51
|
Engel L, Whitehurst DGT, Haagsma J, Janssen MF, Mulhern B. What is measured by the composite, single-item pain/discomfort dimension of the EQ-5D-5L? An exploratory analysis. Qual Life Res 2022; 32:1175-1186. [PMID: 36469212 DOI: 10.1007/s11136-022-03312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE This study examines the EQ-5D-5L pain/discomfort dimension by drawing comparisons with five other pain and discomfort items (pain severity, discomfort severity, pain frequency, discomfort frequency and pain interference) collected in the Australian psychometric study for the EQ Health and Wellbeing instrument. METHODS Participants, recruited via a market research company, completed an online survey. Methods of analyses included the assessment of descriptive statistics, variation in reporting patterns using chi-square tests and cross-tabulations, correlation analyses, ordered univariate logistic regression, and discriminatory power analyses (Shannon index (H') and Shannon Evenness index (J')). RESULTS Survey data from 514 participants were used. Compared with EQ-5D-5L pain/discomfort, there was a higher proportion of respondents reporting some level of impairment on at least one of the pain severity and discomfort severity items (74% versus 81%). Correlation with EQ-5D-5L pain/discomfort was strongest for pain severity (r = 0.83) and weakest for discomfort frequency (r = 0.41); the same inferences were drawn for predictive ability. Adding any additional pain or discomfort items to the EQ-5D-5L increased the absolute informativity (H') but not the relative informativity (J'). When replacing EQ-5D-5L pain/discomfort with separate pain and/or discomfort items - i.e., adding items to a modified 'EQ-4D-5L'-absolute informativity increased, while relative informativity increased only when pain interference and frequency-related items (independently or in combination) were added. CONCLUSION The EQ-5D-5L pain/discomfort dimension captures aspects of pain more than aspects of discomfort. Potential reasons include the absence of descriptors or because pain is mentioned first in the composite item.
Collapse
Affiliation(s)
- Lidia Engel
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Level 4, 553 St. Kilda Road, Melbourne, VIC, 3004, Australia.
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Juanita Haagsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands
| | - M F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
52
|
Rencz F, Janssen MF. Analyzing the Pain/Discomfort and Anxiety/Depression Composite Domains and the Meaning of Discomfort in the EQ-5D: A Mixed-Methods Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:2003-2016. [PMID: 35973925 DOI: 10.1016/j.jval.2022.06.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/20/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES The EQ-5D has 2 composite domains: pain/discomfort (PD) and anxiety/depression (AD). This study aims to explore how respondents use the composites to self-report health and what the meaning of discomfort is in the EQ-5D for the general public. METHODS Both qualitative and quantitative data were collected in an online cross-sectional survey involving a nationally representative general population sample in Hungary (n = 1700). Respondents completed the 5-level version of EQ-5D, followed by the composites split into individual subdomains. Open-ended questions were asked to explore respondents' interpretations and experiences of discomfort. RESULTS Six different response behaviors were identified in the composites: "uniform" (21%-32%), "most severe" (30%-34%), "least severe" (16%-23%), "average" (2%-4%), "synergistic" (4%-5%), and "inconsistent" (13%-15%). Compared with the individual subdomains, many respondents under-reported their problems on both composites (PD 16%-22% and AD 6%-13%, P < .05). In respondents who scored differently in the 2 separate domains, mainly problems with the first subdomain determined responses in the composites (PD 66% and AD 61%). The discomfort subdomain in the EQ-5D captured more than 100 different problems, including pain, nonpain physical discomfort (eg, tiredness, dizziness, and nausea), and psychological discomfort (eg, anxiety, nervousness, and sadness). Women, older adults, and those in worse general health status more often considered discomfort as pain (P < .05). CONCLUSIONS We found empirical evidence of measurement error in the composite responses on the EQ-5D, including under- and inconsistent reporting, ordering effects, potential differential item functioning, and interdomain dependency. Our findings contribute new knowledge to the development of new and refinement of existing self-reported health status instruments, also beyond the EQ-5D.
