Quality of Life Research

, Volume 25, Issue 10, pp 2523–2533 | Cite as

Comparability of the Patient-Reported Outcomes Measurement Information System Pediatric short form symptom measures across culture: examination between Chinese and American children with cancer

  • Yanyan Liu
  • Changrong Yuan
  • Jichuan Wang
  • Jeanne Geiger Brown
  • Fen Zhou
  • Xiufang Zhao
  • Min Shen
  • Pamela S. Hinds



Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric forms measure symptoms and function of pediatric patients experiencing chronic disease by using the same measures. Comparability is one of the most important purposes of the PROMIS initiative. This study aimed to test the factorial structures of four symptom measures (i.e., Anxiety, Depression, Fatigue, and Pain Interference) in the original English and the Chinese versions and examine the measurement invariance of the measures across two cultures.


Four PROMIS Pediatric measures were used to assess symptoms, respectively, in Chinese (n = 232) and American (n = 200) children and adolescents (8–17 years old) in treatment for cancer or in survivorship. The categorical confirmatory factor analysis (CCFA) model was used to examine factorial structures, and multigroup CCFA was applied to test measurement invariance of these measures between the Chinese and American samples.


The CCFA models of the four PROMIS Pediatric symptom measures fit the data well for both the Chinese and American children and adolescents. Minor partial measurement invariance was identified. Factor means and factor variances of the four PROMIS measures were not significantly different between the two populations.


Our results provide evidence that the four PROMIS Pediatric symptom measures have valid factorial structures and a statistical property of measurement invariance across American and Chinese children and adolescents with cancer. This means that the items of these measures were interpreted in a conceptually similar manner by two groups. They could be readily used for meaningful cross-cultural comparisons involving pediatric oncology patients in these two countries.


PROMIS Pediatric Measurement invariance Categorical confirmatory factor analysis (CCFA) Cancer Culture 



The Chinese study was supported by the National Natural Science Foundation of China (Project No. 71473262) and the Oncology Nursing Society (ONS) Foundation and China Scholarship Council (No. 201406580007). The America study (PROMIS®) was funded with cooperative agreements from the National Institutes of Health (NIH) Common Fund Initiative (Northwestern University, PI: David Cella, PhD, U54AR057951, U01AR052177; Northwestern University, PI: Richard C. Gershon, PhD, U54AR057943; American Institutes for Research, PI: Susan (San) D. Keller, PhD, U54AR057926; State University of New York, Stony Brook, PIs: Joan E. Broderick, PhD and Arthur A. Stone, PhD, U01AR057948, U01AR052170; University of Washington, Seattle, PIs: Heidi M. Crane, MD, MPH, Paul K. Crane, MD, MPH, and Donald L. Patrick, PhD, U01AR057954; University of Washington, Seattle, PI: Dagmar Amtmann, PhD, U01AR052171; University of North Carolina, Chapel Hill, PI: Harry A. Guess, MD, PhD (deceased), Darren A. DeWalt, MD, MPH, U01AR052181; Children’s Hospital of Philadelphia, PI: Christopher B. Forrest, MD, PhD, U01AR057956; Stanford University, PI: James F. Fries, MD, U01AR052158; Boston University, PIs: Alan Jette, PT, PhD, Stephen M. Haley, PhD (deceased), and David Scott Tulsky, PhD (University of Michigan, Ann Arbor), U01AR057929; University of California, Los Angeles, PIs: Dinesh Khanna, MD (University of Michigan, Ann Arbor) and Brennan Spiegel, MD, MSHS, U01AR057936; University of Pittsburgh, PI: Paul A. Pilkonis, PhD, U01AR052155; Georgetown University, PIs: Carol. M. Moinpour, PhD (Fred Hutchinson Cancer Research Center, Seattle) and Arnold L. Potosky, PhD, U01AR057971; Children’s Hospital Medical Center, Cincinnati, PI: Esi M. Morgan DeWitt, MD, MSCE, U01AR057940; University of Maryland, Baltimore, PI: Lisa M. Shulman, MD, U01AR057967; and Duke University, PI: Kevin P. Weinfurt, PhD, U01AR052186). NIH Science Officers on this project have included Deborah Ader, PhD, Vanessa Ameen, MD (deceased), Susan Czajkowski, PhD, Basil Eldadah, MD, PhD, Lawrence Fine, MD, DrPH, Lawrence Fox, MD, PhD, Lynne Haverkos, MD, MPH, Thomas Hilton, PhD, Laura Lee Johnson, PhD, Michael Kozak, PhD, Peter Lyster, PhD, Donald Mattison, MD, Claudia Moy, PhD, Louis Quatrano, PhD, Bryce Reeve, PhD, William Riley, PhD, Peter Scheidt, MD, Ashley Wilder Smith, PhD, MPH, Susana Serrate-Sztein, MD, William Phillip Tonkins, DrPH, Ellen Werner, PhD, Tisha Wiley, PhD, and James Witter, MD, PhD. The contents of this article use data developed under PROMIS. These contents do not necessarily represent an endorsement by the US Federal Government or PROMIS. See for additional information on the PROMIS® initiative.

Compliance with ethical standards

Conflict of interest

The authors have no conflict of interest to disclose.

Ethical approval

All the studies conducted in China and USA have got the ethical approval from the hospitals and institutions. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee.

Informal consent

Informed consent was obtained from all individual participants included in this study.


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Yanyan Liu
    • 1
  • Changrong Yuan
    • 1
  • Jichuan Wang
    • 2
    • 3
  • Jeanne Geiger Brown
    • 4
  • Fen Zhou
    • 5
  • Xiufang Zhao
    • 6
  • Min Shen
    • 7
  • Pamela S. Hinds
    • 3
    • 8
  1. 1.School of NursingSecond Military Medical UniversityShanghaiChina
  2. 2.Division of Biostatistics and Study Methodology, Center for Translational ScienceChildren’s National Health SystemWashingtonUSA
  3. 3.School of MedicineThe George Washington UniversityWashingtonUSA
  4. 4.Department of Family and Community HealthUniversity of Maryland School of NursingBaltimoreUSA
  5. 5.Department of Hematology and OncologyShanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of MedicineShanghaiChina
  6. 6.Nursing DepartmentWest China Second University Hospital Affiliated to Sichuan UniversitySichuanChina
  7. 7.Nursing DepartmentChildren’s Hospital of Soochow UniversitySuzhouChina
  8. 8.Department of Nursing Research and Quality Outcomes, Center for Translational ScienceChildren’s National Health SystemWashingtonUSA

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