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Reliability and validity of using EQ-5D-5L among healthy and adolescents with major mental health disorders in Ethiopia

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Abstract

Background

The EQ-5D is a validated and widely used generic measure of health-related quality of life (HRQoL) in both healthy individuals and those with various medical conditions. The objective of this study was to test whether EQ-5D-5L is reliable and valid for use among school sample adolescents and those with major mental health disorders in Ethiopia.

Methods

Participants were recruited from ten sub-districts comprising the Butajira Rural Health Programme (BRHP) and Butajira major mental health disorders center. Data were collected using an Amharic (Ethiopia) EQ-5D-5L self-complete-paper and the questionnaire was administered 10 days after the first completion for test–retest procedures. Two-way mixed-effects models absolute intraclass correlation coefficient (ICC) was used to test reliability of the instrument while Kruskal–Wallis rank test with pairwise comparison was used to assess the known group validity of the instrument.

Results

There were 501 (201 school sample and 300 adolescents with major mental health disorders) participants recruited and 497 were included in the sample for analysis. The ICC was high (ICC > 0.7, p < 0.001) for all EQ-5D-5L dimensions, EQ-5D-5L utility index and EQ-VAS scores. The findings revealed that the Amharic EQ-5D-5L has significant known group validity as shown by the difference in scores among various disease group (depression, schizophrenia, and bipolar) and experience of chronic illness.

Conclusions

The results shows that the Amharic EQ-5D-5L is reliable and valid instrument for the measurement of HRQoL among adolescent populations in Ethiopia.

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References

  1. WHO/EMOH:. Mental Health System in Ethiopia. WHO, Geneva (2006)

  2. Burstr, K.: EQ-5D-Y as a health-related quality of life measure in children and adolescents with functional disability in Sweden: testing feasibility and validity. Acta Pediatr. 103, 426–435 (2014)

    Article  Google Scholar 

  3. Vieta, E., Bobes, J., Ballesteros, J., Pinto, A.G., Luque, A., Ibarra, N.: Validity and reliability of the Spanish versions of the Bech-Rafaelsen Õ s mania and melancholia scales for bipolar disorders. Acta Psychiatr. Scand. 117(3), 207–215 (2008)

    Article  CAS  Google Scholar 

  4. Bergfors, S., Åström, M., Burström, K., Egmar, A.-C.: Measuring health-related quality of life with EQ-5D-Y instrument in children with asthma. Acta Paediatr. 104(2), 167–173 (2015)

    Article  Google Scholar 

  5. Brauer, C.A., Rosen, A.B., Greenberg, D., Neumann, P.J.: Trends in the measurement of health utilities in published cost-utility analyses. Value Health 9(4), 213–218 (2006)

    Article  Google Scholar 

  6. Litwin, M.S.: Health-Related Quality of Life, pp. 237–251. Humana Press, Totowa (2006)

    Google Scholar 

  7. Karimi, M., Brazier, J.: Health, health-related quality of life, and quality of life: what is the difference? Pharmacoeconomics 34(7), 645–649 (2016)

    Article  Google Scholar 

  8. Whitehead, S.J., Ali, S.: Health outcomes in economic evaluation: the QALY and utilities. Br. Med. Bull. 96(1), 5–21 (2010)

    Article  Google Scholar 

  9. Kularatna, S., Whitty, J.A., Johnson, N.W., Uk, F., Scuffham, P.A., Arts, P.: Health state valuation in low- and middle-income countries: a systematic review of the literature. Value Health 16(6), 1091–1099 (2013)

    Article  Google Scholar 

  10. Janssen, B. EQ-5D-5L User Guide. 2015 (April)

  11. Johansson, K.A., Strand, K.B., Fekadu, A., Chisholm, D.: Health gains and financial protection provided by the Ethiopian mental health strategy: an extended cost-effectiveness analysis. Health Policy Plan 32, 1–8 (2016)

    Google Scholar 

  12. Oppe, M., & van Hout B.: EuroQol Working Paper Series experimental design of the EQ-VT, pp. 1–17. EuroQol Res Found, Rotterdam (2017)

