Blackwell Science, LtdOxford, UKPCNPsychiatry and Clinical Neurosciences1323-13162004 Blackwell Science Pty Ltd5961118Original ArticleQOL in adolescentsJ-L. Fuh et al.

Psychiatry and Clinical Neurosciences (2005), 59, 11–18

Regular Article
Assessing quality of life for adolescents in Taiwan
JONG-LING FUH, md,1 SHUU-JIUN WANG, md,1 SHIANG-RU LU, md3 AND
KAI-DIH JUANG, md2
1
The Neurological Institute and 2Department of Psychiatry, Taipei Veterans General Hospital and National
Yang-Ming University Schools of Medicine, Taipei and 3Department of Neurology, Kaohsiung Medical
University Chung-Ho Memorial Hospital, Kaohsiung, Taiwan

Abstract This study was to evaluate the psychometric properties of the Taiwanese quality of life question-
naire for adolescents and the factors affecting the quality of life of Taiwanese adolescents. The sur-
vey involved 5538 junior high school students, aged 13–15 years. An initial 90-item questionnaire
was shortened to 38 items by means of principal component analyses. Quality of life assessment
involved seven factors: family, residential environment, personal competence, social relationships,
physical appearance, psychological well-being, and pain. The rate of missing data was low. The
Cronbach a coefficient remained above the 0.75 threshold criterion for the global scale and seven
subdomain scales. A lower quality of life score was evident for female adolescents in higher grades
in school, those living with a single parent or other relatives, and those living in rural areas. This 38-
item questionnaire should serve as a reliable tool for future studies.

Key words adolescent health, quality of life, questionnaire, Taiwan, validation.

