Giving voice to the child perspective: psychometrics and relative precision findings for the Child Health Questionnaire self-report short form (CHQ-CF45)
To derive and evaluate a shorter self-report Child Health Questionnaire (CHQ) legacy measure for use in research and clinical trials/care.
Stepwise regression, factor analysis, and item scaling principles were used to derive and guide item selection, using data from a large general sample in the Netherlands (n = 933). Feasibility was assessed in a school sample (n = 114) and item internal consistency, discriminant validity, floor, and ceiling effects were evaluated using an external larger validation sample in the US (n = 1468). Reliabilities were estimated using Cronbach’s alpha. Relative precision (RP), the ability to distinguish between clinical subgroups, was computed by comparing the proportion of variance explained by the short-form scales vs. respective full-length scales.
The CHQ-CF was reduced from 87 to 45 items. The median alpha coefficient was 0.89. Ninety-seven to 100% scaling successes for item discriminant validity were observed. Floor effects were not observed; some ceiling effects were detected. RP estimates ranged from 0.73 to 1.37.
The CHQ-SF45 is reliable and valid and exceeds item level scaling criteria.
KeywordsPsychometrics Children Adolescents Health-related Quality of life PRO Child-centered
The principal author would like to thank Suzanne Fitch, D. Ed., Mr. Mike Collins, P., teachers, and parents for their overwhelming support for this work and most especially, the students for their enthusiastic participation and insights.
Compliance with ethical standards
Conflict of interest
None of the authors received financial compensation for this work nor do they have a conflict of interest to report. Ms. Landgraf is the Vice President and Chief Scientific Officer at HealthActCHQ, Inc., which owns the intellectual property rights to the CHQ-CF45.
- 3.Landgraf, J. M., Maunsell, E., Nixon-Speechley, K. N., Bullinger, M., Campbell, S., Abetz, L., & Ware, J. E. (1998). Canadian-French, German and United Kingdom versions of the Child Health Questionnaire (CHQ-PF50): Methodology and preliminary item scaling results. Quality of Life Research, 7(5), 433–445.CrossRefPubMedGoogle Scholar
- 4.Drotar, D. (1998). Measuring health-related quality of life in children and adolescents: Implications of research and practice. New Jersey: Lawrence Erlbaum Associates.Google Scholar
- 8.Landgraf, J. M. & Abetz, L. (1996). Measuring health outcomes in pediatric populations: Issues in psychometrics and application. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (pp. 793–802). Philadelphia: Lipincott-Raven.Google Scholar
- 9.Landgraf, J. M. (2005). Practical considerations in the measurement of health-related quality of life in child/adolescent clinical trials. In P. Fayers & R. D. Hays (Eds.), Eds.), Assessing the quality of life in clinical trials (2nd edn., pp. 339–356). Oxford: Oxford University Press.Google Scholar
- 11.Olson, L. M., Radecki, L., Frintner, M. P., Weiss, K. B., Korfmacher, J., & Siegel, R. M. (2007). At what age can children report dependably on their asthma health status. Pediatrics, 119(1), e93–e102.Google Scholar
- 14.Bevans, K. B., Riley, A. W., Landgraf, J. M., Carle, A. C., Teneralli, R. E., Fiese, B. H., Meltzer, L. J., Ettinger, A. K., Becker, B. D., & Forrest, C. B. (2017). Children’s family experiences: Development of the PROMIS® pediatric family relationships measures. Quality of Life Research, 26, 3011. https://doi.org/10.1007/s11136-017-1629-y. (Epub ahead of print).CrossRefPubMedGoogle Scholar
- 15.Pediatric Patient Reported Outcomes in Chronic Diseases (PEPR) https://www.peprconsortium.org/. Accessed 10 Jan 2018.
- 16.Environmental Influences on Child Health Outcomes (ECHO) Program https://www.nih.gov/echo. Accessed 10 Jan 2018.
- 17.Landgraf, J. M., Abetz, L., & Ware, J. E. (1996). The Child Health Questionnaire (CHQ): A user’s manual. Boston, MA: The Health Institute, New England Medical Center.Google Scholar
- 18.https://www.healthactchq.com/bibliographies.php. Accessed 10 Jan 2018.