  13. Ravens-sieberer, U., Erhart, M., Wille, N., Wetzel, R., Nickel, J., Bullinger, M.: Generic health-related quality-of-life assessment in children and adolescents methodological considerations. Pharmacoeconomics 24(12), 1199–1220 (2006)

    Article  Google Scholar 

  14. Welie, A.G., Gebretekle, G.B., Stolk, E., Mukuria, C., Krahn, M.D., Enquoselassie, F., et al.: Valuing health state: an EQ-5D-5L value set for Ethiopians. Value Health Reg. Issues 22, 7–14 (2019)

    Article  Google Scholar 

  15. Scott, D., Ferguson, G.D., Jelsma, J.: The use of the EQ-5D-Y health related quality of life outcome measure in children in the Western Cape, South Africa: psychometric properties, feasibility and usefulness—a longitudinal, analytical study. Health Qual. Life Outcomes (2017). https://doi.org/10.1186/s12955-017-0590-3

    Article  PubMed  PubMed Central  Google Scholar 

  16. Ravens-Sieberer, U., Wille, N., Badia, X., Bonsel, G., Burström, K., Cavrini, G., et al.: Feasibility, reliability, and validity of the EQ-5D-Y: results from a multinational study. Qual. Life Res. 19(6), 887–897 (2010). https://www.ncbi.nlm.nih.gov/pubmed/20401552

  17. Wille, N., Badia, X., Bonsel, G., Burstro, K., Ravens-sieberer, L.S.U.: Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual. Life Res. 19, 875–886 (2010)

    Article  Google Scholar 

  18. Goñi, J.M.R., Oppe, M., Stolk, E., Shah, K., Kreimeier, S., Rivero, O., et al.: International valuation protocol for the EQ-5D-Y-3L. Pharmacoeconomics (2020). https://doi.org/10.1007/s40273-020-00909-3

    Article  PubMed  PubMed Central  Google Scholar 

  19. van Reenen, M., Janssen, B.: EQ-5D-5L User Guide basic information on how to use the EQ-5D-5L instrument, pp. 1–25. EuroQol Res Found, Rotterdam (2015)

  20. De, V.H.C.W., Terwee, C.B., Knol, D.L., Bouter, L.M.: When to use agreement versus reliability measures. J. Clin. Epidemiol. 59(10), 1033–1039 (2006)

    Article  Google Scholar 

  21. Liu, H., Feurer, I.D., Dwyer, K., Speroff, T., Shaffer, D., Pinson, C.W.: The effects of gender and age on health-related quality of life following kidney transplantation. J. Clin. Nurs. 17(1), 82–89 (2008)

    PubMed  Google Scholar 

  22. Brazier, J., Jones, N., Kind, P.: Testing the validity of the Euroqol and comparing it with the SF-36 health survey questionnaire. Qual. Life Res. 2(3), 169–180 (1993)

    Article  CAS  Google Scholar 

  23. Koo, T.K., Li, M.Y.: A guideline of selecting and reporting intraclass correlation coefficients for reliability research. J. Chiropr. Med. (2015). https://doi.org/10.1016/j.jcm.2016.02.012

    Article  Google Scholar 

  24. Bassett, A.S., Collins, E.J., Nuttall, S.E., Honer, W.G.: Positive and negative symptoms in families with schizophrenia. Schizophr. Res. 11(1), 9–19 (1993)

    Article  CAS  Google Scholar 

  25. Feng, Y.S., Kohlmann, T., Janssen, M.F., Buchholz, I.: Psychometric properties of the EQ-5D-5L : a systematic review of the literature. Qual. Life Res. 30(3), 647–673 (2021). https://doi.org/10.1007/s11136-020-02688-y

    Article  PubMed  Google Scholar 

  26. Franklin, M., Enrique, A., Palacios, J., Richards, D., Franklin, M.: Psychometric assessment of EQ-5D-5L and ReQoL measures in patients with anxiety and depression : construct validity and responsiveness. Qual. Life Res. 30(9), 2633–2647 (2021). https://doi.org/10.1007/s11136-021-02833-1

    Article  PubMed  PubMed Central  Google Scholar 

  27. Bilbao, A., Martín-fernández, J., García-pérez, L., Ignacio, J., Arrasate, M., Candela, R., et al.: Psychometric properties of the EQ-5D-5L in patients with major depression : factor analysis and Rasch analysis. J. Ment. Health (2021). https://doi.org/10.1080/09638237.2021.1875422

