Content and face validity of preference-based quality of life instruments in indigenous youth experiencing mental health problems: a qualitative study

Mainstream preference-based quality of life (QoL) measures have been traditionally based on Western principles of health. It is critical to examine whether existing preference-based QoL measures capture what is important to Indigenous people while being comprehensive and culturally acceptable. This study aims to assess the content and face validity of the EuroQol-5 dimensions 5-levels (EQ-5D-5 L), 12-item short form survey (SF-12), assessment of quality of life–6 dimensions (AQoL-6D), and recovering quality of life 10-item (ReQoL-10) within the context of indigenous youth mental health.

Eight individual yarns and five yarning circles were conducted with 20 indigenous young people aged 15˗25 years, with a history of at least 1 mental health problem in the Perth and Bunbury regions of Western Australia. The measures were explored in random order using the yarning approach, and then ranked by relevance by participants. Data were analysed using thematic and constant comparative approaches.

The face and content validity of each preference-based QoL instrument was summarised into four themes: (1) appropriateness, (2) comprehensiveness, (3) comprehensibility, and (4) layout and format. The ReQoL-10 emerged as a more suitable measure due to its mental health focus, clear response options, and well-designed layout and format. While some positive comments were made about the other measures, there were critical issues around their content and face validity. Our data revealed a clear preference for the ReQoL.

The ReQoL-10 appears to be a promising measure in the context of indigenous youth mental health, and was explicitly preferred by indigenous youth.