Content and face validity of quality-of-life instruments for youth with visual impairments: A Delphi study

Abstract

Youth with visual impairments (VI) who are physically active are more likely to have higher quality of life (QoL) outcomes, however, typically have higher levels of sedentary time and decreased motor competence, health-related fitness, and physical activity levels than their sighted peers. A major challenge in examining the relationship between QoL and physical activity among children with VI is a lack of psychometrically vetted assessment instruments. The purpose of this Delphi study was to explore the preliminary content and face validity for two measures of QoL for youth with VI by achieving expert consensus on the items of the PedsQL™ and the revised HEAR-QL (now named VISION-QL) survey. A panel of 11 experts in VI assessed each item of the PedsQL™ and VISION-QL on the appropriateness for youth with VI and overall clarity using a 4-point Likert-type scale ranging from 1 (completely disagree) to 4 (completely agree). In addition, experts provided feedback on whether the revised questions maintained the meaning from the original question. Panelists were instructed to provide feedback for scores below 3 regarding how to improve the clarity or appropriateness of the item. Items with a median score below 3.25 and 70% agreement were revised and then distributed to the expert panel for a second assessment using the same Likert-type scale and instructions to leave comments for scores below 3. Thirty-four questions were revised for the VISION-QL survey from the HEAR-QL survey. Both instruments reached consensus following two rounds. The results of this study feature the first initial vettings for two separate QoL measures evaluated specifically for ecological validity for individuals with VI. Practitioners can now choose depending upon who their target audience is (e.g., child vs. caregiver) and can do so with confidence.