- 19.Wild, D., Grove, A., Martin, M., Eremenco, S., McElroy, S., Verjee-Lorenz, A., & Erikson, P. (2005). Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: Report of the ISPOR task force for translation and cultural adaptation. Value in Health, 8(2):94–104.CrossRefPubMedGoogle Scholar
- 21.de Wit, M., Delemarre-van de Waal, H. A., Bokma, J. A., Haasnoot, K., Houdijk, M. C., Gemke, R. J., & Snoek, F. J. (2007). Self-report and parent-report of physical and psychosocial well-being in Dutch adolescents with type 1 diabetes in relation to glycemic control. Health Quality of Life Outcomes, 5, 10.CrossRefPubMedGoogle Scholar
- 22.Buysse, C. M., Raat, H., Hazelzet, J. A., Hop, W. C., Maliepaard, M., & Joosten, K. F. (2007). Long-term health-related quality of life in survivors of meningococcal septic shock in childhood and their parents. Quality of Life Research, 16, 1567–1576. https://doi.org/10.1007/s11136-007-9271-8.CrossRefPubMedGoogle Scholar
- 24.Hosli, E. J., Detmar, S. B., Raat, H., Bruil, J., Vogels, T. G. C., & Verrips, E. H. W. (2007). Reliability, validity, and structure of the self-report form of the Child Health Questionnaire (CHQ-CF87) in a Dutch adolescent population. Expert Review of Pharmacoeconomics & Outcomes Research, 7(4), 393–401. ( https://doi.org/10.1586/1473718.104.22.1683).CrossRefGoogle Scholar
- 25.Raat, H., Mangunkusumo, R. T., Landgraf, J. M., Kloek, G., & Brug, J. (2007). Feasibility, reliability and validity of adolescent health status measurement by the Child Health Questionnaire Child Form (CHQ-CF87): Internet administration compared with the standard paper version. Quality of Life Research, 16, 675–685.CrossRefPubMedPubMedCentralGoogle Scholar
- 26.Coons, S. J., Gwaltney, C. J., Hays, R. D., Lundy, J. J., Sloan, J. A., Revicki, D. A., Lenderkinbg, W. R., Cella, D., & Basch, E. on behalf of the ISPOR ePRO Task Force. (2009). Recommendations on evidence needed to support measurement equivalence between electronic and paper-based patient reported outcome (PRO) measures: ISPOR ePRP good research practices task force report. Value in Health 12 (4):419–429.CrossRefPubMedGoogle Scholar
- 27.World Health Organization. (1948). Constitution of the World Health Organization. Geneva: WHO Basic Documents.Google Scholar
- 28.Landgraf, J. M., Vogel, I., Oostenbrink, R., van Baar, M. E., & Raat, H. (2013). Parent-reported health outcomes in infants/toddlers: Measurement properties and clinical validity of the ITQOL-SF47. Quality of Life Research, 22(3), 635–646. https://doi.org/10.1007/s11136-012-0177-8. (Epub 2012 April).CrossRefPubMedGoogle Scholar
- 31.HealthActCHQ. (2018). CHQ-CF45 scoring manual. Boston, MA: HealthActCHQ.Google Scholar
- 32.Ware, J. E., Harris, W. J., Gandek, B., Rogers, B. W., & Reese, P. R. (1997). MAPR for windows version 1.1. Boston, MA: Health Assessment Lab.Google Scholar
- 34.The GfK Group Confidential Proprietary Project Report for the HealthActCHQ (HACHQ) Norming Surveys (2015). GfK: East Hanover, NJ; HACHQ: Boston, MA.Google Scholar
- 35.HealthActCHQ Inc (2018). CHQ-CF45 US Norms. Boston, MA, USA: HealthActCHQ, Inc.Google Scholar
- 37.Nunnally, J. C., & Bernstein, I. H. (1994). Psychometric theory (3rd edn.). New York: McGraw-Hill.Google Scholar
- 40.Lapp, D., Flood, J., Brock, C. H., & Fisher, D. (2007). Teaching reading to every child (4th edn.). New York: Routledge Taylor and Francis Group.Google Scholar