Cultural adaptation and psychometric evaluation of the CHU9D in Hong Kong adolescents

Objective This study aimed to perform a cultural adaptation of the Child Health Utility 9D (CHU-9D) instrument into Traditional Chinese specifically for use in Hong Kong, and evaluating its psychometric properties among a representative 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, the Pediatric Quality of Life Inventory (PedsQL), and relevant demographic items. Psychometric evaluations encompassed assessments of ceiling and floor effects, factorial validity through confirmatory factor analysis, convergent validity via correlations with PedsQL scores, 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 utility scores and PedsQL items and subscales. 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, establishing it as a valid tool for measuring and valuing HRQoL in this population and cultural context.