INTRODUCTION physical, psychological, independence, social relation-

ship, and environment – originated in Japan. When the
Adolescent health is increasingly being recognized as
questionnaire was tested in China, the Cronbach a was
an important facet of overall public health.1 Accord-
0.92 for the entire 70 items and ranged from 0.70 to
ingly, the interest in measuring the quality of life
0.87 for each of the five domains. In a pilot study, we
(QOL) in adolescents is increasing. Adopting QOL
determined that the Cronbach a ranged from 0.16 to
approaches might help to understand adolescents’
0.87 for these five domains, which are not satisfactory.
health and establish policy to promote their health in
Thus, the present study was undertaken to develop and
Taiwan. Such QOL evaluations have been constrained
test the reliability of the Taiwanese QOL questionnaire
by the lack of a generic self-administered instrument
for adolescents (TQOLQA).
that accurately reflects the Taiwanese adolescent’s
There is widespread agreement that QOL is a mul-
point of view. Developing a reliable and valid QOL
tidimensional concept that encompasses psychologi-
questionnaire for adolescents in Taiwan is, therefore,
cal, physical, and social well-being. We planned this
an important and necessary step.
questionnaire to cover the important domains for
The Chinese version of the quality of life question-
adolescents, fitting the personal (physical and mental),
naire for adolescents (QOLQA) was developed in
interpersonal (family function, intimate friends, and
China on the basis of the QOL project of the World
social networks), external (income and housing), and
Health Organization.2,3 The first quantifiable version –
global (macro environment) spheres that Lindstrom
a 70-item questionnaire divided into five domains of
proposed.4 For example, it is well known that the fam-
ily is highly valued in Chinese society. Indeed, several
studies have shown that a single-parent family is a
Correspondence address: Dr Jong-Ling Fuh, The Neurological Insti- strong risk factor for adolescent childbearing in Tai-
tute, Taipei Veterans General Hospital, 11217, Taipei, Taiwan. Email: wan.5,6 Therefore, the QOL assessment also considered
jlfuh@vghtpe.gov.tw the influence of single-parent versus two-parent
Received 28 July 2003; revised 12 April 2004; accepted 9 May 2004. families.
12
METHODS
Subjects
This study was conducted at three public junior high
schools in Taiwan. Two of the schools were in urban
areas (where the majority of Taiwanese citizens dwell),
and the remaining school was in a rural area. The
choice of junior high schools reflected the fact that over
90% of 13–15-year-old teenagers from diverse eco-
nomic backgrounds attend these schools, according to
the Ministry of Education in Taiwan. The remainder of
this age group attends private schools. The Ministry of
Education also prescribes specific standards for curric-
ulum, instructional material and equipment for all jun-
ior high schools under its jurisdiction. The choice of
public junior high schools, thus, provided the greatest
sampling diversity and a relatively homogeneous
school environment.
Development of a new questionnaire:
item generation and reduction
The original 70 items in the Chinese version of the
QOLQA were pooled with 20 new items in the first-
phase questionnaire. The majority of the new items
addressed the relationships of the adolescents with
parents, teachers and classroom learning. These
choices reflected expressed concerns of Taiwanese
adolescents.
Next, the 90 items were reduced to a more workable
number of questionnaire items. To accomplish this, a
random sample of 515 adolescents from the above
three schools were selected. The age and gender of this
selected population did not differ from the whole pop-
ulation. Principal component analyses with varimax
rotation was used to determine the underlying factor
structure of the initial 90-item questionnaire. Only
those factors with an eigenvalue > 1.5 upon the appli-
cation of Kaiser’s ‘eigenvalues greater than 1’ rule and
scree plot test7 were retained. Items with a loading of
< 0.5 on any of the factors were omitted. After confirm-
ing the domain content, each domain was named
according to the meaning of its constitutive items. The
final version of TQOLQA (Table 1) was comprised of
38 items.
The Taiwanese Quality of Life Questionnaire
for Adolescents
This new questionnaire is rated on a 5-point Likert
scale (‘very much’, ‘quite a bit’, ‘average’, ‘not much’,
and ‘not at all’) ranging from 1 to 5 for each item. After
the raw scores were converted for the reverse ques-
tions, higher QOLOA scores reflected a better QOL.
J-L. Fuh et al.
The questionnaire enquired as to the respondent’s
experiences over the preceding 2 weeks. The items
were grouped into dimensions after principal compo-
nent analysis with varimax rotation. Each scale is then
standardized so that they each range from zero (lowest
level of functioning) to 100 (highest level).
Survey procedures
A letter describing the study objectives and methods
was mailed to the school principals of the selected
schools for their approval. Students in these schools
(n = 5538) then answered a self-administered QOLQA
with basic demographic data. The students also
reported their illnesses, if any. The students were clas-
sified as having a chronic health problem (e.g. asthma,
epilepsy), an acute health problem (acute respiratory
tract infection), or no health difficulty.
Statistics
Statistical analysis was performed using the Statistical
Products of Service Solution (SPSS) software, version
11 (SPSS 11.0 for Windows; SPSS, Inc., Chicago, IL).
Differences between mean values or the percentages
for two or three groups (three schools, sex, grade,
health status and living environment) were evaluated
using the Student t-test, a one-way anova with Bonfer-
roni correction, or the c2 test.
Principal component analysis with varimax rotation
was used to examine the factor structure of the ques-
tionnaire. Reliability was assessed by using the Cron-
bach a coefficient as a measure of internal consistency.
We hypothesized that the subjects who were ill or liv-
ing with single parent or other relatives had a lower
QOL.
A P-value < 0.05 was indicative of a statically signif-
icant difference, and the significance of post-hoc
comparisons after the Bonferroni modification was
accepted at the P < 0.006 level.
RESULTS
Descriptive statistics for the students
In total, 5538 students in the seventh to ninth grades
completed the questionnaire. The response rate was
89.4%.
Table 2 shows the descriptive statistics of the study
population in the three sampled schools. The rural
school had significantly fewer male students, a higher
percentage of students living with a single parent or
other relatives (mostly grandparents), and more stu-
dents with acute illness (P < 0.001).
QOL in adolescents 13

Table 1. List of the 38 items of the Taiwanese Quality Of Life Questionnaire For Adolescents

