Development of a Children's Visual Function Quality of Life (CVF-QoL) Instrument for Rural School-Going Children with Visual Impairments Within a South African Context: Item Generation and Validation.

Background: Assessing visual function and quality of life in children with visual impairments is crucial for understanding its impact and evaluating interventions. While tools exist for developed countries, there is a lack of instruments for rural school-going children in middle- to low-income countries. This study aimed to develop and validate an instrument to measure Children's Visual Function Quality of Life (CVF-QoL) for South African children aged 6 to 17 with uncorrected refractive errors, visual impairments, or blindness. Methods: The CVF-QoL instrument was created through a literature review and focus group discussions with experts and children. Readability was assessed, resulting in two versions of the CVF-QoL instrument. The contents of both versions were validated by experts, and pre-testing was performed with school children aged 6-17 years. Results: From the literature review, 769 items were identified, and 477 statements were generated from focus group discussions. After merging and eliminating duplicates, 91 items were classified into eight domains. The tool was divided into Version 1.1 for ages 10-17 (89 items) and Version 2.1 for ages 6-9 (63 items), both demonstrating strong clarity, coherence, and relevance. Conclusions: The CVF-QoL instruments are valid for evaluating the quality of life-related to visual function among rural school-going children with visual impairments in South Africa. This instrument thus provides an additional QoL tool to those already existing that may be more appropriate for measuring quality of life for rural school-going children in low- and middle-income countries.