Health-related Quality Of Life And Subjective Well-being Among Children Aged 9-12 Years In Shandong Province

BackgroundHealth Related quality of Life(HRQoL)can comprehensively reflect the health status of individuals or groups from multiple dimensions such as physiology,psychology and society.As a subjective and overall concept,subjective well-being(SWB)has a meaning beyond health-related quality of life,and the two can be used as complementary measurements.Children aged 9-12 are in the early stage of puberty,experiencing physical growth,sexual organ development and accelerated social and psychological development.Under the influence of physical,psychological and social environment,they may face a series of physical health and social and psychological problems,which will affect their quality of life and happiness.Therefore,it is of great significance to study the health-related quality of life and subjective well-being of children.ObjectivesThis study aims to measure the health-related quality of life and subjective well-being of children aged 9-12 in Shandong Province from the perspectives of children and parents,further verify the psychometric characteristics of CHU9D instruments in children in eastern China,to assess and compare the agreement on HRQoL and SWB instruments;and then to examine concordance within parent-child dyads.In order to provide basic data support for the selection of measuring tools and methods of children’s health-related quality of life and subjective well-being.MethodsThis study is a cross-sectional study design,on June 6,2018-August with multi-stage random sampling method.From the southeast of Shandong province(Linyi),middle(Jinan),northeast(Yantai)randomly select a county/district of a city,each county/district randomly select a comprehensive school,every 4 to 6 grade in randomly selected two classes,The sample class of children and their parents were surveyed by questionnaire,divided into two versions:children and parents.Health-related quality of life(HRQoL)was measured by CHU9D and PedsQLTM4.0,while subjective well-being(SWB)was measured by SLSS.Social demographic characteristics of children and parents were collected,810 children and 810 parents were surveyed.The questionnaire for children is organized by the head teacher and filled out in the classroom environment,while the questionnaire for parents is organized and filled out in the parent meeting.ResultsA total of 799 children and 643 parents were included in the analysis.The ratio of male to female is basically the same,the number of rural residents is higher than that of urban residents,the number of non-only-child is slightly more,and 93.0%of children’s self-reported overall health level is "good" or above.Their parents’ marital status is good,and most of them have junior high school education(32.2%).The utility value score of CHU9D based on the utility value scoring system of four countries(England,Australia,Netherlands and China)was 0.90±0.09,0.86±0.14,0.88±0.16 and 0.87±0.12,respectively.PedsQL scale scores reported by children and parents were 83.47±13.45 and 68.61±18.23,respectively,and SLSS scores reported by children and parents were 30.90±5.85 and 31.23±4.57,respectively.There was a moderate correlation between HRQoL intruments(CHU9D&PedsQL,r=0.52),and a weak correlation between HRQoL and SWB intruments(CHU9D&SLSS,r=0.27;SLSS&PedsQL,r=0.30),and exploratory factor analysis results showed that the HRQoL and SWB intruments were complementary rather than substitutive.Kappa test results showed that the concordance between parents and children was low in most domains(Kappa<0.2);The concordance of physiological function between father and child(0.063)was higher than that between mother(0.052).In other dimensions,the concordance between mother and child was slightly higher than that between father and child.ConclusionsThe main conclusions of the study include:the overall health status of the sample population is good,and the CHU9D instruments has good psychometric characteristics,which can be used to measure the health-related quality of life of mainland children;HRQoL and SWB instruments were complementary.There are differences in the concordance of child reports and parental reports,and mothers may be better surrogates than fathers.Based on these conclusions,it is suggested that future research should focus on children’s self-reported health outcomes,supplemented by parental reports in some special cases,which is of great significance for improving children’s quality of life.