Reliability and validity of the Spanish version of the TAPQOL: A health-related quality of life (HRQOL) instrument for 1- to 5-year-old children

https://doi.org/10.1016/j.ijnurstu.2010.09.004Get rights and content

Abstract

Objectives

To evaluate the reliability, and construct validity of the Spanish version of the TNO-AZL preschool children quality of life (TAPQOL).

Methods

A consecutive sample of children (3 months to 5 years old) was recruited from primary care centers and two teaching hospitals in Spain. The TAPQOL and a set of questions related to their child's health status were administered to parents. Clinical diagnoses were collected from clinical records. Principal component analysis (PCA) with varimax rotation was used to analyze the instrument's structure. Effect size (ES) and analysis of variance (ANOVA) were used to analyze differences between subgroups known to be in poor health compared to the healthy subgroup.

Results

A total of 228 children participated in the study (response rate = 95%). Ten of the 12 scales showed more than 30% ceiling effect. All dimensions except one had Cronbach's alpha coefficients greater than 0.7. PCA explained 75% of the variance. Healthy children in general had better scores than the other subgroups. Children at risk of poor health outcomes and those with respiratory problems scored lower in several scales than the healthy subgroup.

Conclusions

Although the Spanish TAPQOL shows a non-negligible ceiling effect, it seems to be a reliable and valid instrument for Spanish infants and toddlers, and with similar psychometric characteristics to the original version. Future studies should try to improve questionnaire's structure and assess its sensitivity to change.

Introduction

Measurement of health-related quality of life (HRQOL) in children has advanced significantly in recent years. A large number of generic and disease-specific HRQOL instruments are now available for pediatric populations (Solans et al., 2008). These instruments have indicated to be useful in the evaluation of health interventions and in monitoring children's health. However, very few include preschool children (Cremeens et al., 2006, Holme et al., 2003, Lawford et al., 2001, Ravens-Sieberer et al., 2001), and the majority present quite variable psychometric properties in younger children.

These limitations may be related to the rapid development of cognitive, motor, and behavioral functions occurring during the first years of life (Behrman et al., 2007), and also the need of collecting information using a proxy-respondent, usually the child's mother or (legal) guardian. Instruments that intend to cover the preschool period should take these factors into account.

The HRQOL instruments most widely used in children younger than 5 and based on proxy report are the Infant and Toddler Quality of Life questionnaire (ITQOL) (Raat et al., 2007), the Pediatric Quality of Life instrument (PedsQL) (Varni et al., 2001), and the TNO-AZL preschool children Quality of Life questionnaire (TAPQOL) (Fekkes et al., 2000, Bunge et al., 2005). PedsQL is addressed to children aged 2 years and older. TAPQOL, a generic instrument originally developed in The Netherlands, is the first multi-dimensional HRQOL measure specifically designed for preschool children aged 1–5 years (Fekkes et al., 2000, Bunge et al., 2005). The theoretical background of the TAPQOL is based on relationships between the concepts of health status and HRQOL. In many studies these two terms are used interchangeably. Health status refers to perceptions of illness and report of health conditions and also participation in developmentally appropriate tasks and activities (Starfield, 1974), while HRQOL includes the physical, psychological, and social domains of health, seen as distinct areas that are influenced by a person's experiences, beliefs, expectations, and perceptions (Testa and Simonson, 1996). The TAPQOL assesses functional problems weighted by the degree to which a child shows negative emotions to such problems. It was also a challenge to develop an instrument able to capture the child's rapid psychomotor and cognitive development during infancy and the preschool years. The TAPQOL was translated and adapted to the Spanish population (Sardón-Prado et al., 2008) according to international guidelines (Beaton et al., 2000, Bullinger et al., 1998). The Spanish version was obtained using the forward-back translation method with expert, bilingual translators. Cognitive debriefing interviews were carried out with four mothers and two fathers with children aged between 16 and 60 months. During the adaptation phase, 4 items needed modification and at the end of the process, 37/43 items were classified as without difficulty in the adaptation. There were no problems of comprehension regarding questionnaire content. The aim of the present study was to evaluate the reliability, and construct validity of the adapted Spanish version of the TAPQOL.

Section snippets

TAPQOL

The TAPQOL is a 43-item questionnaire consisting of 12 multi-item scales that cover the domains of physical, social, cognitive, and emotional functioning. There are three to seven items per scale. Most items include a recall period of 3 months. Reporting of a specific complaint or limitation is scored on a three-point scale (never, occasionally, and often). For seven TAPQOL scales (stomach problems, skin problems, lung problems, sleeping, appetite, motor functioning, and communication), a

Results

The response rate was 95% (n = 228). Questionnaires were mainly administered to mothers (80%) or fathers (12%). The remaining respondents were both parents (6%), other family members or non-family (2%). Boys accounted for 54% of the sample. The premature subsample was younger and had a slightly lower parental level of education than the other groups (Table 1).

Table 2 shows the psychometric characteristics of the Spanish TAPQOL for the overall sample as well as by age group. All scales except

Discussion

The TAPQOL is the first HRQOL instrument addressed to the population of infants and toddlers that has been adapted in Spain. This study demonstrates that the Spanish version of the TAPQOL achieved reliability and validity coefficients similar to the original version, thereby providing evidence of the overall equivalence of the Spanish version to the original instrument. The psychometric properties of the adapted Spanish version also suggest that it may be useful to assess health and health care

Acknowledgments

The study was partially financed by a grant from Abbott Spain Laboratories. The study was written with full investigator access to all relevant data. The sponsor has not exerted editorial influence over the written text.

Conflict of interest: None declared.

Funding: The study was partially financed by a grant from Abbott Spain Laboratories.

Ethical approval: All procedures were carried out following the data protection requirements of the European Parliament (Council Directive 95/46/EC of 24

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