The Helping Alliance Questionnaire for Children and Their Caregivers-Validation in a German Sample of Pediatric Chronic Pain Patients

Lisa-Marie Rau, Amelie Florentine Schmidt, Julia Wager

Mai, 2026

Abstract

Objectives: The „helping alliance“ between patients, caregivers, and healthcare professionals (HCPs) plays an important role in the evaluation of therapeutic interventions. The aim of this study was to develop a German version of the Helping Alliance Questionnaire for pediatric patients (HAQ-P) and caregivers (HAQ-CG).

Methods: The questionnaire was adapted from the original version of the HAQ for adults and improved using feedback from HCPs, patients with chronic pain and their caregivers. It was then validated in a sample of N = 216 patients with chronic pain aged 8-17 years, along with their caregivers and HCPs.

Results: Confirmatory factor analysis revealed a good model fit for the 2-factor structure of the HAQ-P and HAQ-CG, with the two subscales relationship and outcome satisfaction demonstrating good to excellent internal consistency across all subgroups. Multi-group analyses showed that the model structure was similar for patients, caregivers, and HCPs. However, means of the three groups differed systematically (e.g., caregivers reported higher satisfaction), thus not allowing for direct comparison of group means.

Conclusions: The HAQ-P and HAQ-CG have strong psychometric properties, and may be useful in clinical practice and research for monitoring, predicting, and improving therapeutic outcomes.