How Do Respondents Interpret and View the EQ-VAS? A Qualitative Study of Three Asian Populations
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ORIGINAL RESEARCH ARTICLE
How Do Respondents Interpret and View the EQ‑VAS? A Qualitative Study of Three Asian Populations Rachel Lee‑Yin Tan1 · Zhihao Yang2 · Ataru Igarashi3 · Michael Herdman4 · Nan Luo1
© Springer Nature Switzerland AG 2020
Abstract Background This study aimed to understand how respondents from three Asian countries interpret and perceive the EuroQol Visual Analogue Scale (EQ-VAS). Method Data were from a project that aimed to examine the cultural appropriateness of EQ-5D in Asia. Members of the general public from China, Japan, and Singapore were interviewed one-to-one in their preferred languages. Open-ended questions (e.g. What does “best imaginable health” mean to you?) were used to elicit participants’ interpretation of the labels of EQ-VAS. How the scale could be improved was also probed. Thematic and content analyses were performed separately for each country before pooling for comparison. Results Sixty Chinese, 24 Japanese, and 60 Singaporeans were interviewed. Interpretations of the label “Best Imaginable Health” varied among the participants. Interestingly, some participants indicated that “Best Imaginable Health” is unachievable. Interpretations for “Worst Imaginable Health” also varied, with participants referring primarily to one of three themes, namely, “death,” “disease,” and “disability.” There were different opinions as to what changes in health would correspond to a 5- to 10-point change on the EQ-VAS. While participants opined that EQ-VAS is easy to understand, some criticized it for being too granular and that scale labels are open to interpretation. Findings from the three countries were similar. Conclusion It appears that interpretations of the EQ-VAS vary across Asian respondents. Future studies should investigate whether the variations are associated with any respondent characteristics and whether the EQ-VAS could be modified to achieve better respondent acceptance.
1 Introduction Though originally developed for use in Europe, the EQ-5D questionnaire [1] is currently used worldwide not only to describe and value health, but also to inform important policy decisions based on economic evaluations. EQ-5D is a generic, self-complete questionnaire comprising two parts. The first part is the EQ-5D descriptive system (DS), which asks respondents to describe their health in five dimensions * Nan Luo [email protected] Rachel Lee‑Yin Tan [email protected] Zhihao Yang [email protected] Ataru Igarashi [email protected] Michael Herdman [email protected]
(Mobility, Self-Care, Usual Activities, Pain/Discomfort, and Anxiety/Depression) using either three or five problem levels (EQ-5D-3L and EQ-5D-5L, respectively). A utility/ index score can be generated using the responses to the DS to indicate the value of the described health state [1]. The second part of the EQ-5D questionnaire is the EuroQol Visual Analogue Scale (EQ-VAS), a 20-cm long vertical visual analog scale. The EQ-VAS contains a five-line instruction for respondents to rate their health on the day
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