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Testing the structural and cross-cultural validity of the KIDSCREEN-27 quality of life questionnaire

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Abstract

Objectives

The aim of this study is to assess the structural and cross-cultural validity of the KIDSCREEN-27 questionnaire.

Methods

The 27-item version of the KIDSCREEN instrument was derived from a longer 52-item version and was administered to young people aged 8–18 years in 13 European countries in a cross-sectional survey. Structural and cross-cultural validity were tested using multitrait multi-item analysis, exploratory and confirmatory factor analysis, and Rasch analyses. Zumbo’s logistic regression method was applied to assess differential item functioning (DIF) across countries. Reliability was assessed using Cronbach’s alpha.

Results

Responses were obtained from n = 22,827 respondents (response rate 68.9%). For the combined sample from all countries, exploratory factor analysis with procrustean rotations revealed a five-factor structure which explained 56.9% of the variance. Confirmatory factor analysis indicated an acceptable model fit (RMSEA = 0.068, CFI = 0.960). The unidimensionality of all dimensions was confirmed (INFIT: 0.81–1.15). Differential item functioning (DIF) results across the 13 countries showed that 5 items presented uniform DIF whereas 10 displayed non-uniform DIF. Reliability was acceptable (Cronbach’s α = 0.78–0.84 for individual dimensions).

Conclusions

There was substantial evidence for the cross-cultural equivalence of the KIDSCREEN-27 across the countries studied and the factor structure was highly replicable in individual countries. Further research is needed to correct scores based on DIF results. The KIDSCREEN-27 is a new short and promising tool for use in clinical and epidemiological studies.

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References

  1. World Health Organization Regional Office for Europe (1996). The Ljubljana charter on reforming health care. Paper presented at the Ljubljana Conference, Ljubljana.

  2. Ravens-Sieberer, U., & Bullinger, M. (1998). Assessing health-related quality of life in chronically ill children with the German KINDL: First psychometric and content analytical results. Quality of Life Research, 7, 399–407.

    Article  PubMed  CAS  Google Scholar 

  3. Eiser, C., Havermans, T., Craft, A., & Kernahan, J. (1995). Development of a measure to assess the perceived illness experience after treatment for cancer. Archives of Disease in Childhood, 72, 302–307.

    Article  PubMed  CAS  Google Scholar 

  4. Vogels, T., Verrips, G. H. W., Verloove-Vanhorick, S. P., et al. (1998). Measuring health-related quality of life in children: the development of the TACQOL parent form. Quality of Life Research, 7, 457–465.

    Article  PubMed  CAS  Google Scholar 

  5. Simeoni, M. C., Auquier, P., Antoniotti, S., Sapin, C., & San Marco, J. L. (2000). Validation of a French health-related quality of life instrument for adolescents: The VSP-A. Quality of Life Research, 9, 393–403.

    Article  PubMed  CAS  Google Scholar 

  6. Rajmil, L., Serra-Sutton, V., Fernandez-Lopez, J. A., et al. (2004). [The Spanish version of the German health-related quality of life questionnaire for children and adolescents: The Kindl]. Anales de Pediatría (Barcelona), 60, 514–521.

    Article  CAS  Google Scholar 

  7. Serra-Sutton, V., Herdman, M., Rajmil, L., et al. (2002). [Cross-cultural adaptation to Spanish of the Vecu et Sante Percue de l’Adolescent (VSP-A): A generic measure of the quality of life of adolescents]. Revista Española de Salud Pública, 76, 701–712.

    Article  PubMed  Google Scholar 

  8. Rajmil, L., Herdman, M., De Sanmamed, M. J. F., et al. (2004). Generic health-related quality of life instruments in children and adolescents: A qualitative analysis of content. Journal of Adolescent Health, 34, 37–45.

    Article  PubMed  Google Scholar 

  9. Patrick, D. L., & Chiang, Y. P. (2000). Measurement of health outcomes in treatment effectiveness evaluations: Conceptual and methodological challenges. Medical Care, 38, II14–25.

