Quality of Life Research

, Volume 17, Issue 7, pp 997–1008 | Cite as

Exploring response shift in the quality of life of healthy adolescents over 1 year

  • Fiona Gillison
  • Suzanne Skevington
  • Martyn Standage



The assessment of child and adolescent quality of life (QoL) is increasingly incorporated into practice and research within health and social care. However, little is known about the stability of the conceptualisation of QoL in the face of normative developmental processes against which to compare changes in response to non-normative events, such as chronic illness. The present study examined the stability of the QoL construct over 1 year in a cohort of healthy community-dwelling adolescents through applying the response shift (RS) model.


A cohort of 356 adolescents (M age = 14.05 years) completed the Kidscreen QoL measure on two occasions, 1 year apart. Both research-design and statistical techniques were employed to assess three types of RS: recalibration, reprioritisation and reconceptualisation.


A significant recalibration of small effect size was found for three QoL domains using a then-test, which was confirmed in the domain of autonomy through statistical modelling. No evidence was found for reprioritisation or reconceptualisation RS using either analytical approach.


The findings support the assumption that the conceptualisation of QoL is stable during adolescence in the absence of significant health threats. However, researchers and clinicians should be aware of potential recalibration effects of some life domains.


Adolescent Health Quality of life 



The authors gratefully acknowledge the insightful and constructive comments provided by an anonymous reviewer. Their helpful suggestions served to improve the final version of this manuscript.


