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The proxy problem: Child report versus parent report in health-related quality of life research

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Author: Theunissen, N.C.M. · Vogels, T.G.C. · Koopman, H.M. · Verrips, G.H.W. · Zwinderman, K.A.H. · Verloove-Vanhorick, S.P. · Wit, J.M.
Institution: TNO Preventie en Gezondheid
Source:Quality of Life Research, 5, 7, 387-397
Identifier: 234576
doi: DOI:10.1023/A:1008801802877
Keywords: Health · Child report · Health status · Health-related quality of life · Parent report · Proxy · Adult · Child · Evaluation Studies · Female · Health Status Indicators · Humans · Linear Models · Male · Parent-Child Relations · Quality of Life · Questionnaires · Sick Role


This study evaluates the agreement between child and parent reports on children's health-related quality of life (HRQoL) in a representative sample of 1,105 Dutch children (age 8-11 years old). Both children and their parents completed a 56 item questionnaire (TACQOL). The questionnaire contains seven eight-item scales: physical complaints, motor functioning, autonomy, cognitive functioning, social functioning, positive emotions and negative emotions. The Pearson correlations between the child and parent reports were between 0.44 and 0.61 (p < 0.001). The intraclass correlations were between 0.39 and 0.62. On average, the children reported a significantly lower HRQoL than their parents on the physical complaints, motor functioning, autonomy, cognitive functioning and positive emotions scales (paired t-test: p < 0.05). Agreement on all of the scales was related to the magnitude of the HRQoL scores and to some background variables (gender, age, temporary illness and visiting a physician). According to multitrait-multimethod analyses, both the child and parent reports proved to be valid.