Child and Adolescent Illness: Concepts, Methods and FindingsBrunner-RoutledgeEast Sussex, UKGoogle Scholar
  5. 5.
    Varni, JW, Burwinkle, TM, Seid, M, Skarr, D 2003The PedsQLTM 4.0 as a pediatric population health measure: Feasibility, reliability, and validityAmbul Pediatr3329341CrossRefPubMedGoogle Scholar
  6. 6.
    Waters, E, Salmon, L, Wake, M 2000The parent-form Child Health Questionnaire in Australia: Comparison of reliability, validity, structure, and normsJ Pediatr Psychol25381391CrossRefPubMedGoogle Scholar
  7. 7.
    Starfield, B, Riley, AW, Green, BF,  et al. 1995The adolescent Child Health and Illness Profile: A population-based measure of healthMed Care33553566PubMedGoogle Scholar
  8. 8.
    Riley, AW 2004Evidence that school-age children can self-report on their healthAmbul Pediatr4371376CrossRefPubMedGoogle Scholar
  9. 9.
    Topolski, TD, Edwards, TC, Patrick, DL 2004Toward youth self-report of health and quality of life in population health monitoringAmbul Pediatr4387394CrossRefPubMedGoogle Scholar
  10. 10.
    McCowan, C, Bryce, FP, Neville, RG, Crombie, IK, Clark, R 1996School absence: A valid morbidity marker for asthmaHealth Bull54307313Google Scholar
  11. 11.
    Weitzman, M 1986School absence rates as outcome measures in studies of children with chronic illnessJ Chron Dis39799808CrossRefPubMedGoogle Scholar
  12. 12.
    Newacheck, PW, Taylor, WR 1992Childhood chronic illness: Prevalence, severity, and impactAm J Public Health82364371PubMedGoogle Scholar
  13. 13.
    McGlynn, EA, Halfon, N 1998Overview of issues in improving quality of care for childrenHealth Ser Res339771000Google Scholar
  14. 14.
    Kaplan, RM 2001Quality of life in children: A health care policy perspectiveKoot, HMWallander, JL eds. Quality of Life in Child and Adolescent Illness Concepts Methods and FindingsBrunner-RoutledgeEast Sussex, Great Britain89120Google Scholar
  15. 15.
    Centers for Disease Control and Prevention2000Measuring Healthy Days: Population Assessment of Health-Related Quality of LifeCDCAtlanta GeorgiaGoogle Scholar
  16. 16.
    Varni, JW, Seid, M, Kurtin, PS 2001The PedsQLTM 4.0: Reliability and validity of the Pediatric Quality of Life InventoryTM Version 4.0 Generic Core Scales in healthy and patient populationsMed Care39800812CrossRefPubMedGoogle Scholar
  17. 17.
    Varni, JW, Burwinkle, TM, Rapoff, MA, Kamps, JL, Olson, N 2004The PedsQLTM in pediatric asthma: Reliability and validity of the Pediatric Quality of Life InventoryTM Generic Core Scales and Asthma ModuleJ Behav Med27297318CrossRefPubMedGoogle Scholar
  18. 18.
    Varni, JW, Burwinkle, TM, Katz, ER, Meeske, K, Dickinson, P 2002The PedsQLTM in pediatric cancer: Reliability and validity of the Pediatric Quality of Life InventoryTM Generic Core Scales, Multidimensional Fatigue Scale, and Cancer ModuleCancer9420902106CrossRefPubMedGoogle Scholar
  19. 19.
    Varni, JW, Seid, M, Knight, TS, Burwinkle, TM, Brown, J, Szer, IS 2002The PedsQLTM in pediatric rheumatology: Reliability, validity, and responsiveness of the Pediatric Quality of Life InventoryTM Generic Core Scales and Rheumatology ModuleArthritis Rheum46714725CrossRefPubMedGoogle Scholar
  20. 20.
    Uzark, K, Jones, K, Burwinkle, TM, Varni, JW 2003The Pediatric Quality of Life InventoryTM in children with heart diseaseProg Pediatr Cardiol18141148Google Scholar
  21. 21.
    Chen, E, Matthews, KA, Boyce, WT 2002Socioeconomic differences in children’s health: How and why do these relationships change with age?Psychol Bull128295329CrossRefPubMedGoogle Scholar
  22. 22.
    Olson, LM, Lara, M, Frintner, MP 2004Measuring health status and quality of life for US children: Relationship to race, ethnicity, and income statusAmbul Pediatr4377386CrossRefPubMedGoogle Scholar
  23. 23.
    Mansour, ME, Kotagal, U, Rose, B,  et al. 2003Health-related quality of life in urban elementary schoolchildrenPediatrics11113721381CrossRefPubMedGoogle Scholar
  24. 24.
    Adler, NE, Boyce, T, Chesney, MA,  et al. 1994Socioeconomic status and health: The challenge of the gradientAm Psychol491524CrossRefPubMedGoogle Scholar
  25. 25.
    Seid, M, Varni, JW, Bermudez, LO,  et al. 2001Parent’s Perceptions of Primary Care: Measuring parent’s experiences of pediatric primary care qualityPediatrics108264270CrossRefPubMedGoogle Scholar