  1. 1.
    Eiser, C., & Morse, R. (2001). The measurement of quality of life in children: Past and future perspectives. Journal of Developmental and Behavioral Pediatrics, 22(4), 248–256.PubMedGoogle Scholar
  2. 2.
    De Civita, M., Regier, D., Alamgir, A. H., Anis, A. H., FitzGerald, M. J., & Marra, C. A. (2005). Evaluating health-related quality-of-life studies in paediatric populations—some conceptual, methodological and developmental considerations and recent applications. PharmacoEconomics, 23(7), 659–685. doi: 10.2165/00019053-200523070-00003.PubMedCrossRefGoogle Scholar
  3. 3.
    Sawyer, M. G., Reynolds, K. E., Couper, J. J., French, D. J., Kennedy, D., Martin, J., et al. (2004). Health-related quality of life of children and adolescents with chronic illness—a two year prospective study. Quality of Life Research, 13(7), 1309–1319. doi: 10.1023/B:QURE.0000037489.41344.b2.PubMedCrossRefGoogle Scholar
  4. 4.
    Davidson-Arad, B. (2005). Fifteen-month follow-up of children at risk: Comparison of the quality of life of children removed from home and children remaining at home. Children and Youth Services Review, 27(1), 1–20. doi: 10.1016/j.childyouth.2004.07.002.CrossRefGoogle Scholar
  5. 5.
    Department for Education, Skills. (2003). Every child matters. London: DfES.Google Scholar
  6. 6.
    Varni, J. W., & Burwinkle, T. M. (2006). The pedsql as a patient-reported outcome in children and adolescents with attention-deficit/hyperactivity disorder: A population-based study. Health and Quality of Life Outcomes, 4, 26. doi: 10.1186/1477-7525-4-26.PubMedCrossRefGoogle Scholar
  7. 7.
    Ravens-Sieberer, U. (2001). The revised KINDL-R: Final results on reliability, validity and responsiveness of a modular HRQOL instrument for children and adolescents. Quality of Life Research, 10(3), 199.Google Scholar
  8. 8.
    The WHOQOL Group. (1995). The world health organisation quality of life assessment (WHOQOL): Position paper from the world health organisation. Social Science & Medicine, 41, 1403–1409. doi: 10.1016/0277-9536(95)00112-K.CrossRefGoogle Scholar
  9. 9.
    Goldbeck, L., Schmitz, T. G., Besier, T., Herschbach, P., & Henrich, G. (2007). Life satisfaction decreases during adolescence. Quality of Life Research, 16(6), 969–979. doi: 10.1007/s11136-007-9205-5.PubMedCrossRefGoogle Scholar
  10. 10.
    DiClemente, R. J. (1996). Handbook of adolescent health risk behavior. New York: Plenum.Google Scholar
  11. 11.
    Williams, P. G., Holmbeck, G. N., & Greenley, R. N. (2002). Adolescent health psychology. Journal of Consulting and Clinical Psychology, 70(3), 828–842. doi: 10.1037/0022-006X.70.3.828.PubMedCrossRefGoogle Scholar
  12. 12.
    Schwartz, C. E., Sprangers, M. A., Carey, A., & Reed, G. (2004). Exploring response shift in longitudinal data. Psychology & Health, 19(1), 51–69. doi: 10.1080/0887044031000118456.CrossRefGoogle Scholar
  13. 13.
    Sprangers, M. A., & Schwartz, C. E. (1999). Integrating response shift into health-related quality of life research: A theoretical model. Social Science and Medicine, 48(11), 1507–1515. doi: 10.1016/S0277-9536(99)00045-3.PubMedCrossRefGoogle Scholar
  14. 14.
    Breetvelt, I. S., & Van Dam, F. S. (1991). Underreporting by cancer patients: The case of response-shift. Social Science and Medicine, 32(9), 981–987. doi: 10.1016/0277-9536(91)90156-7.PubMedCrossRefGoogle Scholar
  15. 15.
    Gibbons, F. X. (1999). Social comparison as a mediator of response shift. Social Science Medicine, 48(11), 1517–1530. doi: 10.1016/S0277-9536(99)00046-5.PubMedCrossRefGoogle Scholar
  16. 16.
    Rapkin, B. D. (2000). Personal goals and response shifts: Understanding the impact of illness and events on the quality of life with people living with aids. In C. E. Schwartz & M. A. Sprangers (Eds.), Adaptation to changing health. Response shift in quality of life research. Washington DC: American Psychological Association.Google Scholar
  17. 17.
    Bisegger, C., Cloetta, B., von Rueden, U., Abel, T., & Ravens-Sieberer, U. (2005). Health-related quality of life: Gender differences in childhood and adolescence. Sozial- und Praventivmedizin, 50(5), 281–291. doi: 10.1007/s00038-005-4094-2.PubMedCrossRefGoogle Scholar
  18. 18.
    Brossart, D. F., Clay, D. L., & Willson, V. L. (2002). Methodological and statistical considerations for threats to internal validity in pediatric outcome data: Response shift in self-report outcomes. Journal of Pediatric Psychology, 27(1), 97–107. doi: 10.1093/jpepsy/27.1.97.PubMedCrossRefGoogle Scholar
  19. 19.
    Drukker, M., Kaplan, C., Schneiders, J., Feron, F. J., & van Os, J. (2006). The wider social environment and changes in self-reported quality of life in the transition from late childhood to early adolescence: A cohort study. BMC Public Health, 6, 133. doi: 10.1186/1471-2458-6-133.PubMedCrossRefGoogle Scholar
  20. 20.
    Zullig, K. J., Valois, R. F., Huebner, E. S., Oeltmann, J. E., & Drane, J. W. (2001). Relationship between perceived life satisfaction and adolescents’ substance abuse. The Journal of Adolescent Health, 29(4), 279–288. doi: 10.1016/S1054-139X(01)00269-5.PubMedCrossRefGoogle Scholar
  21. 21.
    Schwartz, C. E., & Sprangers, M. A. (1999). Methodological approaches for assessing response shift in longitudinal health-related quality-of-life research. Social Science and Medicine, 48(11), 1531–1548. doi: 10.1016/S0277-9536(99)00047-7.PubMedCrossRefGoogle Scholar
  22. 22.
    Graber, J. A., Petersen, A. C., & Brooks Gunn, J. (1996). Pubertal processes: Methods; measures and models. In J. A. Graber, J. Brooks Gunn & A. C. Petersen (Eds.), Transitions through adolescence: Interpersonal domains and context. Mahwah, NJ: Erlbaum.Google Scholar
  23. 23.
    Craft, L. L., Pfeiffer, K. A., & Pivarnik, J. M. (2003). Predictors of physical competence in adolescent girls. Journal of Youth and Adolescence, 32(6), 431–438. doi: 10.1023/A:1025986318306.CrossRefGoogle Scholar
