Reliability and Validity of Ethiopian Amharic Version of the PedsQL^TM 4.0 Generic Core Scales and PedsQL^TM 3.0 Diabetes Module

Figures & data

Table 1 Characteristics of Children and Adolescents with Diabetes

Variables	Category	Frequency(n=229)	Percent (%)
Age	8–12	101	52.3
	13–18	92	47.7
Sex	Male	105	54.4
	Female	88	45.6
Duration with diabetes	<5	145	75.1
	≥5	48	24.9
Glycemic level	Controlled	105	54.4
	Uncontrolled	88	45.6

Table 2 Item Scaling Tests: Convergent and Discriminant Validity for the PedsQL™ 4.0 Generic Core Scales Subscales

Scale	Item	Mean	SD	N	Convergent Validity		Discriminant Validity		Cronbach’s Alpha
					Range of Correlation	Scaling Success (%)	Range of Correlation	Scaling Success (%)
Child self-report
1. Physical function	8	83.52	19.02	193	0.31–0.87	7/8(87.5)	0.25–0.71	23/24(95.6)	0.83
2. Emotional function	5	77.10	19.18	193	0.71–0.779	5/5(100)	0.38–0.68	15/15(100)	0.89
3. Social function	5	88.22	16.60	193	0.79–0.87	5/5(100)	0.41–0.61	15/15(100)	0.88
4. School function	5	73.00	15.41	193	0.62–0.76	5/5(100	0.15–0.62	15/15(100	0.90
Parent proxy report
1. Physical function	8	63.84	10.40	193	0.52–0.75	8/8(100)	0.24–0.58	24/24(100)	0.81
2. Emotional function	5	58.49	11.10	193	0.56–0.67	5/5(100)	0.20–0.50	15/15(100)	0.84
3. Social function	5	65.16	11.56	193	0.68–0.82	5/5(100)	0.27–0.46	15/15(100)	0.80
4. School function	5	58.45	9.10	193	0.59–0.69	5/5(100)	0.19–0.56	15/15(100)	0.81

Table 3 Item Scaling Tests: Convergent and Discriminant Validity for the PedsQL™ 3.0 Diabetes Module Subscales

Scale	Item	Mean	SD	No.	Convergent Validity		Discriminant Validity		Cronbach’s Alpha
					Range of Correlation	Scaling Success (%)	Range of Correlation	Scaling Success (%)
Child self-report
1. Diabetes symptom	11	79.35	15.78	193	0.64–0.77	11/11(100)	0.22–0.54	44/44(100)	0.84
2. Treatment barriers	4	75.13	17.39	193	0.65–0.73	4/4(100)	0.27–0.52	16/16(100)	0.86
3. Treatment adherence	7	84.08	16.55	193	0.75–0.78	7/7(100)	0.20–0.57	28/28(100)	0.83
4. Worry	3	80.66	20.90	193	0.79–0.87	3/3(100)	0.39–0.63	12/12(100)	0.84
5. Communication	3	80.63	20.29	193	0.78–0.83	3/3(100)	0.32–0.60	12/12(100)	0.86
Parent proxy Report
1. Diabetes symptom	11	58.58	9.32	193	0.45–0.65	11/11(100)	0.10–0.45	44/44(100)	0.74
2. Treatment barriers	4	57.46	9.97	193	0.45–0.52	4/4(100)	0.08–0.40	16/16(100)	0.77
3. Treatment adherence	7	62.24	11.52	193	0.59–0.75	7/7(100)	0.17–0.45	28/28(100)	0.75
4. Worry	3	62.30	12.97	193	0.66–0.74	3/3(100)	0.21–0.40	12/12(100)	0.76
5. Communication	3	63.35	11.18	193	0.65–0.74	3/3(100)	0.14–0.34	12/12(100)	0.77

Table 4 Intercorrelations Among PedsQL^TM 4.0 Generic Core Scale Subscales

	Child Self-Report				Parent
	1	2	3	4	5	6	7
Child self-report
1. Physical function
2. Emotional function	0.59
3. Social function	0.69	0.53
4. School function	0.54	0.46	0.52
Parent proxy report
5. Physical function	0.66	0.34	0.34	0.35
6. Emotional function	0.28	0.74	0.26	0.26	0.33
7. Social function	0.53	0.39	0.74	0.45	0.49	0.33
8.School function	0.36	0. 35	0.38	0.72	0.39	0.36	0.48

Notes: N = 193, Multitrait-monomethod correlations are in bold; monotrait-multimethod correlations are underlined; multitrait-multimethod correlations are italicized.

