HISTORICAL EVOLUTION AND CONCEPTUAL FOUNDATIONS OF PEDIATRIC HEALTH-RELATED QUALITY OF LIFE ASSESSMENT
In order to provide an introduction to the field of health-related quality of life (HRQOL) assessment for readers, the first section of this volume discusses (a) an overview of the field of HRQOL assessment with children and adolescents; (b) the history and evolution, as well as ethical and policy issues involved in, the field of pediatric HRQOL assessment; and (c) conceptual and methodological issues involved in development and applications of measures of child and adolescent HRQOL.
In the introductory chapter, Levi and Drotar describe current definitions, theoretical frameworks, and methodological issues concerning the measurement of HRQOL. Their discussion of progress and remaining research, clinical, and policy needs provides an overview of the current state of the field of HRQOL assessment in pediatric populations and a context in which to understand the various contributions. Readers should find the listing of measures of children's HRQOL and functional status to be helpful.
In chapter 2, Schor provides an interesting historical account of the conceptualization and applications of child health and HRQOL. Describing the evolution of the multidimensional nature of the HRQOL construct, Schor highlights the widespread influences and implications involved in the provision of child health care and HRQOL assessments, as well as potential future applications. Over time, the goals and focus of assessment of health status have varied considerably as a function of the prevailing economic climate and social factors. In tracing the historical evolution of conceptualizations of health and well being, Schor informs readers about the current state of the field and concepts of health. Amidst the rapid changes in healthcare and economic conditions, pediatric HRQOL assessments can provide information regarding the effectiveness of health-care services and consequently help ensure that children's health care needs are met.
In this introductory section, authors also present and discuss several prominent, but as yet unanswered issues in the field of pediatric HRQOL assessment. For example, Finkelstein (chapter 3) highlights some of these issues in his discussion of the challenges involved in using HRQOL measures in research and clinical practice. By using illustrations from various studies as well as his own experience as a pediatric endocrinolo-