Research Article: Longitudinal changes in health related quality of life in children with migrant backgrounds

Date Published: February 2, 2017

Publisher: Public Library of Science

Author(s): Ester Villalonga-Olives, Ichiro Kawachi, Josue Almansa, Nicole von Steinbüchel, Jacobus P. van Wouwe.


Little is known about longitudinal changes in the Health Related Quality of Life (HRQoL) among children with migrant backgrounds.

The sample comprised 350 children with predominantly migrant backgrounds enrolled in 7 kindergartens in Frankfurt and Darmstadt, Germany. At baseline, the participants’ mean age was 4.4 years (SD 0.9). Data collection started in May 2009. Two waves of data were collected one year apart (94% response rate). HRQoL was evaluated with the Kiddy-KINDL. The other variables under study were sex, age, socioeconomic status, country of origin, developmental status (WET) and individual behavior (VBV). Data were collected from the children, parents and teachers. Structural equation modeling (SEM) was used to assess the Wilson and Cleary theoretical framework on changes in HRQoL and Generalized Estimated Equations (GEE) to model the longitudinal trend in HRQoL.

Overall HRQoL remained stable between baseline and follow-up. SEM model fit was χ2 = 8.51; df = 5; p = 0.13; SRMR = 0.02 RMSEA = 0.06 and indicated that there were differences in kindergarten activities (p<0.05). The GEE model elucidated that the differences in HRQoL between the baseline and follow-up varied according to kindergarten activities that the children were assigned to (music, art, or no activities) (p<0.05), but that there were no differences in terms of country of origin. On average, girls reported better HRQoL. Overall HRQoL scores remained stable over follow-up in a sample of migrant children and there were no differences in terms of origin. However, there was heterogeneity in the results depending on the kindergarten activities that the children were assigned to.

Partial Text

Health Related Quality of Life (HRQoL) is a concept that represents a person’s own judgement of his or her subjective health status, functioning, and well-being in the domains of physical, psychological, social and role performance [1]. Measures of pediatric HRQoL combine different components such as perceived health, health behavior and well-being. Instruments have been developed to assess HRQoL in both general and specific populations. HRQoL allows identification of specific groups with high rates of unrecognized conditions, social and emotional problems, and poor functioning [2]. HRQoL in children is relevant for evaluating medical outcomes of interventions and treatments [3]. HRQoL is also useful as an indicator of emotional and social aspects of living in situations such as migration or disadvantaged socioeconomic circumstances.

Girls represented 52.3% of the participants (Table 2). In almost 10% of the families one parent was unemployed. 31.9% of the children had at least one native German parent, while the second most important group was from Asia (predominantly from Turkey; 29%), followed by Africans (mostly from Ghana and Morocco; 22%). The overall HRQoL at baseline was 69.7 (SD 17.7) and at follow-up was 70.5 (SD 15.7). In boys and girls an increment in HRQoL between baseline and follow-up was observed, which however was not statistically significant (Table 3). Children coming from families with higher socioeconomic levels (i.e. fathers were professionals with advanced qualifications and managers) (N = 50) had an increase in HRQoL over the follow-up of a year while other SES categories remained stable (p = 0.03). With regard to kindergarten activities, group 1 (no intervention) showed a notable increment in HRQoL in wave 2, while in group 2 (musical activities) a significant decrease was observed. No significant differences were noted for group 3 (painting). There was some evidence of regression towards the mean, i.e. HRQoL scores differed between some kindergartens at baseline and converged towards the mean at follow-up.

Our results revealed that, overall, the HRQoL of our sample remained stable. However, there is an important heterogeneity in the results depending, for the most part, on the kindergarten activities.




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