Author: Chan, Wing Wai
Title: Translation and cross-cultural adaptation of promis paediatric-25 profile v2.0 for children with cancer in Hong Kong
Advisors: Wong, Arnold (RS)
Pang, Marco (RS)
Degree: DHSc
Year: 2020
Subject: Chronic diseases in children
Clinical health psychology
Quality of life
Hong Kong Polytechnic University -- Dissertations
Department: Faculty of Health and Social Sciences
Pages: xv, 162 pages
Language: English
Abstract: Background: Childhood cancer has increasingly drawn global attention due to its poor prognosis and high morbidity among children. The incidence of American childhood cancer aged under 20 years is 15.3 cases per 100,000 person-years (approximately 1 case in every 6,500 children). It is well known that cancer treatments have significant adverse effects on the physical and psychosocial health of children with cancer. Therefore, it is crucial to have a reliable and valid instrument to accurately assess their Health-related Quality of Life (HRQOL). PROMIS Paediatric-25 Profile version 2.0 (PROMIS-25) is a validated self-reported instrument to assess HRQOL in children with chronic diseases (e.g., asthma) and cancers (e.g., leukemia). It comprises of physical function, anxiety, depressive symptoms, fatigue, peer relationships and pain interference domains. However, no research has culturally adapted PROMIS-25 for evaluating HRQOL of Chinese children with cancer. Objectives: The aims of this study were to (1) translate and adapt the English version of the PROMIS-25 into traditional Chinese; (2) test its psychometric properties; and (3) determine the Minimal Important Difference (MID) of each domain of Chinese PROMIS-25 among Chinese children. Methods: An established translation procedure (including forward and backward translation, and a pilot testing through cognitive debriefing interviews) was adopted to translate PROMIS-25. Three panel members evaluated the semantic equivalence score and content validity index. The translated questionnaire was validated on 103 Chinese children undergoing cancer treatment (10 to 18 years) in a local public hospital. Structural validity was assessed by Rasch principal component analysis of residuals and item fit statistics. Convergent and divergent validity were assessed by the correlations between Chinese PROMIS-25 domains and Numerical Pain Rating Scale (NPRS), Patient Health Questionnaire-9 (PHQ-9) and Paediatric Quality of Life InventoryTM 4.0 (PedsQL 4.0) domains (i.e., physical, emotional, social, school functioning). The test-retest reliability and internal consistency were examined by Intraclass Correlation Coefficient (ICC) and Cronbach's alpha respectively. The responsiveness of Chinese PROMIS-25 was tested against 24 predefined hypotheses that stated the anticipated magnitudes and directions of correlation between Chinese PROMIS-25 domains and NPRS, PHQ-9 and PedsQL 4.0 domains following the cancer treatment. The Minimal Important Difference (MID) of each PROMIS-25 domain was determined using anchored-based method (using Numeric Global Rating of Change Scale as an anchor), Receiver Operating Curve (ROC) analysis method, and distribution-based method.
Results: The semantic equivalence score and content validity index of PROMS-25 were both 100%. Rasch analysis supported the unidimensionality of each of the six PROMIS-25 domains (the total variance of each domain: >55.5%; Eigenvalue of the first contrast of each domain: <2.0). All items showed acceptable item fit statistics (between 0.6 and 1.4). For convergent validity, the Chinese PROMIS-25 domains demonstrated moderate to large correlations with Chinese PedsQLTM 4.0 domains (r ≥ ±0.69), PHQ-9 Item-4 and its total score (r = 0.75-0.80), except NPRS (r =0.44). For divergent validity, Chinese PROMIS-25 had negligible correlations with Chinese PedsQLTM 4.0 domains (r < ±0.21), PHQ-9 item-4 (r =0.3) and NPRS (r = -0.12). The PROMIS-25 fatigue domain was weakly correlated with NPRS (r =0.39). Additionally, all domains demonstrated good internal consistency (Cronbach's alpha: 0.82-0.85), test-retest reliability (ICC: 0.80-0.97) and good to excellent responsiveness to change following cancer treatments. All domains (except peer relationships) indicated deteriorated functioning after two days of cancer treatment in the responsiveness analysis. Using an anchor-based method, MID were determined and all exceeded the measurement error with a confidence of 95%: Physical Function: 12.3; Anxiety: 17.2; Depression: 15.4; Fatigue: 13.6; Peer Relationships: 6.5; and Pain Interference: 13. Conclusions: The findings substantiated that traditional Chinese version of PROMIS-25 was a reliable and valid instrument to assess HRQOL among Chinese children with cancer. This validated instrument can be used to monitor the temporal changes in health-related functioning of Chinese children with cancer.
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Access: restricted access

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