    PubMed  CAS  Google Scholar 

  10. Schmidt, S., & Bullinger, M. (2003). Current issues in cross-cultural quality of life instrument development. Archives of Physical Medicine and Rehabilitation, 84, S29–S34.

    Article  PubMed  Google Scholar 

  11. Herdman, M., Fox-Rushby, J., & Badia, X. (1998). A model of equivalence in the cultural adaptation of HRQoL instruments: The universalist approach. Quality of Life Research, 7, 323–335.

    Article  PubMed  CAS  Google Scholar 

  12. Ravens-Sieberer, U., Gosch, A., Abel, T., et al. (2001). Quality of life in children and adolescents: A European public health perspective. Sozial-Und Praventivmedizin, 46, 294–302.

    Article  PubMed  CAS  Google Scholar 

  13. Ravens-Sieberer, U., Auquier, P., Erhart, M., et al. The KIDSCREEN-27 quality of life measure for children and adolescents – psychometric results from a cross-cultural survey in 13 European countries. Quality of Life Research. doi: 10.1007/s11136-007-9240-2.

  14. Mokken, R. (1971). A theory and procedure of scale analysis. The Hague: Mouton, Berlin De Gruyter.

    Google Scholar 

  15. Mokken, R., & Lewis, C. (1982). A nonparametric approach to the analysis of dichotomous item responses. Applied Psychological Measurement, 6, 417–430.

    Google Scholar 

  16. Molenaar, I. (1982). Mokken sclaing revisited. Kwantitatieve Methoden, 3, 145–164.

    Google Scholar 

  17. Wright, B., & Masters, G. (1982). Rating scale analysis. Chicago: MESA Press.

    Google Scholar 

  18. Wright, B., & Stone, M. (1979). Best test design. Chicago: MESA Press.

    Google Scholar 

  19. Zumbo, B. (1999). A handbook on the theory and methods of differential item functioning (DIF): Logistic regression modeling as a unitary framework for binary and Likert-type (Ordinal). Item scores. Ottawa, ON: Directorate of Human Resources Research and Evaluation, Department of National Defense.

  20. Ware, J., Harris, W., & Gandek, B. (1997). MAP-R for Windows: Multitrait:multi-item analysis program—Revised user’s guide. Boston, MA: Health Assessment Laboratory.

    Google Scholar 

  21. Thompson, B. (2004). Exploratory and confirmatory factor analysis: Understanding concepts and applications. American Psychological Association.

  22. Rajmil, L., Berra, S., von-Rueden, U., Tebe, C., Erhart, M., Gosh, A., et al. (2004). Representativity of 12 national surveys of children and adolescents 8–18 years old included in the KIDSCREEN HRQOL study. Quality of Life Research, 13(9), 1576.

    Google Scholar 

  23. Veldman, D. (1978). Fortran programming for the behavioural sciences. New York: Holt, Rinehart, & Winston.

    Google Scholar 

  24. Jöreskog, K. (1990). New developments in LISREL: Analysis of ordinal variables using polychoric correlations and weighted least squares. Quality and Quantity, 24, 387–404.

    Article  Google Scholar 

  25. Maruyama, G. (1998). Basic of structural equation modeling. Thousand Oaks, CA: Sage.

    Google Scholar 

  26. Bollen, K., & Long, J. (1993). Alternative ways of assessing model fit. Testing structural equation models. Sage Publications.

  27. Flora, D. B., & Curran, P. J. (2004). An empirical evaluation of alternative methods of estimation for confirmatory factor analysis with ordinal data. Psychological Methods, 9, 466–491.

    Article  PubMed  Google Scholar 

  28. Jöreskog, K. (1971). Simultaneous factor analysis in several populations. Psychometrika,36, 409–426.

    Article  Google Scholar 

  29. Campbell, D., & Fiske, D. (1959). Convergent and discriminant validation by multitrait-multimethod matrix. Psychological Bulletin, 56, 81–105.