Table 5 Intercorrelations Among PedsQL^TM 3Diabetes Module Subscales

	Child Self-Report					Parent Proxy
	1	2	3	4	5	6	7	8	9
Child self-report
1. Diabetes symptom
2. Treatment barrier	0.44
3. Treatment adherence	0.50	0.36
4. Worry	0.54	0.37	0.53
5. Communication	0.38	0.34	0.48	0.45
Parent proxy report
6. Diabetes symptom	0.63	0.14	0.28	0.34	0.18
7. Treatment barrier	0.21	0.59	0.23	0.19	0.11	0.32
8. Treatment adherence	0.27	0.14	0.71	0.22	0.21	0.39	0.29
9. Worry	0.30	0.27	0.29	0.74	0.23	0.36	0.28	0.24
10. Communication	0.24	0.14	0.35	0.23	0.751	0.29	0.12	0.33	0.27

Notes: N = 193; Multitrait- monomethod correlations are in bold; monotrait-multimethod correlations are underlined; multitrait-multimethod correlations are italicized.

Table 6 Intercorrelations Among Total PedsQL^TM 4.0 Generic Core Scales Score and PedsQL^TM 3.0 Diabetes Module Subscale

Total PedsQL^TM 4.0 GCS	PedsQL^TM 3.0DM
	Child Self-Reports						Parent Proxy Reports
	DS	TB	TA	WO	Com	Tot D	DS	TB	TA	WO	Com	Tot D
Child self-report	0.67	0.60	0.59	0.59	0.47	0.78	0.37	0.35	0.32	0.43	0.35	0.55
Parent proxy reports	0.41	0.35	0.44	0.42	0.37	0.53	0.49	0.43	0.49	0.52	0.47	0.73

Abbreviations: DS, diabetes symptom; TB, Treatment Barrier; TA, Treatment Adherence; WO, worry; Com, communication; Tot D, Total score Diabetes module.

Table 7 PedsQL™ 4.0 Generic Core Scale Questionnaire Factor Loadings for Child Self-Reports

	F1	F2	F3	F4
Physical function
1. It is hard for me to walk more than one block	0.92	0.05	0.09	−0.06
2. It is hard for me to run	0.91	0.04	0.04	−0.04
3. It is hard for me to do sports activity or exercise	0.83	−0.04	0.08	0.14
4. It is hard for me to lift something heavy	0.10	0.12	−0.02	0.16
5. It is hard for me to take a bath or shower by myself	0.15	0.27	0.43	0.23
6. It is hard for me to do chores around the house	0.58	0.20	−0.02	0.24
7. I hurt or ache	0.86	0.04	0.25	0.01
8. I have low energy	0.71	0.12	0.16	0.15
Emotional function
1. I feel afraid or scared	0.37	−0.01	−0.04	0.59
2. I feel sad or blue	0.11	−0.08	−0.04	0.79
3. I feel angry	−0.12	0.06	0.06	0.86
4. I have trouble sleeping	0.43	0.02	0.04	0.51
5. I worry about what will happen to me	0.37	−0.05	0.04	0.56
Social function
1. I have trouble getting along with other kids	0.68	0.06	−0.37	−0.01
2. Other kids do not want to be my friend	0.63	0.04	−0.40	0.12
3. Other kids tease me	0.56	0.08	−0.42	0.12
4. I cannot do things that other kids my age can do	0.61	0.09	−0.37	0.10
5. It is hard to keep up when I play with other kids	0.67	0.05	−0.34	0.01
School function
1. It is hard to pay attention in class	0.11	0.41	0–0.43	0.28
2. I forget things	0.04	0.51	−0.39	0.33
3. I have trouble keeping up with schoolwork	0.01	0.61	−0.29	0.29
4. I miss school because of being unwell	0.09	0.77	0.10	−0.02
5. I miss school to go to the hospital	0.01	0.87	0.09	−0.16

Notes: PedsQL™ 4.0 generic core scale for child self-reports summarized by 4 (F)= factors, Eigenvalue cutoff: 1.0; Total Variance Explained for child self-reports: 72.79%; Bold = highest factor loading for each item.

