Validity and psychometrics of the Chinese (Hong Kong) version of the chronic liver disease questionnaire

Abstract

Background: The Chronic Liver Disease Questionnaire (CLDQ) is the first available and widely used disease-specific health-related quality of life (HRQOL) measure for chronic liver disease. It has been adapted to different countries but it has not been validated in the Cantonese-speaking Chinese population in Hong Kong (HK) where 8% of the population has chronic hepatitis B infection. Aim: The aim of this study is to translate, validate and test the psychometric properties of the CLDQ for the Chinese population in HK so that we can have a disease-specific HRQOL measures to evaluate the impact of chronic hepatitis B (CHB) infections.and the effectiveness of treatment. Methods: The Chinese (HK) CLDQ was tested on 150 patients in HK. Each patient completed a structured questionnaire on morbidity and socio-demographic, the Chinese (HK) CLDQ and Chinese (HK) SF-36 administered by a trained interviewer. Scaling assumptions were tested by item-domain correlations. Internal reliability was measured by the Cronbach's alpha coefficient (CAC). Two-week test-retest reliability was assessed by intra-class correlation (ICC) coefficients in patients with stable condition. Validity was determined by Spearman correlations between corresponding CLDQ and SF-36 domain scores. The mean CLDQ scores between patients with uncomplicated and complicated CHB groups were compared. Results: The sample consisted of 73 uncomplicated CHB (normal liver function) and 77 complicated (cirrhosis or hepatocellular carcinoma) patients, and 71.3% of them were male. Corresponding item-domain correlations within the same domain were similar and ranged from 0.43 to 0.85 for different domains. Internal consistency (CAC>0.70) and test-retest reliability (ICC=0.59-0.89) were acceptable for all domains. Validity was supported by moderate to strong correlations between the CLDQ and SF-36 scores of similar domains. The mean scores of CLDQ were significantly lower in complicated than uncomplicated CHB for all domains except emotional function, supporting sensitivity. Conclusions: The CLDQ has been shown to be valid, reliable and sensitive for evaluating the HRQOL the Chinese CHB patients in HK.