No. Question Domain

1 Do you worry about pain or discomfort? Pain 1

2 Do you have any difficulty in managing or coping with pain or discomfort? Pain 2
3 Does your pain or discomfort interfere with things you need to do? Pain 3
4 Can you concentrate? PC 1
5 Do you feel inferior because of your appearance? PA 1
6 Do you feel uneasy about any part of your body or physical appearance? PA 2
7 Are you upset? PW 1
8 Does the feeling of depression or sorrow interfere with your daily activities? PW 2
9 Do you worry about depression? PW 3
10 Do you have any difficulty in performing your daily activities? PW 4
11 Do you feel safe in your daily life? RE 1
12 Do you feel safe and protected in your home? RE 2
13 Is your home cozy? RE 3
14 Do you like where you live? RE 4
15 Is your living environment healthy? RE 5
16 Can you accept your physical appearance? PA 3
17 Can you finish your daily affairs? PC 2
18 Are your friends reliable when you need them? SR1
19 Does your home fulfill your needs? RE6
20 Does your family have enough money? RE7
21 Are you satisfied with your quality of life? RE8
22 Do you satisfy your abilities? PC 3
23 Are you satisfied with your physical appearance? PA 4
24 Are you satisfied with the support you receive from friends? SR 2
25 Are you satisfied with the help and support you receive from your family? Family 1
26 Do you have friends with whom you can have fun and talk to about anything? SR 3
27 Do your friends consider you someone whom they can count on for support? SR 4
28 Do you have a friend who understands you well? SR 5
29 Are you satisfied with your memory? PC 4
30 Do you think you have a good relationship with your parents? Family 2
31 Are you satisfied with your family atmosphere? Family 3
32 Do you think it is important for you to have an intact family? Family 4
33 Are you satisfied with your parents’ attitude towards you? Family 5
34 Are you satisfied with your relationship with your parents? Family 6
35 Do your parents affirm your efforts? Family 7
36 Do you think you can finish your school work? PC 5
37 Can you learn normally? PC 6
38 How do you rate your learning ability? PC 7

PC, personal competence; PW, psychological well-being; PA, physical appearance; RE, residential environment; SR, social
relationship.

Factor analysis of study measures
Principal-component factor analysis with varimax
rotation of the final 38-item TQOLQA, revealed
seven factors that accounted for 63.5% of the vari-
ance (Table 3). The seven factors were family, resi-
dential environment, personal competence, social
relationships, physical appearance, psychological well-
being, and pain. The family domain involved the sub-
jects’ relationship with their parents, their family
atmosphere, and the support they received from their
family. The residential environment domain consisted
of the subjects’ living conditions and material well-
being. The personal competence domain addressed
the confidence the subject has in his or her academic
performance and other abilities. The social relation-
ship domain consists of friendship and social support.
The physical appearance domain concerned the sub-
ject’s feelings about his or her appearance. The psy-
chological well-being domain consisted of emotional
symptoms. The pain domain addressed the feeling of
pain.
14 J-L. Fuh et al.

Table 2. Descriptive statistics of the study population

Urban Junior Urban Junior Rural Junior

Total No. High School A High School B High School C
(n = 5538) (n = 1002) (n = 3081) (n = 1455) c2 P-value†

Sex 7.4 0.025

Male 54.3% 56.5% 55.0% 51.4%
Female 45.7% 43.5% 45.0% 48.6%
Grade 54.4 0.000
7 31.8% 22.7% 34.9% 31.6%
8 34.0% 37.6% 32.2% 35.3%
9 34.2% 39.7% 32.9% 33.1%
Living with 48.8 0.000
Two parents 88.3% 91.5% 89.3% 83.8%
Single parent 9.2% 7.0% 8.7% 11.8%
Other relatives 2.5% 1.5% 2.0% 4.4%
Sickness 91.2 0.000
None 80.1% 80.3% 83.3% 73.0%
Acute disease 15.0% 15.2% 11.5% 22.4%
Chronic disease 4.9% 4.5% 5.2% 4.6%

† 2
c test.

Item-level analysis male adolescents consistently displayed significantly

Table 4 shows the psychometric results in our study
population. The rate of missing data ranged from 0.2%
to 1.2%. The rate on most surveys (81.1%) was less
than 0.5%. The most frequently missing item was ques-
tion 2: ‘Do you have any difficulty in managing or cop-
ing with pain or discomfort?’ Results in all domains
and the total questionnaire demonstrated high internal
consistency.
The effect of sex, age, health status and
living environment
Table 5 presents the seven subdomain scores across the
different health status scores. The TQOLQA scores by
sex, grade, living environment, and family structure are
reported in Table 6.
The results showed the expected direction of scores
for the health status and family structure. The sub-
groups analysis showed students who lived in a single
parent household had significantly lower scores in fam-
ily and residential environment subdomains. These
findings were consistent in all three schools. Students
with acute or chronic illness had significantly reduced
QOL scores in the psychological well-being and pain
subdomains. The seven subdomain scores in the male
adolescents were significantly higher than those of
female adolescents, except for scores in the family and
personal competence domains. In the subgroup analy-
sis of the gender differences in these three schools,
higher scores of psychological well-being and pain sub-
domains. Rural students, as well as those students in
the higher grades, had lower scores in the seven sub-
domains. In subgroup analysis of grade effect between
urban and rural schools, the urban students who
were in the higher grades had lower scores in all
subdomains. Nevertheless, the rural students who were
in the higher grades had lower scores in the seven
subdomains except social relationship and physical
appearance.
DISCUSSION
The present study was conducted to examine the valid-
ity and the overall psychometric performance of the
TQOLQA. The outcomes of these assessments are
favorable, and indicate that the evaluation may be pro-
ductively used in QOL studies.
This questionnaire was developed with the aim of
producing an instrument that was sufficiently short and
simple in format to be feasible for use in a wide range
of health assessments. The observation that few ques-
tions were left unanswered attests to the acceptance of
the questionnaire’s structure and length.
In the present study there was a continuous decrease
in QOL scores with grade among Taiwanese adoles-
cents. This mirrors the findings with Japanese, British,
Nordic, and Canadian adolescents, but differs from the
pattern produced with Chinese adolescents.3,8–10
QOL in adolescents 15

