gms | German Medical Science

Background: PREMs, such as health-related quality-of-life (hr-QoL) measures, are essential in monitoring medical care, especially for children and adolescents. Challenging aspects of pediatric care are the age variance partly necessitating proxy measures, the variety of diagnoses, and the interplay of patients with their caregivers in most aspects of disease and healthcare. Healthcare Satisfaction (HCS) may greatly impact other PREMS, including hr-QoL. PedsQL is a questionnaire series that is available and validated in many languages, including German, but no validated German measure currently evaluates HCS in a pediatric setting.

Objective: In a multi-step protocol, we culturally adapted the English version of the PedsQl 3.0 Healthcare Satisfaction Generic Module (HCSGM) to German and tested its psychometric properties in a pediatric surgery setting.

Methods: Using a multi-step procedure, we adapted the HCSGM to a German context. After two independent forward translations, a combined version was translated backward and approved by the original author, J.W. Varni. The German HCSGM was then pre-tested on caregivers of 10 patients using the thinking-aloud technique and semi-structured interviews. The results were recorded, transcribed, and a qualitative content analysis was performed using MAXQDA (Cleverbridge GmBH, 2022). This was the basis for a second consensus meeting with stakeholders to create the final German version. Dr. Varni approved the conference protocol and final version. We tested the psychometric properties of the German HCSGM in 200 caregivers of children with different ages and diagnoses. Caregivers completed the HCSGM again after ≥ 3 days to assess test-retest-reliability. The PedsQl Family Impact Module and a sociodemographic questionnaire were completed simultaneously.

Results: The original forward translations were changed at all process steps. Linguistic validation identified 11 minor and 7 major issues to be discussed in the consensus process. These issues prompted 10 changes in the wording of introductions, questions, answer scales, and layout. In our pretest, 70% of the caregivers were female, and their mean age was 38.7 years. The patients were 63% boys, with a mean age of 6.6 years.

The psychometric properties of the German HCSGM were evaluated by handing out 200 questionnaires, of which 78% were returned. The average time participants needed to complete the HCSGM was 4.86 minutes. Only a small number of missing or not applicable values were recorded.

The content validity of the questionnaire was assessed, and significant correlations between the items were found. The reliability of the questionnaire was evaluated using Cronbach's alpha, which showed a high correlation of 0.91. The test-retest reliability score was above 0.8.

Implication for research and healthcare practice: The PedsQl Healthcare Satisfaction Generic Module is now available in German to measure HCS, an important PREM for research and patient management optimization in pediatric patients of all ages, and probably in most pediatric, pediatric surgery, and other similar settings. Our study shows that the German HCSGM is valid and reliable. The very high Cronbach’s alpha may indicate that some questions may be redundant and possibly a short form of the HCSGM could be developed in the future.

Funding: Other funding; Project name: Gesundheitsbezogene Lebensqualität; Grant number: Kinderstiftung Playmobil