Table 8 PedsQL™ 3 PedsQL™ 4.0 Generic Core Scale Questionnaire Factor Loadings for Parent Proxy

Scale	F 1	F2	F3	F 4
Physical function
1. Walk more than one block	0.01	−0.92	−0.10	0.13
2. Running	0.08	−0.82	−0.03	0.02
3. Participating in sports activity or exercise	0.22	−0.66	0.14	−0.12
4. Lift something heavy	0.25	−0.49	0.22	−0.13
5. Take a bath or shower by him/her self	0.01	−0.92	−0.10	0.13
6. Doing chores around the house	0.28	−0.33	0.372	0.01
7. Having hurts or aches	−0.14	−0.81	0.126	0.06
8. Low energy level	0.11	−0.61	0.241	−0.11
Emotional function
1. Feeling afraid or scared	0.06	−0.02	0.81	−0.04
2. Feeling sad or blue	0.64	0.24	0.46	−0.16
3. Feeling angry	−0.13	0.07	0.76	0.11
4. Trouble sleeping	0.27	−0.15	0.48	0.12
5. Worrying about what will happen to him or her	0.18	−0.13	0.55	0.01
Social Function
1. Getting along with other kids	0.77	−0.16	−0.10	−0.02
2. Other kids not wanting to be his or her friend	0.76	−0.11	0.06	−0.02
3. Getting teased by other	0.90	0.11	0.02	−0.02
Not able to do thing that other kids do on his or her age	0.79	−0.01	0.06	−0.01
5. Keep up when playing with other kids	0.77	−0.124	−0.13	0.07
School function
1. Pay attention in class	0.61	0.03	0.12	0.28
2. Forgetting things	0.55	0.09	0.24	0.21
3. Keeping up with schoolwork	0.44	−0.12	0.21	0.19
4. Miss school because of being unwell	0.03	−0.20	0.07	0.68
5. Missing school to go to the doctor/hospital	0.09	0.06	0.01	0.84

Notes: PedsQL™ 4.0 generic core scale for parents proxy reports summarized by 4 (F)= factors, Eigenvalue cutoff: 1.0; Total Variance Explained for parents proxy reports: 67.58%; Bold = highest factor loading for each item.

Table 9 PedsQL™ 3.0 Diabetes Module Questionnaire Factor Loadings for Child Self-Reports

	F1	F2	F3	F4	F5
Diabetes symptom
1. I feel hungry	0.67	0.21	−0.09	0.24	0.12
2. I feel thirsty	0.09	−0.05	−0.77	0.01	−0.01
3. I have to go to the bathroom too often	0.11	0.15	−0.69	0.03	0.13
4. I have stomachaches	−0.11	0.10	−0.79	−0.02	0.15
5. I have headaches	0.20	−0.13	−0.66	−0.28	−0.11
6. I go “low”	0.69	0.13	−0.20	0.09	0.10
7. I feel tired or fatigued	0.89	−0.05	0.10	−0.06	0.04
8. I get shaky	0.69	0.11	−0.07	−0.02	0.12
9. I get sweaty	0.49	−0.05	−0.21	−0.25	0.01
10. I have trouble sleeping	0.77	0.03	−0.10	−0.05	0.01
11. I get irritable	0.75	−0.02	−0.10	−0.16	0.01
Treatment barriers
1. It hurts to prick my finger/give insulin shots	0.18	−0.10	−0.11	0.01	0.65
2. I am embarrassed about having diabetes	0.21	−0.07	0.20	−0.30	0.66
3. My parents and I argue about my diabetes care	−0.10	0.11	−0.17	0.11	0.72
4. It is hard for me to stick to my diabetes care plan	0.09	0.33	−0.08	−0.04	0.50
Treatment Adherence
1. It is hard for me to take glucose tests	0.39	0.62	−0.11	0.08	−0.07
2. It is hard for me to take insulin shots	0.31	0.64	−0.10	0.03	−0.02
3. It is hard for me to exercise	0.18	0.54	−0.14	−0.19	0.15
4. It is hard for me to keep track of carbohydrates	0.05	0.64	−0.17	0.15	0.14
5. It is hard for me to wear my diabetic ID	−0.01	0.78	−0.07	0.12	0.07
6. It is hard for me to carry a fast acting carbohydrate	0.09	0.59	−0.15	0.10	0.16
7. It is hard for me to eat snacks	−0.09	0.78	0.08	−0.10	−0.13
Worry
1. I worry about “going low”	0.11	0.28	−0.26	−0.48	0.05
2. I worry whether or not medical treatment are working	0.18	0.23	−0.13	−0.63	−0.05
3. I worry about long term complications diabetes	−0.04	0.15	−0.11	−0.77	0.11
Communication
1. It is hard for me to tell the doctors and nurses how I feel	−0.02	0.52	−0.05	−0.26	0.29
2. It is hard for me to ask the doctors and nurses questions	0.06	0.50	0.01	−0.18	0.23
3. It is hard for me to explain my illness to other people	0.22	0.49	0.09	−0.16	0.12