Table 3. Factor analysis after varimax rotation of the final Taiwanese Quality Of Life Questionnaire For Adolescents

Dimension F1 F2 F3 F4 F5 F6 F7

Family 1 0.63 0.325 0.201 0.236 0.162

Family 2 0.818 0.218 0.141
Family 3 0.807 0.287 0.136 0.113 0.101 0.111
Family 4 0.617 0.216 0.147 0.108
Family 5 0.799 0.216 0.168 0.115
Family 6 0.835 0.228 0.134 0.105
Family 7 0.608 0.198 0.374 0.144
RE 1 0.145 0.558 0.222 0.159 0.133 0.205 0.103
RE 2 0.138 0.709 0.176 0.131
RE 3 0.250 0.790 0.164 0.120
RE 4 0.312 0.772 0.140 0.106
RE 5 0.199 0.569 0.209 0.132
RE 6 0.299 0.730 0.170 0.171 0.123
RE 7 0.285 0.531 0.202 0.165 0.148
RE 8 0.368 0.579 0.219 0.221 0.142 0.121
PC 1 0.122 0.191 0.643 0.133
PC 2 0.118 0.311 0.575 0.152 0.141
PC 3 0.180 0.180 0.520 0.197 0.409 0.134
PC 4 0.167 0.584 0.127 0.184 0.140
PC 5 0.179 0.216 0.778 0.108
PC 6 0.207 0.249 0.776 0.134
PC 7 0.186 0.141 0.775 0.123 0.139
SR 1 0.111 0.280 0.164 0.700
SR 2 0.228 0.198 0.152 0.733 0.128
SR 3 0.139 0.121 0.145 0.732
SR 4 0.113 0.114 0.748
SR 5 0.135 0.112 0.145 0.770
PA 1 0.811 0.234
PA 2 0.113 0.726 0.322 0.146
PA 3 0.300 0.324 0.171 0.640
PA 4 0.1672 0.218 0.283 0.197 0.740
PW 1 0.130 0.273 0.710 0.132
PW 2 0.135 0.807 0.212
PW 3 0.137 0.829 0.173
PW 4 0.114 0.190 0.100 0.101 0.535 0.201
Pain 1 0.174 0.816
Pain 2 0.192 0.823
Pain 3 0.329 0.733
Variance explained (%) 32.1 9.2 6.1 5.0 4.3 4.1 2.8

Factor loading < 0.10 not reported.

PC, personal competence; PW, psychological well-being; PA, physical appearance; RE, residential environment; SR, social
relationship.

In Taiwan, the ninth grade is an important turning
point for adolescents. Most ninth grade students must
take an entrance examination to attend senior high
school or other occupational schools. Much parental
attention and focus is paid to this examination. As a
result, the affected adolescents experience a great
deal of stress. This might be at the root of the
observed relationship between age and QOL in the
present survey.
We found that female adolescents aged 13–15 years
reported significantly lower QOL, especially in the psy-
chological well-being and pain subdoamins. There are
significant gender differences in self-esteem as a con-
sequence of different patterns of social roles and inter-
personal experience that characterize men and women
from their earliest years.11 These differences might fur-
ther reflect their subjective perception of QOL. Previ-
ous studies also demonstrated that the perception of
16 J-L. Fuh et al.