    Article  PubMed  CAS  Google Scholar 

  30. McHorney, C. A., Ware, J. E. Jr., Lu, J. F., & Sherbourne, C. D. (1994). The MOS 36-item Short-Form Health Survey (SF-36): III. Tests of data quality, scaling assumptions, and reliability across diverse patient groups. Medical Care, 32, 40–66.

    Article  PubMed  CAS  Google Scholar 

  31. Cronbach, L. (1951). Coefficient alpha and the internal structure of tests. Psychometrika, 16, 297–334.

    Article  Google Scholar 

  32. Nunnally, J., & Bernstein, I. (1994). Psychometric theory. New York: McGraw-Hill, Inc.

    Google Scholar 

  33. Masters, G. (1982). A Rasch model for partial credit scoring. Psychometrika, 47, 149–174.

    Article  Google Scholar 

  34. Mellenbergh, G. (1982). Contingency table models for assessing item bias. Journal of Educational Statistics, 7, 105–107.

    Article  Google Scholar 

  35. Martin, M., Blaisdell, B., Kwong, J. W., & Bjorner, J. B. (2004). The Short-Form Headache Impact Test (HIT-6) was psychometrically equivalent in nine languages. Journal of Clinical Epidemiology, 57, 1271–1278.

    Article  PubMed  Google Scholar 

  36. Linacre, J. (2003). A user guide to Winsteps. Rasch model computer program. Chicago, IL: MESA edition.

    Google Scholar 

  37. Jöreskog, K., & Sörbom, D. (1996). LISREL 8:User’s reference guide. Chicago: Scientific Software International.

    Google Scholar 

  38. Jöreskog, K., & Sörbom, D. (1988). PRELIS – A program for multivariate data screening and data summarization. A preprocessor for LISREL (2nd ed.). Chicago, Il: Scientific Software, Inc.

    Google Scholar 

  39. Ravens-Sieberer, U., Gosch, A., Rajmil, L., et al. (2006). The KIDSCREEN-52 quality-of-life measure for children and adolescents: Psychometric results from a cross-cultural survey in 13 European countries. Expert Review of Pharmacoeconomics & Outcomes Research, 5(3), 353–364.

    Article  Google Scholar 

  40. Warschburger, P., Landgraf, J., Petermann, F., & Freidel, K. (2003). Health-related quality of life in children assessed by their parents: Evaluation of the psychometric properties of the CHQ-PF50 in two German clinical samples. Quality of Life Research, 12, 291–301.

    Article  PubMed  Google Scholar 

  41. Varni, J., Seid, M., & Kurtin, P. (2001). PedsQL 4.0: Reliability and validity of the Pediatric Quality of Life Inventory version 4.0 generic core scales in healthy and patient populations. Medical Care, 39, 800–812.

    Article  PubMed  CAS  Google Scholar 

  42. Gorsuch, R. (1983). Factor analysis. Hillsdale, NJ: Erlbaum.

    Google Scholar 

  43. Hu, L., & Bentler, P. (1995). Evaluating model fit. In R. Hoyle (Ed.), Structural equation modeling: Concepts, Issues, and Applications (pp. 76—99). Thousand Oaks, CA: Sage.

    Google Scholar 

  44. McHorney, C., & Tarlov, A. (1995). Individual-patient monitoring in clinical practice: Are available health status surveys adequate? Quality of Life Research, 4, 293–307.

    Article  PubMed  CAS  Google Scholar 

  45. Scientific Advisory Committee of the Medical Outcomes Trust (2002). Assessing health status and quality-of-life instruments: Attributes and review criteria. Quality of Life Research, 11, 193–205.

    Article  Google Scholar 

  46. Crane, P., Hart, D., Gibbons, L., & Cook, K. (2006). A 37-item shoulder functional status item pool had negligible differential item functioning. Journal of Clinical Epidemiology, 59, 478–484.

    Article  PubMed  Google Scholar 

  47. Erhart, M., Ravens-Sieberer, U., Hagquist, C., Robitail, S., & van Buuren, S. (2006). Does correcting for differential item functioning (DIF) using two different techniques enhances the validity and diagnostic quality of adolescents HRQoL test scores? Quality of Life Research, 15, A113–A114.

