Mongolian translation and reliability assessment of the PedsQL™ gastrointestinal symptoms module standard form in pediatric patients with gastrointestinal disorders

Abstract

Background: The Pediatric Quality of Life Inventory™ (PedsQL™) is a modular, multidimensional instrument designed to assess health-related quality of life (HRQoL) in children and adolescents aged 2 to 18 years. It encompasses both child self-report and parent proxy-report formats and includes generic as well as disease-specific modules, enabling comprehensive HRQoL assessment across healthy and clinical pediatric populations. In Mongolia, gastrointestinal (GI) disorders represent the second leading cause of morbidity among children aged 10 to 14 years. The assessment of HRQoL in children with GI disorders — particularly those with chronic conditions — is of considerable importance for clinicians and researchers in conducting epidemiological surveillance, monitoring treatment outcomes, and evaluating findings from clinical trials. Aim: To translate the Pediatric Quality of Life Inventory–Gastrointestinal Symptoms Module Standard Form (PedsQL™GI version standard form) into Mongolian and to evaluate its internal consistency reliability. Materials and Methods: The PedsQL™-GI version standard form was selected for translation following written authorization from the original developers. The bilingual forward translation was conducted by a team comprising a professional linguist and a pediatrician with 15 years of clinical experience and academic proficiency in English, adhering to the developer-provided translation protocol. The preliminary Mongolian version was subsequently reviewed by a senior pediatrician with 25 years of professional experience and academic English, with particular attention to medical terminology accuracy and linguistic equivalence. A separate bilingual team — consisting of a second linguist and a pediatrician — then performed the backward translation into English. A small-group expert panel comprising the back-translation team and the research investigators convened to review discrepancies and finalize the English reconciled version, which was submitted to the original developers for approval before the ofÏcial release of the Mongolian version. To evaluate the internal consistency reliability of the Mongolian version, the instrument was administered to 25 children aged 8–12 years and 25 adolescents aged 13 years and above, along with their respective caregivers. Data were analyzed using SPSS version 25.0, employing the Intraclass Correlation CoefÏcient (ICC) and Cronbach’s alpha coefÏcient. Results: The Cronbach’s alpha coefÏcient for the total instrument was α=0.96, indicating excellent internal consistency reliability. Test-retest reliability, assessed using the Intraclass Correlation CoefÏcient, yielded ICC=0.79, demonstrating satisfactory measurement stability over repeated administrations. Conclusions: 1. The overall semantic equivalence of the Mongolian version was 97.8%, and 96% of cognitive interview participants rated the questionnaire as “understandable” indicating that the clinical content and conceptual integrity of the original instrument were fully preserved throughout the translation process. 2. A total of 37 adaptation instances were identified during the translation process, encompassing six categories of linguistic and cross-cultural localization: age-appropriate modification, conversion of medical terminology into everyday language, linguistic and cultural adaptation, synonymous substitution, elaboration, and condensation. These adaptations collectively enhanced the content validity of the instrument. 3. The Mongolian version demonstrated excellent internal consistency reliability (Cronbach’s alpha α=0.96) and satisfactory test-retest reliability (Intraclass Correlation CoefÏcient ICC=0.79), both fully meeting international psychometric standards. These findings confirm that the instrument constitutes a reliable tool for assessing health-related quality of life in Mongolian children with chronic gastrointestinal disorders.