Validation of a Parent Proxy Quality-of-Life Measure for Young Children With Hearing Loss

Cathy Y. Yu, Donna B. Jeffe, Margaret A. Kenna, John A. Germiller, Judith E.C. Lieu

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


Objectives: No hearing-related quality of life (QL) questionnaire currently exists for children < 7 years. This study aimed to develop and evaluate the construct validity and reliability of a new parent-proxy Preschool Hearing Environments and Reflection on Quality of Life (HEAR-QL) questionnaire. Methods: Parents of children 2 to 6 years old with any hearing loss (HL) were recruited from multiple sites. To evaluate the new measure's construct validity, participants completed a 70-item preschool HEAR-QL and validated questionnaires measuring hearing and communication functioning (Parents' Evaluation of Aural/Oral Performance of Children), generic pediatric QL (Pediatric Quality of Life Inventory Parent Report, PedsQL), family functioning (PedsQL Family Impact Module), and parent well-being (Patient Reported Outcomes Measurement Information System Adult Global Report). Participants completed the preschool HEAR-QL 2 weeks later to measure test–retest reliability. Exploratory principal components analysis was used to reduce the number of items and determine the underlying HEAR-QL factor structure. Analysis of variance examined HEAR-QL differences by HL. Results: Among 205 parents, 144 had children with bilateral HL, 50 had children with unilateral HL, 10 had children with normal hearing (NH), and one child's hearing status was unspecified. The 70-item questionnaire was reduced to 23 items with five underlying factors: Behavior and Attention, Hearing Environments, New Social Situations, Social Interactions, and Communication. Cronbach's alpha for each factor ranged from 0.80 to 0.91. Test–retest reliability was 0.93. Moderate-to-strong correlations (r >.300) were observed between each Preschool HEAR-QL factor and previously validated measures. Hearing Environments scores differed significantly between children with NH and any HL. Conclusion: Preschool HEAR-QL correlations with other measures supported its construct validity. Discriminant validity testing requires a larger sample of children with NH. Level of Evidence: NA Laryngoscope, 131:663–670, 2021.

Original languageEnglish
Pages (from-to)663-670
Number of pages8
Issue number3
StatePublished - Mar 2021


  • Quality of life
  • child
  • hearing loss
  • preschool
  • proxy
  • questionnaire
  • survey
  • validation study


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