2.50
Hdl Handle:
http://hdl.handle.net/10755/211556
Type:
Research Study
Title:
PEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRE: MULTI- OR UNIDIMENSIONAL
Abstract:
Background: Asthma is the most common chronic disease affecting children.  It has been suggested that to gain a full picture of the impact of asthma on children, it is necessary to make direct measurements of quality of life (QOL).  A valid conceptual model to measure QOL in children living with asthma would help providers learn about conditions that have the greatest impact on patients’ lives and help evaluate the relative importance of different approaches to patient care. Juniper and colleagues (1996) developed a conceptual model to measure QOL of children living with asthma, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).  The PAQLQ is a condition-specific questionnaire that assesses the QOL of asthmatic children between the ages of 7 and 17 years.  They proposed that QOL for a child living with asthma has three dimensions: symptoms, emotional function, and activity limitations.  The purpose of this analysis was to test this assumption. Methods:  Phoenix Children’s Hospital operates a mobile asthma clinic for medically underserved, inner-city school age children.  234 English speaking children’s Breathmobile charts were abstracted for this analysis.  The PAQLQ has 23-items that attempt to assess the three domains: symptoms (10 items), emotional function (8 items) and activity limitation (5 items).  Confirmatory factor analysis tests the hypothesis about the structure of the questionnaires and evaluates the extent to which a particular instrument actually measures the construct it is supposed to measure (in this case QOL).  Since validity is concerned with whether a variable measures what it is supposed to measure, confirmatory factor analysis is an appropriate approach to further investigate construct validity.  Confirmatory factor analysis is used when there is hypothesized knowledge of the underlying latent variable structure.  In this case, it has been hypothesized that the PAQLQ is a multidimensional instrument.  Analyses were conducted using MPlus (Muthen & Muthen, 2004). Results:  The overall fit of the three-factor hypothesized model was not acceptable (χ2(167) =390.68, p<.000; CFI = .91; RMSEA = .08; SRMR = .05).  Modification indexes and qualitative itemmetric analyses suggested that this is a unidimensional scale and that two sets of questions were identified as potentially having high correlated residuals due to their almost identical wording and content.   A single factor model was tested allowing for the residuals of items 16 and 20, and items 15 and 19 to correlate.  The fit of the model improved (χ2(168) =280.88, p<.000; CFI = .96; RMSEA = .05; SRMR = .04). Implications:  Confirmatory factor analysis reliably evaluates the structural integrity of a measurement instrument.  The hypothesized measurement structure of the PAQLQ had not been systematically tested previously.  We found problems with the hypothesized three-factor structure; a one-factor structure with the same two correlated residuals to account for wording similarity provided an adequate and parsimonious fit.  Decisions related to treatment, health resource allocations, and interventions are often based on the subscales of PAQLQ-generated data.  This analysis clearly suggests that the PAQLQ should be used only as an overall scale score of QOL for children living with asthma.  Implications will be further discussed.
Keywords:
Pediatric asthma; Quality of life
Repository Posting Date:
20-Feb-2012
Date of Publication:
20-Feb-2012
Other Identifiers:
5470
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typeResearch Studyen_GB
dc.titlePEDIATRIC ASTHMA QUALITY OF LIFE QUESTIONNAIRE: MULTI- OR UNIDIMENSIONALen_GB
dc.identifier.urihttp://hdl.handle.net/10755/211556-
dc.description.abstractBackground: Asthma is the most common chronic disease affecting children.  It has been suggested that to gain a full picture of the impact of asthma on children, it is necessary to make direct measurements of quality of life (QOL).  A valid conceptual model to measure QOL in children living with asthma would help providers learn about conditions that have the greatest impact on patients’ lives and help evaluate the relative importance of different approaches to patient care. Juniper and colleagues (1996) developed a conceptual model to measure QOL of children living with asthma, the Pediatric Asthma Quality of Life Questionnaire (PAQLQ).  The PAQLQ is a condition-specific questionnaire that assesses the QOL of asthmatic children between the ages of 7 and 17 years.  They proposed that QOL for a child living with asthma has three dimensions: symptoms, emotional function, and activity limitations.  The purpose of this analysis was to test this assumption. Methods:  Phoenix Children’s Hospital operates a mobile asthma clinic for medically underserved, inner-city school age children.  234 English speaking children’s Breathmobile charts were abstracted for this analysis.  The PAQLQ has 23-items that attempt to assess the three domains: symptoms (10 items), emotional function (8 items) and activity limitation (5 items).  Confirmatory factor analysis tests the hypothesis about the structure of the questionnaires and evaluates the extent to which a particular instrument actually measures the construct it is supposed to measure (in this case QOL).  Since validity is concerned with whether a variable measures what it is supposed to measure, confirmatory factor analysis is an appropriate approach to further investigate construct validity.  Confirmatory factor analysis is used when there is hypothesized knowledge of the underlying latent variable structure.  In this case, it has been hypothesized that the PAQLQ is a multidimensional instrument.  Analyses were conducted using MPlus (Muthen & Muthen, 2004). Results:  The overall fit of the three-factor hypothesized model was not acceptable (χ2(167) =390.68, p<.000; CFI = .91; RMSEA = .08; SRMR = .05).  Modification indexes and qualitative itemmetric analyses suggested that this is a unidimensional scale and that two sets of questions were identified as potentially having high correlated residuals due to their almost identical wording and content.   A single factor model was tested allowing for the residuals of items 16 and 20, and items 15 and 19 to correlate.  The fit of the model improved (χ2(168) =280.88, p<.000; CFI = .96; RMSEA = .05; SRMR = .04). Implications:  Confirmatory factor analysis reliably evaluates the structural integrity of a measurement instrument.  The hypothesized measurement structure of the PAQLQ had not been systematically tested previously.  We found problems with the hypothesized three-factor structure; a one-factor structure with the same two correlated residuals to account for wording similarity provided an adequate and parsimonious fit.  Decisions related to treatment, health resource allocations, and interventions are often based on the subscales of PAQLQ-generated data.  This analysis clearly suggests that the PAQLQ should be used only as an overall scale score of QOL for children living with asthma.  Implications will be further discussed.en_GB
dc.subjectPediatric asthmaen_GB
dc.subjectQuality of lifeen_GB
dc.date.available2012-02-20T12:02:06Z-
dc.date.issued2012-02-20T12:02:06Z-
dc.date.accessioned2012-02-20T12:02:06Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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