  26. 26.
    Fairclough, DL 2002Design and Analysis of Quality of Life Studies in Clinical Trials: Interdisciplinary StatisticsChapman & Hall/CRCNew YorkGoogle Scholar
  27. 27.
    Ware, JE 1993SF-36 Health Survey: Manual and Interpretation GuideThe Health InstituteBoston, MAGoogle Scholar
  28. 28.
    Fairclough, DL, Cella, DF 1996Functional Assessment of Cancer Therapy (FACT-G): Non-response to individual questionsQual Life Res5321329CrossRefPubMedGoogle Scholar
  29. 29.
    Essink-Bot, ML, Krabbe, PFM, Bonsel, GJ, Aaronson, NK 1997An empirical comparison of four generic health status measures: The Nottingham Health Profile, the Medical Outcomes Study 36-Item Short-Form Health Survey, the COOP/WONCA Charts, and The EuroQol InstrumentMed Care35522537CrossRefPubMedGoogle Scholar
  30. 30.
    McHorney, CA, Ware, JE, Lu, JFR, Sherbourne, CD 1994The MOS 36-item short-form health survey (SF-36): III Tests of data quality, scaling assumptions, and reliability across diverse patient groups.Med Care324066PubMedGoogle Scholar
  31. 31.
    Cronbach, LJ 1951Coefficient alpha and the internal structure of testsPsychometrika16297334Google Scholar
  32. 32.
    Nunnally, JC, Bernstein, IR 1994Psychometric Theory3McGraw-HillNew YorkGoogle Scholar
  33. 33.
    Pedhazur, EJ, Schmelkin, LP 1991Measurement, Design, and Analysis: An Integrated ApproachErlbaumHillsdale, NJGoogle Scholar
  34. 34.
    McHorney, CA, Ware, JE, Raczek, AE 1993The MOS 36-item short-form health survey (SF-36): II Psychometric and clinical tests of validity in measuring physical and mental health constructs.Med Care31247263PubMedGoogle Scholar
  35. 35.
    McHorney, CA, Ware, JE, Rogers, W, Raczek, AE, Lu, JFR 1992The validity and relative precision of MOS short- and long-form health status scales and Dartmouth COOP charts: Results from the Medical Outcomes StudyMed Care30MS253MS265PubMedGoogle Scholar
  36. 36.
    Cohen, J 1988Statistical Power Analysis For the Behavioral Sciences2ErlbaumHillsdale NJGoogle Scholar
  37. 37.
    Bartko, JJ 1966The intraclass correlation coefficient as a measure of reliabilityPsychol Rep19311PubMedGoogle Scholar
  38. 38.
    Wilson, KA, Dowling, AJ, Abdolell, M, Tannock, IF 2001Perception of quality of life by patients, partners and treating physiciansQual Life Res910411052Google Scholar
  39. 39.
    SPSS1998SPSS 8.0 for WindowsSPSS, Inc.ChicagoGoogle Scholar
  40. 40.
    Thompson, RJ, Gustafson, KE 1996Adaptation to Chronic Childhood IllnessAmerican Psychological AssociationWashington DCGoogle Scholar
  41. 41.
    Wallander, JL, Varni, JW 1998Effects of pediatric chronic physical disorders on child and family adjustmentJ Child Psychol Psyc392946Google Scholar
  42. 42.
    Bradley, RH, Corwyn, RF 2002Socioeconomic status and child developmentAnnual Rev Psychol53371399PubMedGoogle Scholar
  43. 43.
    Dillman, DA 2000Mail and Internet Surveys: The Tailored Design Method2WileyNew YorkGoogle Scholar
  44. 44.
    Carman, KL, Short, PF, Farley, DO, Schnaier, MA, Elliott, DB, Gallagher, PM 1999Early lessons from CAHPS demonstrations and evaluationsMed Care37MS97MS105CrossRefPubMedGoogle Scholar
  45. 45.
    Fowler, FJ,Jr., Gallagher, PM, Nederend, S 1999Comparing telephone and mail responses to the CAHPS survey instrumentMed Care37MS41MS49CrossRefPubMedGoogle Scholar
  46. 46.
    Institute of Medicine2004Children’s Health, the Nation’s Wealth: Assessing and Improving Child HealthNational Academies PressWashington, D.C.Google Scholar
  47. 47.
    Fiscella, K, Franks, P, Gold, MR, Clancy, CM 2000Inequality in quality: Addressing socioeconomic, racial, and ethnic disparities in health careJ Am Med Assoc28325792584Google Scholar

Copyright information

© Springer 2006

Authors and Affiliations

  • James W. Varni
    • 1
    • 2
    Email author
  • Tasha M. Burwinkle
    • 3
  • Michael Seid
    • 4
  1. 1.Department of Landscape Architecture and Urban Planning, College of ArchitectureTexas A&M UniversityCollege StationUSA
  2. 2.Department of Pediatrics, College of MedicineTexas A&M UniversityCollege StationUSA
  3. 3.Department of AnesthesiologyUniversity of WashingtonSeattleUSA
  4. 4.RAND HealthSanta MonicaUSA

Personalised recommendations