Iranian Journal of Medical Sciences

Document Type: Original Article(s)


1 Department of Allergy and Clinical Immunology, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

3 Allergy Research Center, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran

4 Allergy Research Center, Department of Pediatrics, Nemazee Teaching Hospital, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran


Background: Child-parent agreement is a controversial aspect of measuring health-related quality of life (HRQoL) in children and adolescents. The aim of this study was to assess the agreement between the child self-reports and parent proxy reports of the PedsQL 3.0 Asthma Module in Iranian children with asthma to evaluate HRQoL. Moreover, the psychometric properties of the child and parent reports of the PedsQL 3.0 Asthma Module were assessed in the present study.Methods: Participants were 112 children with asthma and their parents, who completed the Farsi version of the PedsQL 3.0 Asthma Module. The multitrait-multimethod correlation matrix and factor analysis were used to test whether the child self-reports and the parent proxy reports measured the same construct. Additionally, convergent and discriminant validity and internal consistency were assessed using the Pearson correlation.Results: The correlation between the child and parent HRQoL perceptions ranged between 0.13 and 0.36 across the same domains. Our factor analysis revealed that the child self-reports and the parent proxy reports measured 2 different constructs of HRQoL. Furthermore, our findings showed that both the child self-reports and the parent proxy reports of the PedsQL 3.0 Asthma Module had excellent internal consistency and acceptable convergent and discriminant validity.Conclusion: Although the child self-reports and the parent proxy reports of the Farsi version of PedsQL 3.0 Asthma Module showed good psychometric properties, they were not interchangeable. Our children with asthma and their parents evaluated child HRQoL from their own viewpoints.