Collapse
Affiliation(s)
- Fanni Rencz
- Department of Health Policy, Corvinus University of Budapest, Budapest, Hungary.
| | - Mathieu F Janssen
- Section Medical Psychology and Psychotherapy, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| |
Collapse
|
53
|
Finch AP, Mulhern B. Where do measures of health, social care and wellbeing fit within a wider measurement framework? Implications for the measurement of quality of life and the identification of bolt-ons. Soc Sci Med 2022; 313:115370. [PMID: 36240533 DOI: 10.1016/j.socscimed.2022.115370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/02/2022] [Accepted: 09/09/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND There is variability across studies in the dimensionality i.e., set of latent variables to which health, social care and wellbeing measures relate. This variability may impact the development of new measures and the identification of bolt-on dimensions. We examine the dimensionality of commonly used measures and identify a set of potential bolt-ons for the EQ-5D-5L. METHODS We used the OMS dataset, an online survey of health, social care and wellbeing measures in patients and members of the general public. A content analysis provided a theoretical framework for results interpretation. Quantitative analyses were based on a pool of 79 items from 7 measures. Confirmatory factor analysis was used to assess health, social care and wellbeing measures dimensionality and their contribution to quality of life. The relationship between EQ-5D-5L items and the identified factors was used for bolt-ons identification. RESULTS The dimensionality comprised of seven factors, namely physical functioning, psychological symptoms, energy/sleep, physical pain, social functioning, needs and satisfaction. Health measures covered five of the seven factors identified, wellbeing measures three and the social care measure one. A list of candidate bolt-on items for the EQ-5D-5L was presented e.g., cognition, energy, dignity. CONCLUSIONS This study provides evidence on the dimensionality of health, social care and wellbeing measures and presents a list of candidate bolt-ons for the EQ-5D-5L.
Collapse
Affiliation(s)
- Aureliano Paolo Finch
- EuroQol Office, EuroQol Research Foundation, Rotterdam, Netherlands; Health Values Research and Consultancy, Amsterdam, Netherlands.
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| |
Collapse
|
54
|
Wu J, He X, Chen P, Xie S, Li X, Hu H, Zhao K, Xie F. China Health Related Outcomes Measures (CHROME): Development of a New Generic Preference-Based Measure for the Chinese Population. PHARMACOECONOMICS 2022; 40:957-969. [PMID: 35844001 PMCID: PMC9288864 DOI: 10.1007/s40273-022-01151-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Existing generic preference-based measures were all developed in Western countries. Evidence shows that the Chinese population may have different perceptions about health and health-related quality of life. This study aimed at developing a descriptive system of a new generic preference-based measure under the initiative of China Health Related Outcomes Measures (CHROME). METHODS Qualitative data were collected through semi-structured interviews conducted in-person or online. Respondents were recruited from both the general public and populations with chronic diseases. Open-ended questions about the respondent's perception of general health and important aspects of health-related quality of life were asked. Probing questions based on a systematic review of existing generic preference-based measures were also used. The framework analysis was used to synthesize the qualitative data. Candidate items for the descriptive system were selected following the ISPOR and COSMIN guidelines. Expert panel review and cognitive debriefings were conducted for further revisions. RESULTS Qualitative interviews were conducted among 68 respondents, with 48.5% male and a mean age of 47.8 years (range 18-81 years). In total, 1558 codes were identified and then aggregated to 31 sub-themes and corresponding six themes to inform the development of the initial version of the descriptive system. Feedback from the expert panel survey and meeting (n = 15) and the cognitive debriefing interviews (n = 30) was incorporated into the revised version of the measure. Finally, the generic version of CHROME (CHROME-G) included 12 items across six domains, namely, pain, fatigue, appetite, mobility, vision, hearing, sleeping, daily activities, depression, worry, memory, and social interactions. The descriptive system used a mix of four-level and five-level response options and a 7-day recall period. CONCLUSIONS The CHROME-G is the first generic preference-based measure to be developed based on the inputs from the Chinese populations.