    Google Scholar 

Download references

Acknowledgements

Source of support: The KIDSCREEN project was financed by a grant from the European Commission (QLG-CT-2000-00751) within the EC 5th Framework-Programme “Quality of Life and Management of Living Resources”.

Author information

Authors and Affiliations

  1. EA 3279, School of Medicine, Perceived Health Research Unit, Marseille, France

    Stephane Robitail, Marie-Claude Simeoni & Pascal Auquier

  2. School of Public Health, WHO Collaborating Center for Child and Adolescent Health Promotion, University of Bielefeld, Bielefeld, Germany

    Ulrike Ravens-Sieberer

  3. Agency for Quality, Research and Assessment in Health (AQuRAHealth), Barcelona, Spain

    Luis Rajmil

  4. Child Health Unit, Prevention and Physical Activity, TNO Quality of Life, Leiden, The Netherlands

    Jeanet Bruil

  5. Department of Psychiatry, University of Edinburgh, Royal Edinburgh Hospital, Edinburgh, Scotland

    Mick Power

  6. Ludwig Boltzmann-Institute for Sociology of Health and Medicine, University of Vienna, Vienna, Austria

    Wolfgang Duer

  7. Unit for Health Research, Institute for Social and Preventive Medicine, University of Bern, Bern, Switzerland

    Bernhard Cloetta

  8. Prague Psychiatric Center, Prague, Czech Republic

    Ladislav Czemy

  9. Department of Epidemiology, National Research Institute of Mother & Child, Warsaw, Poland

    Joanna Mazur

  10. Health Promotion and Development, Centre Child Health Department, Budapest, Hungary

    Agnes Czimbalmos

  11. Centre for Health Services Research and Hellenic Society for Health Promotion and Education, Athens, Greece

    Yannis Tountas

  12. Karlstad University, Karlstad, Sweden

    Curt Hagquist

  13. HSE, Programme of Action for Children, Dublin, Ireland

    Jean Kilroe

  14. Service de Santé Publique. Faculté de Médecine, 27, bd Jean Moulin, Marseille , 13385, France

    Pascal Auquier

  15. Department of Public Health, Timone University Hospital, Marseilles, France

    Pascal Auquier

Authors
  1. Stephane Robitail
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  2. Ulrike Ravens-Sieberer
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  3. Marie-Claude Simeoni
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  4. Luis Rajmil
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  6. Mick Power
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  7. Wolfgang Duer
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  9. Ladislav Czemy
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  13. Curt Hagquist
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  14. Jean Kilroe
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  15. Pascal Auquier
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the KIDSCREEN Group

Corresponding author

Correspondence to Pascal Auquier.

Additional information

Members of the KIDSCREEN group are: Austria: Wolfgang Duer, Kristina Fuerth; Czech Republic: Ladislav Czerny; France: Pascal Auquier, Marie-Claude Simeoni, Stephane Robitail, Germany: Ulrike Ravens-Sieberer (international coordinator in chief), Michael Erhart, Jennifer Nickel, Bärbel-Maria Kurth, Angela Gosch, Ursula von Rüden; Greece: Yannis Tountas, Christina Dimitrakakis; Hungary: Agnes Czimbalmos, Anna Aszman; Ireland: Jean Kilroe, Eimear Flannery; The Netherlands: Jeanet Bruil, Symone Detmar, Eric Veripps; Poland: Joanna Mazur, Ewa Mierzejeswka; Spain: Luis Rajmil, Silvina Berra, Cristian Tebé, Michael Herdman, Jordi Alonso; Sweden: Curt Hagquist; Switzerland: Thomas Abel, Corinna Bisegger, Bernhard Cloetta, Claudia Farley; United Kingdom: Mick Power, Clare Atherton, Katy Phillips.

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Robitail, S., Ravens-Sieberer, U., Simeoni, MC. et al. Testing the structural and cross-cultural validity of the KIDSCREEN-27 quality of life questionnaire. Qual Life Res 16, 1335–1345 (2007). https://doi.org/10.1007/s11136-007-9241-1

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