PROs from Children
PROs directly from children and youth are taking greater prominence among all interested parties, following similar development as that for adults and older adults (Starfield, 1996). Children and youth represent a special case, however, given knowledge of variation in how and when children develop, the wide variation in willingness and ability to self-report across the age spectrum, and the “special” language of children and adolescents in different cultures of the world. Rapid progress is being made in Europe and North America, to be followed and informed by work in other parts of the world, often less accessible to Western parties.
Cross Cultural PROs
Demand is also increasing for quality of life measures available for use in cross-cultural comparisons, which requires special attention to cultural adaptation and validation for each culture in which the measure is applied (Acquadro et al., 2003).