Collapse
Affiliation(s)
- Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Pinan Chen
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Xue Li
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Technology Assessment, China National Health Development Research Centre, Beijing, China
| | - Hao Hu
- Liaoning Institute of Basic Medicine, Liaoning, China
| | - Kun Zhao
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
| |
Collapse
|
55
|
Carlton J, Peasgood T, Mukuria C, Johnson J, Ogden M, Tovey W. The role of patient and public involvement and engagement (PPIE) within the development of the EQ Health and Wellbeing (EQ-HWB). J Patient Rep Outcomes 2022; 6:35. [PMID: 35394269 PMCID: PMC8993969 DOI: 10.1186/s41687-022-00437-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/18/2022] [Indexed: 11/20/2022] Open
Abstract
Objectives The value of patient and public involvement and engagement (PPIE) within the development and refinement of outcome measures is becoming increasingly recognized. The aim of this paper is to provide an overview of how PPIE was integrated within the development of a new measure designed for use in economic evaluations across health and social care, the EQ Health and Wellbeing (EQ-HWB™). Methods Four PPIE sessions were held at key stages. Discussions from each session and the outcome of any tasks were shared with the wider research team and used to help inform decision-making. Results and discussion PPIE covered several components of outcome measure development including; review of conceptual model; discussion on sub-domain inclusion; item refinement and reduction; pre-testing of items; selection of items for the measure; and design of the measure. Key learning points for future projects were highlighted including; consideration of practicalities, resources and logistics of PPIE activities; how sessions and activities are managed effectively; and how to managing expectations and communication from both researcher and PPIE perspectives. Conclusions The PPIE group provided invaluable insight into perspectives of future patients and carers. Their input was fed into a number of developmental stages. The formal involvement from the PPIE group meant that the voice of the general public was heard. This helped ensure the appropriateness of the design of the final measure.
Collapse
Affiliation(s)
- Jill Carlton
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.
| | - Tessa Peasgood
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Clara Mukuria
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | - Julie Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK
| | | | - Wade Tovey
- On Behalf of the EQ-HWB PPIE Group, Sheffield, UK
| |
Collapse
|
56
|
Peasgood T, Mukuria C, Brazier J, Marten O, Kreimeier S, Luo N, Mulhern B, Greiner W, Pickard AS, Augustovski F, Engel L, Gibbons L, Yang Z, Monteiro AL, Kuharic M, Belizan M, Bjørner J. Developing a New Generic Health and Wellbeing Measure: Psychometric Survey Results for the EQ-HWB. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:525-533. [PMID: 35365299 DOI: 10.1016/j.jval.2021.11.1361] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/29/2021] [Accepted: 11/04/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES The development of measures such as the EQ-HWB (EQ Health and Wellbeing) requires selection of items. This study explored the psychometric performance of candidate items, testing their validity in patients, social carer users, and carers. METHODS Article and online surveys that included candidate items (N = 64) were conducted in Argentina, Australia, China, Germany, United Kingdom, and the United States. Psychometric assessment on missing data, response distributions, and known group differences was undertaken. Dimensionality was explored using exploratory and confirmatory factor analysis. Poorly fitting items were identified using information functions, and the function of each response category was assessed using category characteristic curves from item response theory (IRT) models. Differential item functioning was tested across key subgroups. RESULTS There were 4879 respondents (Argentina = 508, Australia = 514, China = 497, Germany = 502, United Kingdom = 1955, United States = 903). Where missing data were allowed, it was low (UK article survey 2.3%; US survey 0.6%). Most items had responses distributed across all levels. Most items could discriminate between groups with known health conditions with moderate to large effect sizes. Items were less able to discriminate across carers. Factor analysis found positive and negative measurement factors alongside the constructs of interest. For most of the countries apart from China, the confirmatory factor analysis model had good fit with some minor modifications. IRT indicated that most items had well-functioning response categories but there was some evidence of differential item functioning in many items. CONCLUSIONS Items performed well in classical psychometric testing and IRT. This large 6-country collaboration provided evidence to inform item selection for the EQ-HWB measure.
Collapse
Affiliation(s)
- Tessa Peasgood
- Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia; School of Health and Related Research, University of Sheffield, Sheffield, England, UK.
| | - Clara Mukuria
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - John Brazier
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | - Ole Marten
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Simone Kreimeier
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Brendan Mulhern
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, New South Wales, Australia
| | - Wolfgang Greiner
- Department of Health Economics and Health Care Management, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - A Simon Pickard
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | | | - Lidia Engel
- Deakin Health Economics, School of Health and Social Development, Deakin University, Geelong, Australia
| | - Luz Gibbons
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China
| | - Andrea L Monteiro
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Maja Kuharic
- Department of Pharmacy Systems, Outcomes and Policy, College of Pharmacy, University of Illinois Chicago, Chicago, IL, USA
| | - Maria Belizan
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | | |
Collapse
|