Notes: PedsQL™ 3.0 diabetes modules for child self-reports summarized by 5 (F)= factors, Eigenvalue cutoff: 1.0; Total Variance Explained for child self-reports: 69.119%; Bold = highest factor loading for each item.

Table 10 PedsQL™ 3.0 Diabetes Module Questionnaire Factor Loadings for Parent Proxy -Report

Scale	F1	F2	F3	F4	F5
Diabetes symptom
1. Feeling hungry	0.68	0.28	−0.23	0.09	−0.08
2. Feeling thirsty	−0.04	0.87	0.05	−0.09	−0.11
3. Having to go to the bathroom too often	0.09	0.73	0.02	0.07	0.07
4. Having stomachaches	−0.06	0.63	0.04	0.13	0.15
5. Having headaches	0.13	0.51	0.24	−0.02	0.06
6. Going “low”	0.61	0.10	−0.04	0.20	0.17
7. Feeling tired or fatigued	0.80	−0.09	0.11	0.11	−0.03
8. I get shaky	0.66	0.12	0.05	0.03	0.16
9. Getting sweaty	0.48	0.16	0.28	−0.02	0.02
10. Having trouble sleeping	0.68	−0.03	0.22	0.04	0.01
11. Getting irritable	0.54	0.12	0.33	−0.03	0.06
Treatment Barriers
1. Needle sticks causing him/her pain	0.22	0.18	−0.10	−0.31	0.51
2. Getting embarrassed about having diabetes	0.32	−0.14	0.29	−0.20	0.30
3. Arguing with my spouse about diabetes care	−0.14	0.12	0.06	0.07	0.54
4. Sticking to my diabetes care plan	0.21	0.14	−0.01	0.14	0.45
Treatment adherence
1. It is hard for him /her to take glucose tests	0.40	0.11	−0.13	0.56	0.10
2. It is hard for him/her to take insulin shots	0.37	0.06	−0.02	0.62	0.01
3. It is hard for him /her to exercise	0.25	0.06	0.26	0.53	0.15
4. It is hard for him /her to keep track of carbohydrates	0.27	0.02	0.15	0.58	0.17
5. It is hard for him/her to wear my diabetic card	0.07	0.05	−0.10	0.63	0.23
6. It is hard for him/her to carry a fast acting carbohydrate	0.08	−0.04	0.16	0.59	0.23
7. It is hard for him/her to eat snack	−0.14	0.06	0.12	0.69	−0.03
Worry
1. Worrying about “going low”	0.13	0.15	0.67	0.22	−0.07
2. Worrying whether or not medical treatment are working	0.05	0.09	0.79	0.08	−0.05
3. Worrying about long term complications diabetes	−0.06	0.10	0.79	−0.02	0.16
Communication
1. It is hard to tell the doctors and nurses how he/she feeling	−0.09	−0.03	0.12	0.13	0.79
2. It is hard for him /her to ask the doctors and nurses questions	−0.02	−0.05	0.01	0.16	0.77
3. It is hard for her/him to explain my illness to other people	0.24	−0.10	0.02	0.20	0.43

Notes: PedsQL™ 3.0 diabetes modules for parents proxy-reports summarized by 5 (F)= factors, Eigenvalue cutoff: 1.0; Total Variance Explained for parents proxy-reports 59.74%; Bold = highest factor loading for each item.

