Quality of life in childhood.

The aim of this thesis was to develop a child self-report quality of life (QOL) measure
for children below eight years. Two questions were central to the development of our
instrument. First, can children below eight years self-report on their thoughts, feelings,
and lives? Second, if so what are the best ways to gain self-reports from children? In
answering these questions, we produced a set of guidelines that can be applied by
researchers developing self-report measures for children.
Studies 1 and 2 report the initial validation of our child self-report QOL measure (the
teddy bear QOL measure, TedQL.l & 2). In Study 1, children's TedQL.l scores were
positively correlated to their scores on an established measure (the PedsQLTM4.0). In
Study 2, the response scale used to complete TedQL.2 items impacted on the
psychometric properties of our measure. Study 3 reported further development of the
content of our measure, using interview data from children about their lives. Based on
the results of Study 3, a new version of our measure was developed (due to deletion,
alteration, and addition of items).
Study 4 established the most appropriate response scale for the TedQL.4, by comparing
the psychometric properties of children's responses to TedQL.3 items across three
response scales. Study 4 showed that children used concrete examples of specific
situations to answer the TedQL.3 items, which may explain why young children's self reports
are less stable over time compared to older children. The analysis in Study 4
revealed eight items that could be removed from the TedQL.3. Study 5 reported further
validation of the child and parent versions of the TedQL.4. Both children's and parent's
TedQLA scores were correlated to their PedsQLTM4.0 scores. No relations between
child and parent rated child QOL were found for the PedsQLTM4.0 scores, however
children's and parent's TedQL.4 scores were correlated across some of their scores.
This thesis has shown the importance of gaining self-reports from children themselves,
, and highlighted the best methods to use for such instruments. The applications of our
TedQL measure have been discussed in the concluding section.