青少年和家长对青少年体重及健康相关生活质量的评估：测量偏差问题
Adolescent body weight and health-related quality of life rated by adolescents and parents: the issue of measurement bias.
作者信息
Gandhi Pranav K, Revicki Dennis A, Huang I-Chan
机构信息
School of Pharmacy, South College, 400 Goodys Ln, Knoxville, TN 37922, USA.
Outcomes Research, Evidera, 7101 Wisconsin Ave., Suite 1400, Bethesda, MD 20814, USA.
出版信息
BMC Public Health. 2015 Nov 30;15:1192. doi: 10.1186/s12889-015-2533-4.
BACKGROUND
Evidence is sparse about whether body weight categories in adolescents are associated with differences in pediatric HRQoL rated by adolescents and parents. Additionally, it is unknown whether HRQoL rated by individuals with different body mass index (BMI) weight categories is psychometrically comparable. This study aimed to assess whether difference in pediatric HRQoL rated by adolescents and their parents was explained by BMI weight status, and to test measurement properties of HRQoL items related to weight categories using differential item functioning (DIF) methodology. DIF refers to the situation when the individuals across subgroups rate an item differently (e.g., item score three by one subgroup and four by another) given the same underlying construct.
METHODS
A cross-sectional study utilizing a sample of parents (n = 323) and their adolescents aged 15-18 years old (n = 323) who enrolled in Florida's Medicaid. Adolescent self-reports and parent proxy-reports of the Pediatric Quality of Life Inventory was adopted to measure pediatric HRQoL. We classified body weight categories as normal weight, overweight, and obesity. A Multiple Indicator Multiple Cause (MIMIC) method was used to assess DIF associated with BMI weight status, especially testing the disparity in the parameters of different weight categories (reference: lower weight category) associated with a response to a HRQoL item conditioning on the same underlying HRQoL. DIF analyses were conducted by adolescent self-reports and parent proxy-reports.
RESULTS
Parents reported lower pediatric HRQoL across all domains than adolescents did. Excess body weight (combined overweight and obese) was significantly associated with a greater discrepancy in the rating of emotional and total functioning between adolescents and parents (p < 0.05). DIF associated with BMI weight categories was identified by two items in adolescent self-reports and five items in parent proxy-reports.
CONCLUSIONS
Adolescents' BMI weight categories significantly contribute to a difference in the rating of pediatric HRQoL by adolescents and parents.
背景
关于青少年的体重类别是否与青少年及家长评定的儿童健康相关生活质量（HRQoL）差异相关的证据稀少。此外，不同体重指数（BMI）体重类别的个体所评定的HRQoL在心理测量学上是否具有可比性尚不清楚。本研究旨在评估青少年及其家长评定的儿童HRQoL差异是否可由BMI体重状况来解释，并使用差异项目功能（DIF）方法检验与体重类别相关的HRQoL项目的测量属性。DIF是指在相同潜在结构的情况下，不同亚组个体对一个项目的评分不同（例如，一个亚组的项目得分为3分，另一个亚组为4分）的情况。
方法
一项横断面研究，样本为参加佛罗里达州医疗补助计划的家长（n = 323）及其15 - 18岁的青少年（n = 323）。采用青少年自我报告和家长代理报告的儿童生活质量量表来测量儿童HRQoL。我们将体重类别分为正常体重、超重和肥胖。采用多指标多原因（MIMIC）方法评估与BMI体重状况相关的DIF，特别是检验在相同潜在HRQoL条件下不同体重类别（参照：较低体重类别）与HRQoL项目反应相关参数的差异。通过青少年自我报告和家长代理报告进行DIF分析。
结果
家长报告的所有领域的儿童HRQoL均低于青少年。超重（超重和肥胖合并）与青少年和家长在情绪功能和总体功能评分上的更大差异显著相关（p < 0.05）。在青少年自我报告中有两个项目以及家长代理报告中有五个项目识别出与BMI体重类别相关的DIF。
结论
青少年的BMI体重类别显著导致青少年和家长对儿童HRQoL评分的差异。
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