Table 11 Discriminatory Validity of PedsQL™ 4.0 Generic Score Across the Patient Characteristics

Items of Health-Related Quality of Life
Variables	Categories	Physical Function	Emotional Function	Social Function	School Function	Total
Age	8–12	86.3± 18.5	79.5±18.1	90.±15.6	74.4±15.6	82.6 ±13.9
	13–18	80.46 ±19.2	74.4 ±20	86.2±17.4	71.4 ±15	77.9±14.8
	t-test	2.15	1.86	1.59	1.39	2.24
	p-value	0.03	0.06	0.11	0.16	0.02
Sex	Male	85.4±18.4	78.9±18.3	90.6±14.7	75.4±14.4	82.4±13.6
	Female	81.3±19.6	74.94±20	85.4±18.3	70.11±16	77.9±15.4
	t-test	1.49	1.44	2.18	2.41	2.14
	p-value	0.14	0.15	0.03	0.02	0.03
Glycemic level	Controlled	91.7± 13.8	81.2±17.5	94.7±9.8	77.4±13.5	86.3± 9.8
	Uncontrolled	73.8 ±19.7	72.2±20	80.4±19.4	67.7±15.9	73.3±16
	t-test	7.38	3.30	6.62	4.58	6.84
	p-value	0.0001	0.001	0.0001	0.0001	0.0001
Duration with diabetes	<5	82.8±20	76.5±19.8	89.2±16	73±15	80.4 ±14.7
	≥5	84.5±17.5	77.9±18.4	86.9±17	72.8±15.7	80.3±14.5
	t-test	−0.61	−0.53	0.91	0.11	0.02
	p- value	0.54	0.59	0.36	0.91	0.98

Table 12 Discriminatory Validity of PedsQL™ 3.0 Diabetes Module Across the Patient Characteristics

	Items of Health-Related Quality of Life
Variables	Categories	Diabetes Symptom	Treatment Bariers	Treatment Adherence	Worry	Communication	Total
Age	8–12	81.2± 15.3	76.2±17.5	82.3±17	82.6±21.4	79.4±20.8	80.3±13.8
	13–18	77.3±16.132	73.9±17.2	86±15.9	78.5±20	82±19.7	79.6±13.3
	t-test	1.75	0.87	−1.54	1.36	−0.91	0.41
	p-value	0.08	0.38	0.13	0.18	0.36	0.69
Sex	Male	80.7±14.8	76.6±16.8	77.7±15	82.5±20.3	77.7±20.6	81.3±12.8
	Female	80.7±16.8	73.3±18	85.4±18	83.1±21	80.6±20.0	78.4±14.2
	t-test	1.33	1.31	1.18	1.81	−0.04	1.49
	p-value	0.18	0.19	0.24	0.07	0.97	0.13
Glycemic level	Controlled	84.2±12.7	80.01±15.1	88.5±12.7	87.6±17.8	87.7±17.2	85.6±9.0
	Uncontrolled	73.5±17.2	69.3±18.2	78.8±18.9	72.5±21.4	72.2±20.5	73.219±14.8
	t-test	4.98	4.46	4.18	5.41	5.73	7.10
	p-value	0.0001	0.0001	0.0001	0.0001	0.0001	0.0001
Duration with diabetes	<5	80.3±16	74.8±16.5	82.7±16.4	80.8±21	80.2±20.3	79.8±13.5
	≥5	78±15.4	75.5±18.7	85.9±16.65	80.5±20.6	81.3±20.5	80.2±13.6
	t-test	1.01	−0.27	−1.34	0.11	−0.37	−0.23
	p- value	0.31	0.79	0.18	0.91	0.71	0.81