Table 4. Psychometric results from the Taiwanese Quality Of Life Questionnaire For Adolescents in the study population

Dimension (Numbers of item) Missing Data Rate (%) Mean† SD High (%) Low (%) Reliability‡

Family (7) 0.4 64.5 20.5 0.3 4.2 0.91

RE (8) 0.4 60.7 17.9 0.1 2.5 0.89
PC (7) 0.4 55.5 16.9 0.2 0.9 0.87
SR (5) 0.4 60.0 18.1 0.6 2.0 0.78
PA (4) 0.3 66.4 18.3 0.4 5.7 0.82
PW (4) 0.4 70.9 16.4 0.1 6.8 0.79
Pain (3) 1.0 73.3 16.1 0.1 12.3 0.77

†
Range, 1–5; ‡Cronbach a.
PC, personal competence; PW, psychological well-being; PA, physical appearance; RE, residential environment; SR, social
relationship.

Table 5. Global and domains of Taiwanese Quality Of Life Questionnaire For Adolescents by health status

Health Status Family RE PC SR PA PW Pain

Healthy 65.0 ± 20.3 61.3 ± 17.8‡ 56.1 ± 16.8‡ 60.4 ± 18.0 67.2 ± 17.9‡ 71.8 ± 16.0‡§ 74.2 ± 15.7‡§
(n = 4281)
Acute illness 63.0 ± 21.1 58.7 ± 18.2† 53.1 ± 16.8† 59.1 ± 18.4 63.5 ± 19.6† 67.4 ± 17.6† 69.6 ± 16.9†
(n = 792)
Chronic illness 62.4 ± 22.2 59.5 ± 18.3 54.4 ± 17.9 57.6 ± 19.2 63.7 ± 20.0 67.8 ± 17.0† 70.7 ± 17.8†
(n = 258)
F-value 4.8 8.3 12.0 4.3 17.7 29.9 35.4

†
Differs from the healthy group; ‡Differs from the acute-illness group; §Differs from the chronic-illness group.
PC, personal competence; PW, psychological well-being; PA, physical appearance; RE, residential environment; SR, social
relationship.

pain differed between the genders.12 The results of
our studies are in line with the previous studies in
adults.11,12
In studies by Apajasalo et al.,13,14 healthy female ado-
lescents aged 12–15 years reported a significantly lower
status on the dimensions of vitality, sleeping, physical
appearance, and depression, but those aged 8–11 years
did not. In the surveys conducted in China, Japan, and
the United Kingdom, the scores did not significantly
differ by sex.3,8 Nevertheless, Nordic girls aged 12–17
years had a tendency to have a higher QOL.9 Despite
the statistically significant differences, the absolute dif-
ference in the scores in these studies (including this
one) was small, and the clinical importance is question-
able. The other explanation for this controversy is the
cultural effect. Although the population in China and
Taiwan are both ethnic Chinese, the two sides across
Taiwan Strait have had no official contact since 1949.
Private exchanges between the two sides began in 1987
after the Taiwanese government began allowing citi-
zens to visit their relatives in China, and have increased
rapidly since then. Nevertheless, both societies differ
due to the long-term separation.
The present study has documented lower QOL
scores in urban and rural adolescents. This contrasts
with the results of a survey of 6–14-year-old children in
the United Kingdom.8 However, our results are consis-
tent with several reports conducted in Taiwan which
documented the disadvantage of rural communities for
adolescents which included a greater prevalence of
depression, teenage pregnancies, single-parent or ‘bro-
ken families’, and substance abuse in rural areas versus
urban communities.15–18 More job opportunities in cit-
ies attract a lot of people from rural areas. Therefore,
young and middle-aged rural parents are working in
cities and leaving their children in rural areas with their
grandparents. In addition, the families with better
socioeconomic status choose to migrate to urban areas.
In our survey, we also found that a higher percentage
of rural adolescents lived with a single parent or with
a foster parent. Both the adverse rural environment
in Taiwan and the selective migration of families of
higher socioeconomic status to the cities might explain
this urban–rural difference.
This study had three possible methodological limita-
tions. First, some causal items that are not highly cor-
QOL in adolescents 17

Table 6. Global and domains’ scores of the Taiwanese Quality Of Life Questionnaire For Adolescents by sex, grade and living
environment

