Cultural adaptation and psychometric evaluation of the CHU-9D in Hong Kong adolescents

OBJECTIVE: This study aimed to perform a cultural adaptation of the Child Health Utility 9D (CHU-9D), a health-related quality of life (HRQoL) instrument, into Traditional Chinese specifically for use in Hong Kong, and evaluating its psychometric properties among a sample of local adolescents. METHODS: A cross-sectional survey design was employed for data collection. Adolescents aged 13 to 17 years were recruited from diverse local community settings to complete a self-administered questionnaire that included the adapted CHU-9D and relevant demographic items. Psychometric evaluations encompassed assessments of ceiling and floor effects, factorial validity through confirmatory factor analysis, convergent validity via correlation analysis, and known-group validity to examine differences across predefined risk groups. RESULTS: A total of 627 adolescents successfully completed the survey, providing a robust dataset for analysis. The unidimensionality of the CHU-9D was confirmed, demonstrating excellent model fit indices. A ceiling effect was observed, with 27% of participants reporting full health status on the CHU-9D descriptive system, indicating potential limitations in capturing variations at the upper end of health. Convergent validity was supported by significant correlations between CHU-9D and conceptually relevant items and subscales from another HRQoL instrument. The instrument exhibited strong known-group validity, effectively discriminating HRQoL differences across various risk groups with statistically significant results. CONCLUSION: The culturally adapted Traditional Chinese version of the CHU-9D demonstrates sound psychometric properties in Hong Kong adolescents, supporting it as a valid tool for measuring and valuing HRQoL in this population and cultural context.