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.