    Article  PubMed  Google Scholar 

  28. Crick, K., Al, F., Arto, S., Jeffrey, O.: Responsiveness of the anxiety/depression dimension of the 3- and 5-level versions of the EQ-5D in assessing mental health. Qual. Life Res. 27(6), 1625–1633 (2018). https://doi.org/10.1007/s11136-018-1828-1

    Article  PubMed  Google Scholar 

  29. Dams, J., Rimane, E., Steil, R., Renneberg, B., Rosner, R.: Reliability, validity and responsiveness of the EQ-5D-5L in assessing and valuing health status in adolescents and young adults with posttraumatic stress disorder : a randomized controlled trail. Psychiatr. Q. 92, 459–471 (2021)

    Article  Google Scholar 

  30. Mulhern, B., Mukuria, C., Barkham, M., Knapp, M., Byford, S., Soeteman, D., et al.: Using generic preference-based measures in mental health : psychometric validity of the EQ-5D and SF-6D Using generic preference-based measures in mental health : psychometric validity of the EQ-5D and SF-6D. Br. J. Psychiatry 22(03), 236–243 (2014)

    Article  Google Scholar 

  31. Peasgood, T., Brazier, J., Papaioannou, D.: A systematic review of the validity and responsiveness of EQ-5D and SF-6D for depression and anxiety. HEDS Discuss Pap. 12(15), 1–62 (2012)

    Google Scholar 

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Acknowledgements

Authors would like to thank all study participants for their participation. Special thanks to the EuroQol Foundation for funding this research project.

Funding

This project was financial supported by EuroQol foundation, The Netherlands (project ID 20180500). EuroQol Research Foundation, EQ-project-20180500, Abraham Gebregziabiher Welie

Author information

Authors and Affiliations

  1. School of Pharmacy, College of Health Science, Mekelle University, Mekelle, Ethiopia

    Abraham G. Welie & Yared Belete Belay

  2. Executive Office, EuroQol Research Foundation, Rotterdam, The Netherlands

    Elly Stolk

  3. Health Economics and Decision Science, School of Health and Related Research, University of Sheffield, Sheffield, UK

    Clara Mukuria

  4. Toronto Health Economics and Technology Assessment (THETA) Collaborative, University Health Network, University of Toronto, Toronto, Canada

    Murray D. Krahn & Beate Sander

  5. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Beate Sander

  6. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Beate Sander

  7. Public Health Ontario, Toronto, ON, Canada

    Beate Sander

  8. School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia

    Gebremedhin Beedemariam Gebretekle

Authors
  1. Abraham G. Welie
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  2. Elly Stolk
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  3. Clara Mukuria
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  4. Yared Belete Belay
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  5. Murray D. Krahn
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  6. Beate Sander
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  7. Gebremedhin Beedemariam Gebretekle
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Contributions

AG, GBG, and YB conceived the idea; AG, ES, CM and YBB designed the study, acquired the funding, and provided detailed information regarding data collection processes in Ethiopia. AG and GBG performed data quality control. AG and MK prepared the draft manuscript. All authors reviewed the analysis, interpretation of the results, and the final manuscript.

Corresponding author

Correspondence to Abraham G. Welie.

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Conflict of interest

Elly Stolk is a member of the EuroQol Research Foundation. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Ethical approval

Ethical approval was secured from Ethics Review Committee of School of Pharmacy, Addis Ababa University, Ethiopia and prior permission was sought from Demographic Health Surveillance site of Butajira Rural Health Project (BRHP) office, Ethiopia. Written Informed consent was obtained from all study participants to confirm their willingness for participation after explaining the purpose of study.

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Welie, A.G., Stolk, E., Mukuria, C. et al. Reliability and validity of using EQ-5D-5L among healthy and adolescents with major mental health disorders in Ethiopia. Eur J Health Econ 23, 1105–1119 (2022). https://doi.org/10.1007/s10198-021-01412-y

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  • DOI: https://doi.org/10.1007/s10198-021-01412-y

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