The main objective of this study was to propose a model, which includes personal and social factors associated to health-related quality of Life (HRQoL) in children and in adolescents.
A sample of 3195 children and adolescents was randomly selected from 5th and 7th graders, in Portuguese public schools. The Portuguese versions of KIDSCREEN-52, Harter's SPPS, LOT-R, SSSS and HBSC (selected items) were used to evaluate personal and social factors and health behaviors.
Various structural equation models were developed in association with gender, age, socioeconomic status (SES) and using the global sample. The studied models presented good adjustment indexes, which suggest a good fit for the hypothesized model.
The psychosocial variables have a strong impact in the HRQoL. Consequently, health promotion programs for children and adolescents should include the psychosocial approach. Based on our results, we discuss and propose strategies to develop HRQoL in children and adolescents, in schools and in families.
Keywords: health -related quality of life, children, adolescents
The most widely cited definition of Quality of Life (QoL) is provided by the World Health Organization (WHOQoL group), which defines QoL as the individual's physical health, psychological well-being, independence level, social relationships and relationship with their environment and social context, and it is seen as a " self- perception", a personal perception of individuals' own life in their specific cultural context and value systems; and related with their goals, expectations, values and perspectives (WHOQOL, 1994,1995;1996; 1998a; 1998b).
Health-related quality of life (HRQoL) is generally conceptualized as a multidimensional construct encompassing domains such as psychological, mental, social and spiritual areas of life (Eiser & Morse, 2001). HRQoL can be viewed as a psychological construct which describes the physical, mental, social, psychological and functional aspects of well-being and function (Ravens et al. 2005).
The Well-being and health-related quality of life (HRQoL) in children and in adolescents is a quite recent concept and is a concern amongst health professionals (Koot, 2002). This must be considered within an ecological perspective, including multiple levels of analysis, namely self-perceptions and family perceptions (Harding, 2001). Children's perceptions of their HRQoL are influenced by several factors such as gender, age, personal and family characteristics, as well as their socio economic status (Caldera & Hart, 2004).
Studies focusing on children's subjective well-being include interactions between demographics (e.g. age, gender and socio economic status), interpersonal characteristics (Self Perceptions, Psychological Well-being, Mood and Emotions) and perception of well-being and happiness (McCullough, Huebner & Laughlin, 2000). Clear differences between gender, age and socioeconomic status can be found in the HRQoL of children and adolescents. For instance, according to previous Kidscreen surveys in other countries, girls' perception of health-related quality of life is inferior in all dimensions with the exception of "Social Support and Peers", "School Environment" and "Social Acceptance and Bullying". Adolescents (aged 12 to 16) presented an inferior perception of HRQoL in all measures except in the "Financial Resources" and "Social Acceptance and Bullying"; low SES perception of HRQoL is also inferior in all dimensions on behalf of children and adolescents (Bisegger et al. 2005; The KIDSCREEN Group Europe, 2006; Ravens-Sieberer et al.; 2005; Rueden et al. 2006).
The socioeconomic status has a deep impact on HRQoL, and is often associated to low academic background on the parents' behalf, interpersonal conflict, low socioeconomic status and ethnic minorities (Chen, Matthews & Boyce, 2002; STEP/BIT, 2003). According to the …