title: Pediatric health-related quality of life: a structural equation modeling approach.
abstract: OBJECTIVE
  One of the most referenced theoretical frameworks to measure Health Related Quality of Life (HRQoL) is the Wilson and Cleary framework. With some adaptions this framework has been validated in the adult population, but has not been tested in pediatric populations. Our goal was to empirically investigate it in children.
  
  
  METHODS
  The contributory factors to Health Related Quality of Life that we included were symptom status (presence of chronic disease or hospitalizations), functional status (developmental status), developmental aspects of the individual (social-emotional) behavior, and characteristics of the social environment (socioeconomic status and area of education). Structural equation modeling was used to assess the measurement structure of the model in 214 German children (3-5 years old) participating in a follow-up study that investigates pediatric health outcomes.
  
  
  RESULTS
  Model fit was χ2 = 5.5; df = 6; p = 0.48; SRMR  = 0.01. The variance explained of Health Related Quality of Life was 15%. Health Related Quality of Life was affected by the area education (i.e. where kindergartens were located) and development status. Developmental status was affected by the area of education, socioeconomic status and individual behavior. Symptoms did not affect the model.
  
  
  CONCLUSIONS
  The goodness of fit and the overall variance explained were good. However, the results between children' and adults' tests differed and denote a conceptual gap between adult and children measures. Indeed, there is a lot of variety in pediatric Health Related Quality of Life measures, which represents a lack of a common definition of pediatric Health Related Quality of Life. We recommend that researchers invest time in the development of pediatric Health Related Quality of Life theory and theory based evaluations.
authors.affiliation: Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Ester
authors.initials: E
authors.lastname: Villalonga-Olives
authors.affiliation: Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts, United States of America.
authors.forename: Ichiro
authors.initials: I
authors.lastname: Kawachi
authors.affiliation: Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Josué
authors.initials: J
authors.lastname: Almansa
authors.affiliation: Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Witte
authors.affiliation: Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Lange
authors.affiliation: Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Christiane
authors.initials: C
authors.lastname: Kiese-Himmel
authors.affiliation: Institute of Medical Psychology and Medical Sociology, Georg-August-University Göttingen, Göttingen, Germany.
authors.forename: Nicole
authors.initials: N
authors.lastname: von Steinbüchel
mesh_terms: D002669:Child Welfare / Q000706:statistics & numerical data*; D002673:Child, Hospitalized / Q000706:statistics & numerical data; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006306:Health Surveys / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D011788:Quality of Life; D012923:Social Class; D011795:Surveys and Questionnaires