Tang Tracy C W, Wong Mun, Li Jian-Bin, Chan Derwin K C
The Education University of Hong Kong, Hong Kong, China.
Qual Life Res. 2025 May 15. doi: 10.1007/s11136-025-03988-x.
This 3-study paper aimed to develop and validate a self-reported Health-Related Quality of Life Pictorial Inventory for Early Childhood Children (HEALTH-PIC). The scale was designed to overcome existing barriers of parent-proxy response styles such as observation bias and offer an alternative to age-suited literary questionnaires to assess self-reported health-related quality of life, including physical health, emotional health, social health and school health in early childhood.
Each study targeted a specific aspect of scale development, employing distinct samples to refine and validate the inventory. Study 1 involved item development/revision, which utilized a panel of 10 experts (Mean = 34.8, SD = 4.9) and 25 parents (Mean = 38.9; SD = 4.1) via the Delphi method to revise the scale and establish agreement. Study 2 is a cross-sectional study that invited a sample of 22 primary school students (Mean = 6.18, SD = 0.39) and 20 kindergarten students (Mean = 4.55, SD = 0.50) to establish face validity amongst primary respondents. Finally, Study 3 is a cross-sectional study that invited 342 parent and child (Mean = 6.30, SD = 1.31) dyads to complete the HEALTH-PIC and reference health-related quality of life (HRQoL) questionnaires to establish the questionnaire's factorial, concurrent, discriminant and criterion validity in addition to internal consistency.
Scale items in Study 1 were developed alongside experts and parents with a strong theoretical and statistical support calculated using Aiken's agreement (Aiken's V p < 0.05), ensuring that the items were clear, accurate and applicable for children. In Study 2, we ensured that primary respondents of different ages were able to accurately identify the pictorial images (Aiken's V p < 0.05) and complete the questionnaire when the scripted instructions were read aloud. In Study 3, structural equation modelling of the HEALTH-PIC demonstrated a robust factor structure (CFI and TLI > 0.99; RMSEA and SRMR ≤ 0.08), concurrent validity, discriminant validity, criterion validity and an acceptable level of internal consistency (i.e., Cronbach's α = 0.60-0.66).
The findings of the three studies provide preliminary evidence to support the content validity and construct validity of the HEALTH-PIC. This novel pictorial scale not only provides a reliable and valid assessment of the multidimensional aspects of health-related quality of life among children but can also overcome existing barriers of parent-proxy or age-suited questionnaires.
这篇由三项研究组成的论文旨在开发并验证一份针对幼儿的自我报告式健康相关生活质量图片量表（HEALTH-PIC）。该量表旨在克服诸如观察偏差等家长代理应答方式存在的现有障碍，并为适合年龄的文字问卷提供一种替代方法，以评估自我报告的健康相关生活质量，包括幼儿期的身体健康、情绪健康、社会健康和学校健康。
每项研究针对量表开发的一个特定方面，采用不同样本对量表进行完善和验证。研究1涉及项目开发/修订，通过德尔菲法利用10名专家（平均年龄 = 34.8岁，标准差 = 4.9岁）和25名家长（平均年龄 = 38.9岁；标准差 = 4.1岁）组成的小组来修订量表并达成共识。研究2是一项横断面研究，邀请了22名小学生（平均年龄 = 6.18岁，标准差 = 0.39岁）和20名幼儿园学生（平均年龄 = 4.55岁，标准差 = 0.50岁）的样本，以在主要应答者中建立表面效度。最后，研究3是一项横断面研究，邀请了342对亲子（平均年龄 = 6.30岁，标准差 = 1.31岁）完成HEALTH-PIC和参考健康相关生活质量（HRQoL）问卷，以建立问卷的因子效度、同时效度、区分效度、效标效度以及内部一致性。
研究1中的量表项目是在专家和家长的共同参与下开发的，具有强大的理论和统计支持，使用艾肯一致性系数计算（艾肯Vp < 0.05），确保项目清晰、准确且适用于儿童。在研究2中，我们确保不同年龄的主要应答者能够准确识别图片（艾肯Vp < 0.05），并在大声朗读脚本说明时完成问卷。在研究3中，HEALTH-PIC的结构方程模型显示出稳健的因子结构（CFI和TLI > 0.99；RMSEA和SRMR ≤ 0.08）、同时效度、区分效度、效标效度以及可接受的内部一致性水平（即，克朗巴哈α系数 = 0.60 - 0.66）。
三项研究的结果提供了初步证据，支持HEALTH-PIC的内容效度和结构效度。这种新颖的图片量表不仅为儿童健康相关生活质量的多维度方面提供了可靠有效的评估，还能克服家长代理或适合年龄问卷的现有障碍。
