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Conceptual Framework for Health-related Quality of Life Assessment in Acute Gastroenteritis

Johnston, Bradley C.*; Donen, Rachel; Pooni, Amrita§; Pond, Julia||; Xie, Feng; Giglia, Lucy||; Kam, April||; Bhamber, Amanpaul§; Bami, Karan§; Patel, Yashesh§; Guyatt, Gordon H.

Journal of Pediatric Gastroenterology & Nutrition: March 2013 - Volume 56 - Issue 3 - p 280–289
doi: 10.1097/MPG.0b013e3182736f49
Original Articles: Gastroenterology

Background and Objectives: To date, most trials in pediatric acute gastroenteritis have evaluated short-term clinical disease activity (eg, duration of diarrhea or vomiting, level of dehydration), laboratory outcomes (eg, rotavirus, norovirus), or a composite of these outcomes. Measuring health-related quality of life may also be important in evaluating the effect of interventions for acute gastroenteritis in children. The objectives of this study were to conduct individual interviews and, when possible, focus group discussions, with parents of children with acute gastroenteritis; to determine how parent and child quality of life is negatively affected by acute gastroenteritis; and, from the perspective of parents and children, to develop a conceptual framework for quality of life instrument specific to pediatric acute gastroenteritis.

Methods: We conducted interviews and focus groups with parents of children (3 months–5 years of age) given a diagnosis of gastroenteritis in a hospital emergency department. Interviews and focus groups were conducted to determine the effect of gastroenteritis on quality of life in parents and children (as perceived by the parents).

Results: Interviews and focus groups involving 25 parents suggested a conceptual framework that, for children, includes 2 domains (physical and emotional function) and 14 subdomains. For parents, our framework includes 3 domains (physical, emotional, and social function) with physical function including 4 subdomains, emotional function including 7 subdomains, and social function including 2 subdomains. The framework has been used to develop a preliminary quality of life questionnaire for parents and children.

Conclusions: Acute gastroenteritis has an important adverse effect on health-related quality in both children and parents involving physical symptoms and restrictions in physical function and disturbed emotional function. Upon further research on the psychometric properties of the proposed questionnaires, future trials of effectiveness should consider measuring patient important outcomes such as health-related quality of life.

*Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto

Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton

Division of Paediatric Urology, Hospital for Sick Children, Toronto

§Faculty of Health Sciences, McMaster University

||Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.

Address correspondence and reprint requests to Bradley C. Johnston, PhD, Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Room 2420, 555 University Ave, Toronto, ON M5G 1X8, Canada (e-mail:

Received 5 August, 2011

Accepted 7 September, 2012

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Funding for the study was provided by Biocodex.

The authors report no conflicts of interest.

Copyright 2013 by ESPGHAN and NASPGHAN