Family RE PC SR PA PW Pain

Sex
Male 63.9 ± 20.5 61.7 ± 18.3* 55.6 ± 17.5 58.6 ± 18.4* 69.8 ± 17.8* 74.1 ± 16.7* 76.5 ± 16.2*
(n = 2924)
Female 65.3 ± 20.6 59.6 ± 17.4* 55.3 ± 16.1 61.7 ± 17.7* 67.5 ± 18.0* 67.0 ± 15.1* 69.4 ± 15.2*
(n = 2481)
t-value 2.5 -4.2 -0.7 6.4 -14.9 -16.5 -16.7
Grade
7 (n = 1711) 68.8 ± 20.0‡§ 63.3 ± 18.3‡§ 58.4 ± 17.3‡§ 61.9 ± 17.9§ 69.0 ± 18.3‡§ 71.8 ± 16.3§ 72.8 ± 16.2‡
8 (n = 1842) 64.6 ± 20.9†§ 61.3 ± 18.1†§ 56.2 ± 16.9†§ 60.6 ± 18.2§ 66.3 ± 18.3†§ 72.2 ± 16.0§ 74.6 ± 15.8†§
9 (n = 1852) 60.5 ± 20.1†‡ 57.8 ± 16.9†‡ 52.0 ± 15.8†‡ 57.6 ± 18.0†‡ 64.3 ± 18.0†‡ 68.7 ± 16.8†‡ 72.3 ± 16.3‡
F-value 77.2 45.2 68.4 26.6 30.4 26.1 10.2
Residence
Urban 65.8 ± 20.6* 62.4 ± 17.9* 56.8 ± 17.3* 61.1 ± 18.6* 67.8 ± 18.3* 71.8 ± 16.3* 73.8 ± 16.2*
(n = 3987)
Rural 60.8 ± 20.1* 56.0 ± 17.0* 51.6 ± 14.9* 56.9 ± 16.5* 62.7 ± 17.8* 68.3 ± 16.4* 71.6 ± 15.9*
(n = 1418)
t-value 8.1 12.1 10.9 8.1 9.3 7.0 4.4
Living with
Two parents 65.9 ± 20.2††‡‡ 61.6 ± 17.8††‡‡ 56.0 ± 16.8††‡‡ 60.4 ± 17.9†† 66.7 ± 18.0‡‡ 71.2 ± 16.3†† 73.4 ± 16.0
(n = 4743)
Single parent 53.8 ± 20.5¶ 54.9 ± 17.6¶ 52.2 ± 16.9¶‡‡ 57.5 ± 19.4¶ 64.7 ± 20.0 68.4 ± 17.2¶ 71.9 ± 16.8
(n = 492)
Other 56.7 ± 21.2¶ 56.0 ± 18.8¶ 48.9 ± 15.6¶¶ 56.9 ± 20.7 62.5 ± 20.2¶ 68.4 ± 17.9 73.1 ± 16.6
relatives
(n = 137)
F-value 93.7 37.1 22.4 7.9 6.0 8.6 2.0

*P < 0.006.
†
Differs from grade 7; ‡Differs from grade 8; §Differs from grade 9; ¶Differs from subjects who lived with two parents; †Differs
from subjects who lived with single parent; ‡‡Differs from subjects who lived with other relatives.
PC, personal competence; PW, psychological well-being; PA, physical appearance; RE, residential environment; SR, social
relationship.

related with other items might be omitted in factor CONCLUSION

analysis.19,20 Nevertheless, only three items in our ques-
tionnaire related to symptoms and almost all of them
are indicator variables. Thus, this bias might be minimal.
Second, very few of the students in our sample popu-
lation were afflicted with a severe disease. Of course, the
reported health status was self-assessed and so is sub-
jective. While the differences between the healthy, acute
and chronic groups were small; the observed relation-
ship between health status and reported QOL was not
unexpected. A final limitation concerns the selection of
only two urban junior high schools and a single rural
junior high school among the 708 such schools in Taiwan
in 2001. However, because of the high questionnaire
response rate and the homogeneity of the junior high
school system in Taiwan, we believe that this student
population might provide a representative sample of
13–15-year-old Taiwanese adolescents.
In conclusion, the present study demonstrates that the
psychometric testing with the TQOLQA survey satis-
fies most conventional psychometric criteria. On the
basis of these experiences, the TQOLQA is a promis-
ing tool for the evaluation of QOL of adolescents. Fur-
ther studies will be necessary to validate this potential.
ACKNOWLEDGMENTS
The authors wish to thank all of the teachers and stu-
dents at Yun-Lin, Shih-Pai and Dai-Zh Junior High
Schools for their great help, and Dr Xiangdong Wang
for providing the original Chinese version of the QOL
questionnaire for adolescents. This study was sup-
ported in part by grants from the National Science
Council (NSC-90–2314-B-010–026, NSC-91–2314-B-
075–042).
18
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