Identifying and developing culturally relevant EQ-5D-5L bolt-on items for Chinese population: qualitative phase of a mixed-methods study

EQ-5D might not fully capture certain aspects of health-related quality of life (HRQoL) important to the Chinese population. The study aimed to identify and develop culturally relevant additional items (bolt-ons) for the EQ-5D-5L in China.

This study represents the qualitative phase of a larger mixed-methods project. Based on existing systematic reviews and qualitative work, we developed seven candidate items (sleep, tiredness/lack of strength, appetite, climate adaptation, emotional control, social adaptation and social support), which were commonly used in Chinese HRQoL description and measurement, or reflected Chinese unique understanding of HRQoL. Eleven HRQoL or clinical experts, 15 healthy and 12 chronically ill individuals participated in semi-structured interviews to assess the relevance, comprehensiveness and comprehensibility of each item. Data were analyzed thematically.

Sleep, tiredness/lack of strength, appetite, and social adaptation were mostly regarded as relevant to HRQoL. Most lay respondents acknowledged climate adaptation (x = 17) and emotional control (x = 18) were important, differing from expert opinions; social support was considered partially or not related to HRQoL by 20 respondents.

Suggestions were made regarding dimension headings and addition of illustrative explanations/descriptions, leading to iterative refinements in the item wording.

No additional bolt-ons were proposed by more than two respondents.

Sleep, tiredness/lack of strength, appetite, climate adaptation, emotional control, and social adaptation are potentially useful EQ-5D-5L both-ons for the Chinese population, but not social support. This study contributed to finalizing the bolt-on items and their wording that will be psychometrically tested in the next quantitative phase of the project.