  24. 24.
    Harter, S. (1998). Self-representations in childhood and adolescence. In W. Damon (Ed.), Handbook of child psychology: Social, emotional and personality development. New York: Wiley.Google Scholar
  25. 25.
    Moshman, D. (1999). Adolescent psychological development. Erlbaum: New Jersey.Google Scholar
  26. 26.
    Ravens-Sieberer, U., Gosch, A., Rajmil, L., Erhart, M., Bruil, J., Duer, W., et al. (2005). Kidscreen-52 quality-of-life measure for children and adolescents. Expert Review of Pharmacoeconomics & Outcomes Research, 5(3), 353–364. doi: 10.1586/14737167.5.3.353.CrossRefGoogle Scholar
  27. 27.
    The Kidscreen Group. (2006). The Kidscreen questionnaires quality of life questionnaires for children and adolescents. Germany: Pabst Science.Google Scholar
  28. 28.
    Walls, T. A., & Little, T. D. (2005). Relations among personal agency, motivation, and school adjustment in early adolescence. Journal of Educational Psychology, 97(1), 23–31. doi: 10.1037/0022-0663.97.1.23.CrossRefGoogle Scholar
  29. 29.
    Gillison, F., Standage, M., & Skevington, S. (2008). Changes in quality of life and psychological need satisfaction over the transition to secondary school. The British Journal of Educational Psychology, 78(1), 149–162. doi: 10.1348/000709907X209863.PubMedCrossRefGoogle Scholar
  30. 30.
    Saxena, S., Carlson, D., & Billington, R. (2001). The who quality of life assessment instrument (whoqol-bref): The importance of its items for cross-cultural research. Quality of Life Research, 10(8), 711–721. doi: 10.1023/A:1013867826835.PubMedCrossRefGoogle Scholar
  31. 31.
    Skevington, S. M., & O’Connell, K. A. (2004). Can we identify the poorest quality of life? Assessing the importance of quality of life using the whoqol-100. Quality of Life Research, 13(1), 23–34. doi: 10.1023/ Scholar
  32. 32.
    Howard, G. S., Schmeck, R. R., & Bray, J. H. (1979). Internal invalidity in studies employing self-report instruments: A suggested remedy. Journal of Educational Measurement, 16, 129–135. doi: 10.1111/j.1745-3984.1979.tb00094.x.CrossRefGoogle Scholar
  33. 33.
    Gillison, F. B., Standage, M., & Skevington, S. M. (2006). Relationships among adolescents’ weight perceptions, exercise goals, exercise motivation, quality of life and leisure-time exercise behaviour: A self-determination theory approach. Health Education Research, 21(6), 836–847. doi: 10.1093/her/cyl139.PubMedCrossRefGoogle Scholar
  34. 34.
    Oort, F. J. (2005). Using structural equation modeling to detect response shifts and true change. Quality of Life Research, 14(3), 587–598. doi: 10.1007/s11136-004-0830-y.PubMedCrossRefGoogle Scholar
  35. 35.
    Armenakis, A.A. (1988). A review of research on the change typology. In R. W. Woodman & W. A. Pasmore (Eds.), Research in organizational change and development an annual series featuring advances in theory, methodology and research. JAI Press.Google Scholar
  36. 36.
    Arbuckle, J. L. (2003). AMOS (Version 6.0). Chicago IL: SmallWaters.Google Scholar
  37. 37.
    Hu, L. T., & Bentler, P. M. (1999). Cutoff criterion for fit indexes in covariance structural analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6, 1–55.CrossRefGoogle Scholar
  38. 38.
    Cheung, G. W., & Rensvold, R. B. (2002). Evaluating goodness-of-fit indexes for testing measurement invariance. Structural Equation Modeling, 9(2), 233–255. doi: 10.1207/S15328007SEM0902_5.CrossRefGoogle Scholar
  39. 39.
    Schwartz, C. E., Bode, R., Repucci, N., Becker, J., Sprangers, M. A. G., & Fayers, P. M. (2006). The clinical significance of adaptation to changing health: A meta-analysis of response shift. Quality of Life Research, 15(9), 1533–1550. doi: 10.1007/s11136-006-0025-9.PubMedCrossRefGoogle Scholar
  40. 40.
    Stoll, L., Stobart, G., Martin, S., Freeman, S., Freedman, E., Sammons, P., et al. (2003). Preparing for change: evaluation of the implementation of the key stage 3 strategy pilot. Department of Education and Skills.Google Scholar
  41. 41.
    Bukowski, W. M., & Sandberg, D. (1999). Peer relationships and quality of life. Acta Paediatrica (Oslo, Norway), 88, 108–109. doi: 10.1111/j.1651-2227.1999.tb14365.x.CrossRefGoogle Scholar
  42. 42.
    Robbins, L. B., Pender, N. J., Ronis, D. L., Kazanis, A. S., & Pis, M. B. (2004). Physical activity, self-efficacy, and perceived exertion among adolescents. Research in Nursing & Health, 27(6), 435–446. doi: 10.1002/nur.20042.CrossRefGoogle Scholar
  43. 43.
    Petito, F., & Cummins, R. A. (2000). Quality of life in adolescence: The role of perceived control, parenting style, and social support. Behaviour Change, 17(3), 196–207.CrossRefGoogle Scholar
  44. 44.
    Commons, M. L., Richards, F. A., & Armon, C. (1984). Beyond formal operations: Late adolescent and adult cognitive development. New York, Eastbourne: Praeger.Google Scholar
  45. 45.
    Visser, M. R., Oort, F. J., & Sprangers, M. A. (2005). Methods to detect response shift in quality of life data: A convergent validity study. Quality of Life Research, 14(3), 629–639. doi: 10.1007/s11136-004-2577-x.PubMedCrossRefGoogle Scholar
  46. 46.
    Coleman, L., & Coleman, J. (2002). The measurement of puberty: A review. Journal of Adolescence, 25(5), 535–550. doi: 10.1006/jado.2002.0494.PubMedCrossRefGoogle Scholar
  47. 47.
    Schwartz, C. E., & Sprangers, M. A. (2000). Adaptation to changing health: Response shift in quality-of-life research. Washington, DC: American Psychological Association.Google Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Fiona Gillison
    • 1
  • Suzanne Skevington
    • 2
  • Martyn Standage
    • 1
  1. 1.School for HealthUniversity of BathBathUK
  2. 2.Department of Psychology, WHO Centre for the Study of Quality of LifeUniversity of BathBathUK

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