Alcohol-related quality of life in young people

: development and initial validation of a new targeted outcome measure

Abstract

Overview
There is a paucity of psychometric evidence supporting the use of instruments that can measure how young people's lives are being affected by alcohol and what kind of intervention (if any) is necessary. The current thesis addressed an increasing demand for the construct of quality of life (QoL) to be incorporated into the assessment of adolescents experiencing alcohol-related risk and harm.

Methods
A systematic review (study one) identified candidate domains and items from existing QoL and health-related quality of life (HRQoL) instruments used with populations on the spectrum of addiction-related risk and harm. Semi-structured interviews (study two) with adolescents aged 15 to 17 years old (n=18) using thematic analysis provided qualitative feedback on candidate items and produced themes regarding the impact of alcohol on the most important aspects of adolescents’ lives. A two-round e-Delphi (study three) with experts by experience and professionals (n=20) further refined the pool of candidate items and reached consensus on the essential components in the assessment of QoL in adolescents who consume alcohol, referred to as alcohol-related quality of life (ARQoL) in this thesis. The resultant 55-item pilot measure was administered in a quantitative validation study (study four) with adolescents (n=309). Exploratory factor analysis (EFA) was applied to explore the latent constructs of the measure and assess its structural validity. Tests of internal consistency and criterion validity were performed, and regression analyses investigated the refined 43-item measure’s associations with demographic, social, psychological, and alcohol-related variables.

Results
Study one identified 47 QoL and HRQoL outcome instruments containing 38 domains and 813 unique items. Thematic analysis in study two identified six key themes related to the most important aspects of young people's lives and how they believe alcohol can impact on their QoL. Expert ratings of item appropriateness and necessity in study three produced a 55-item pilot measure. EFA results led to a refined 43-item test measure with two factors. The test measure demonstrated satisfactory structural validity, internal consistency, and construct validity. Regression analyses revealed five variables as significantly associated with the new outcome measure.

Implications
A rigorous process of instrument development and initial validation produced a 43-item novel measure of QoL for adolescents who drink alcohol – the Adolescent Quality of Life Scale (AdQoLS). The item content developed was based on general QoL and informed by adolescents’ perspectives and experiences of how alcohol impacts their lives. Therefore, the items are not alcohol-specific and may have wider applicability both to adolescents involved in other risk-taking behaviours and in general. However, confirmatory testing with more diverse samples in different contexts is required to further validate and shorten the new measure. Nevertheless, researchers and clinicians now have items available with promising psychometric properties to assess the QoL of adolescents who consume alcohol.

Thesis is embargoed until 31 July 2026.

Date of Award	Jul 2024
Original language	English
Awarding Institution	Queen's University Belfast
Sponsors	Northern Ireland Department for the Economy
Supervisor	Paul Toner (Supervisor), David Curran (Supervisor) & Jan Boehnke (Supervisor)