  1. Entezari A, Mehrabi Y, Varesvazirian M, Pourpak Z, Moin M. A systematic review of recent asthma symptom surveys in Iranian children. Chron Respir Dis. 2009;6:109-14. doi: 10.1177/1479972309103884. PubMed PMID: 19411572.
  2. Pawankar R, Canonica GW, Holgate ST, Lockey RF. Allergic diseases and asthma: a major global health concern. Curr Opin Allergy Clin Immunol. 2012;12:39-41. doi: 10.1097/ACI.0b013e32834ec13b. PubMed PMID: 22157151.
  3. Chan KS, Mangione-Smith R, Burwinkle TM, Rosen M, Varni JW. The PedsQL: reliability and validity of the short-form generic core scales and Asthma Module. Med Care. 2005;43:256-65. doi: 10.1097/00005650-200503000-00008. PubMed PMID: 15725982.
  4. Upton P, Lawford J, Eiser C. Parent-child agreement across child health-related quality of life instruments: a review of the literature. Qual Life Res. 2008;17:895-913. doi: 10.1007/s11136-008-9350-5. PubMed PMID: 18521721.
  5. Roncada C, Mattiello R, Pitrez PM, Sarria EE. Specific instruments to assess quality of life in children and adolescents with asthma. J Pediatr (Rio J). 2013;89:217-25. doi: 10.1016/j.jped.2012.11.010. PubMed PMID: 23669217.
  6. Varni JW, Burwinkle TM, Rapoff MA, Kamps JL, Olson N. The PedsQL in pediatric asthma: reliability and validity of the Pediatric Quality of Life Inventory generic core scales and asthma module. J Behav Med. 2004;27:297-318. doi: 10.1023/B: JOBM.0000028500.53608.2c. PubMed PMID: 15259457.
  7. Thissen D, Varni JW, Stucky BD, Liu Y, Irwin DE, Dewalt DA. Using the PedsQL 3.0 asthma module to obtain scores comparable with those of the PROMIS pediatric asthma impact scale (PAIS). Qual Life Res. 2011;20:1497-505. doi: 10.1007/s11136-011-9874-y. PubMed PMID: 21384264; PubMed Central PMCID: PMC3196830.
  8. Varni JW, Limbers CA, Burwinkle TM. Parent proxy-report of their children’s health-related quality of life: an analysis of 13,878 parents’ reliability and validity across age subgroups using the PedsQL 4.0 Generic Core Scales. Health Qual Life Outcomes. 2007;5:2. doi: 10.1186/1477-7525-5-2. PubMed PMID: 17201923; PubMed Central PMCID: PMC1769359.
  9. Eiser C, Morse R. Can parents rate their child’s health-related quality of life? Results of a systematic review. Qual Life Res. 2001;10:347-57. PubMed PMID: 11763247.
  10. Theunissen NC, Vogels TG, Koopman HM, Verrips GH, Zwinderman KA, Verloove-Vanhorick SP, et al. The proxy problem: child report versus parent report in health-related quality of life research. Qual Life Res. 1998;7:387-97. doi: 10.1023/A:1008801802877. PubMed PMID: 9691719.
  11. Baxi SN, Sheehan WJ, Gaffin JM, Yodying J, Panupattanapong S, Lane JP, et al. Agreement between parent and student responses to an asthma and allergy questionnaire in a diverse, inner-city elementary school population. Ann Allergy Asthma Immunol. 2011;107:371-3. doi: 10.1016/j.anai.2011.08.007. PubMed PMID: 21962100; PubMed Central PMCID: PMC3187549.
  12. Hedman L, Bjerg A, Perzanowski M, Ronmark E. Good agreement between parental and self-completed questionnaires about allergic diseases and environmental factors in teenagers. J Clin Epidemiol. 2010;63:783-9. doi: 10.1016/j.jclinepi.2009.08.017. PubMed PMID: 19959330.
  13. Feng L, Zhang Y, Chen R, Hao Y. The Chinese version of the Pediatric Quality of Life Inventory (PedsQL) 3.0 Asthma Module: reliability and validity. Health Qual Life Outcomes. 2011;9:64. doi: 10.1186/1477-7525-9-64. PubMed PMID: 21819618; PubMed Central PMCID: PMC3161836.
  14. Seid M, Limbers CA, Driscoll KA,
  15. Opipari-Arrigan LA, Gelhard LR, Varni JW. Reliability, validity, and responsiveness of the pediatric quality of life inventory (PedsQL) generic core scales and asthma symptoms scale in vulnerable children with asthma. J Asthma. 2010;47:170-7. doi: 10.3109/02770900903533966. PubMed PMID: 20170325.
  16. Reich W, Herjanic B, Welner Z, Gandhy PR. Development of a structured psychiatric interview for children: agreement on diagnosis comparing child and parent interviews. J Abnorm Child Psychol. 1982;10:325-36. doi: 10.1007/BF00912325. PubMed PMID: 7175041.
  17. De Clercq B, De Fruyt F, Koot HM, Benoit Y. Quality of life in children surviving cancer: a personality and multi-informant perspective. J Pediatr Psychol. 2004;29:579-90. doi: 10.1093/jpepsy/jsh060. PubMed PMID: 15491980.
  18. Fayers P, Machin D. Quality of life: the assessment, analysis and interpretation of patient-reported outcomes: John Wiley & Sons. 2nd ed. New York: John Wiley & Sons; 2007.
  19. National Asthma E, Prevention P. National Asthma Education and Prevention Program. Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics--2002. J Allergy Clin Immunol. 2002;110:S141-219. PubMed PMID: 12542074.
  20. Rayens MK, Svavarsdottir EK, Burkart PV. Cultural differences in parent-adolescent agreement on the adolescent’s asthma-related quality of life. Pediatr Nurs. 2011;37:311-9, 21. PubMed PMID: 22256692.
  21. Silva N, Crespo C, Carona C, Bullinger M, Canavarro MC. Why the (dis)agreement? Family context and child-parent perspectives on health-related quality of life and psychological problems in paediatric asthma. Child Care Health Dev. 2015;41:112-21. doi: 10.1111/cch.12147. PubMed PMID: 24797724.
  22. Jafari P, Sharafi Z, Bagheri Z, Shalileh S. Measurement equivalence of the KINDL questionnaire across child self-reports and parent proxy-reports: a comparison between item response theory and ordinal logistic regression. Child Psychiatry Hum Dev. 2014;45:369-76. doi: 10.1007/s10578-013-0407-5. PubMed PMID: 24043561.
  23. Bagheri Z, Jafari P, Tashakor E, Kouhpayeh A, Riazi H. Assessing whether measurement invariance of the KIDSCREEN-27 across child-parent dyad depends on the child gender: A multiple group confirmatory factor analysis. Global journal of health science. 2014;6:142-53.
  24. Jafari P, Bagheri Z, Hashemi SZ, Shalileh K. Assessing whether parents and children perceive the meaning of the items in the PedsQLTM 4.0 quality of life instrument consistently: a differential item functioning analysis. Glob J Health Sci. 2013;5:80-8. doi: 10.5539/gjhs.v5n5p80. PubMed PMID: 23985109.
  25. Rutishauser C, Sawyer SM, Bowes G. Quality-of-life assessment in children and adolescents with asthma. Eur Respir J. 1998;12:486-94. doi: 10.1183/09031936.98.12020486. PubMed PMID: 9727807.
  26. Hill J, Kondryn H, Mackie E, McNally R, Eden T. Adult psychosocial functioning following childhood cancer: the different roles of sons’ and daughters’ relationships with their fathers and mothers. J Child Psychol Psychiatry. 2003;44:752-62. doi: 10.1111/1469-7610.00161. PubMed PMID: 12831119.