**Background:** Indigenous populations have holistic health models that include spiritual, family, environmental, and cultural dimensions often absent from Western HRQoL measures. Despite the United Nations Declaration on the Rights of Indigenous Peoples affirming equal rights to health, Indigenous populations bear inequitable disease burdens. HRQoL measures are used to assess health outcomes and inform policy, but prior reviews focused on adult Indigenous populations; no review had examined HRQoL measures for Indigenous children/youth. This scoping review aimed to (1) identify which HRQoL measures have been used with Indigenous children/youth (aged 8–17 years) in the Pacific Rim, and (2) identify studies that refer to Indigenous health concepts in using child/youth HRQoL measures.
**Methods:** A scoping review following published protocol. Databases searched: Ovid (Medline), PubMed, Scopus, Web of Science, and CINAHL up to 25 June 2020. Eligible papers: written in English, published January 1990–June 2020, included an HRQoL measure used with Indigenous child/youth populations (aged 8–17 years) in the Pacific Rim. Two independent reviewers screened abstracts and full texts; a third resolved disputes. Data extracted included study characteristics, HRQoL measure characteristics, and consideration of Indigenous concepts (created/modified/validated for Indigenous population, Indigenous involvement, reference to Indigenous theories/models/frameworks).
**Key Results:** The search yielded 2207 papers; after removing duplicates, 1393 abstracts were screened, 543 underwent full-text review, and 40 papers (reporting 32 unique studies) were included. Thirteen papers reported research from Australia, 7 from Canada, 6 from New Zealand, 6 from Fiji, 3 from the USA, and 1 each from Taiwan, Malaysia, and Tonga; 2 papers covered two countries. Participant ages ranged from <1 to 77 years; 33 papers were specific to child/youth populations. Twenty-nine different HRQoL measures were used. The Pediatric Quality of Life Inventory (PedsQL) was most common (16 papers). Twenty-five papers used generic measures only, 11 used disease-specific measures only (most commonly oral health measures), and 4 used both. Twenty-three papers used child/youth-specific measures; 10 used adult measures with children/youth. Five preference-based measures were identified. Only 2 of 29 measures were created specifically for Indigenous populations: the Aboriginal Children’s Health and Well-being Measure (ACHWM; child/youth-specific, used with First Nations in Canada) and the Wicozani Instrument (adult measure used with Dakota youth in the USA). Thirty-three of 40 papers did not acknowledge Indigenous concepts of health. Only 7 papers mentioned alternative Indigenous health concepts; 5 of these used Indigenous-specific measures. Nine papers explicitly mentioned Indigenous researcher involvement or Elder guidance. The ACHWM, based on the Medicine Wheel Framework, includes spiritual, emotional, physical, and mental dimensions (62 items). Validation showed ACHWM mean=71.4 vs PedsQL mean=71.1; r=0.52, p=0.0001. The Wicozani Instrument includes mental, physical, and spiritual health (9 items) and is grounded in Indigenous paradigms using a strengths-based approach.
**Clinical Implications:** There is a clear gap in culturally appropriate HRQoL measures for Indigenous children/youth. Most measures used were not created, modified, validated, or found reliable for Indigenous populations. Existing generic measures often omit dimensions critical to Indigenous health (e.g., spiritual health, family/community connection, connection to land). Without culturally valid measures, HRQoL assessments may misrepresent Indigenous children/youth health outcomes, potentially leading to inequitable resource allocation and policy decisions. The authors strongly recommend explicit inclusion of Indigenous concepts and researchers when developing, validating, and using HRQoL measures with Indigenous populations. Limitations include restriction to Pacific Rim countries, focus on HRQoL measures (not broader well-being measures), and focus on current use rather than historical development of measures.