Quality of life of the Indonesian general population: Test-retest reliability and population norms of the EQ-5D-5L and WHOQOL-BREF

Impact of foot ulcer-related factors on quality of life in patients with diabetes: Prospective observational study

Quality of life (QOL) may be impacted by foot ulcer-related factors, with prevention of diabetes-related foot ulcers or more effective early healing helping to improve overall patient QOL. This study, which examined the relationship between foot ulcer-related factors and QOL in patients with diabetes, was conducted as a secondary analysis of a prospective observational study entitled: "Factors associated with the discontinuation of wound care specialist clinic visits in patients with diabetic foot ulcers". We investigated EQ-5D-5L, patient characteristics and foot ulcer-related factors of 73 patients with diabetes-related foot ulcers who visited one wound clinic in Indonesia between August 2020 and February 2021. Results showed that the mean health utility was 0.294 ± 0.371. Factors selected for the multiple regression analysis included inflammation/infection of DMIST, first-ever foot ulcer, and size of DMIST. First-ever foot ulcer (β = 0.309, p = 0.003) and size of DMIST (β = -0.316, p = 0.015) were significantly associated with the health utility (p < 0.001). Significant improvement in the health utility of 15 patients was observed when the ulcer healed (Wilcoxon signed-rank sum test, p = 0.001). In conclusion, not only ulcer severity but also the first-ever foot ulcer itself affected the QOL in patients with diabetes. These results suggest there will be a greater impact on the QOL of patients who develop diabetes-related foot ulcers for the first time, along with the importance of prevention and early healing, through early infection control and wound size reduction.

EQ-5D-5L Population Norms for China Derived From a National Health Survey

OBJECTIVES

To develop the EQ-5D-5L (5L) population norms for China and to assess the relationship between various factors and 5L data.

METHODS

This study used data derived from the Psychology and Behavior Investigation of Chinese Residents, a national sample survey of 21 909 representative participants aged 12 years and above. Participants' health-related quality of life (HRQoL) was measured by the 5L. Their socioeconomic characteristics, behavioral factors, and health conditions were also obtained from the survey. Norm scores were generated and compared for different socioeconomic variables. Multiple linear and logistic regressions were used to assess the relationships of the 3 kinds of variables with the 5L utility, visual analog scale (VAS) scores and 5L health problems.

RESULTS

The mean (SD) age of participants was 39.4 (18.9) years, and 50.0% of them were female. The mean (SD) utility and VAS scores were 0.940 (0.138) and 73.4 (21.6), respectively. Participants reported considerably more problems in anxiety/depression (26.2%) and pain/discomfort (22.2%) dimensions. The gender difference in HRQoL is attenuated. The participants older than 75 years suffered from a sharp decline in HRQoL; the participants in Shanghai and Tibet provinces reported lower utility and VAS scores and more health problems. Those who were younger, with better socioeconomic status and healthier lifestyles, and without diseases tended to report higher utility and VAS scores and fewer health problems.

CONCLUSIONS

This study derived the 5L population norms for China based on a representative population sample.

EQ-5D-3L and EQ-5D-5L population norms for Thailand

BACKGROUND

The previous Thai norm-based scores for the EQ-5D-5L were established with Thai general population samples aged 20-70 years in 2019. Nevertheless, these values need to be updated after the COVID-19 pandemic because of its effects on both physical and mental health. This study therefore aimed to establish population norms of the Thai EQ-5D-3L, EQ-5D-5L and EQ-VAS scores as well as to estimate disutility values associated with self-reported main diseases.

METHODS

Individual face-to-face interviews were conducted with 2000 adult (age ≥ 18 years) members of the general Thai population to estimate norm-based scores. Each participant completed the EQ-5D-3L and EQ-5D-5L as well as questions related to their sociodemographic factors and self-reported main diseases. Responses to the two instruments were converted to health utility (HU) scores on the basis of available value sets. Descriptive statistics were used to report the norm-based scores stratified by age and sex categories. Response redistribution determining the response consistency between EQ-5D versions was investigated. The HU score agreement from those two instruments was investigated using intraclass correlation coefficient (ICC). Tobit regression models were employed to investigate the relationships between sociodemographic factors and HU and EQ-VAS scores. Moreover, it was used to estimate the disutility values associated with self-reported main diseases.

RESULTS

The means (percentage of ceiling effects) of EQ-5D-3L, EQ-5D-5L, and EQ-VAS scores were 0.845 (57.80%), 0.923 (49.05%), and 79.83 (3.20%), respectively. The average percentage of inconsistent response was 1.09%. A good agreement level was found between both EQ-5D versions with the ICCs of 0.789 (95% CI: 0.558-0.878). Female, older, and unemployed participants and those with BMI ≥ 30 reported lower EQ-5D-3L and EQ-5D-5L than their counterparts. Bone/Joint disorder and stroke contributed to the largest disutility value for those two instruments.

CONCLUSIONS

The Thai norm-based scores from those two instruments were diminished when advancing age and among female, unemployed, and obese (BMI ≥ 30) participants. It is expected to provide information to policy makers to better allocate health care resources to those with diminished norm-based scores.

Determining the factors impacting the quality of life among the general population in coastal communities in central Vietnam

People living in coastal areas are frequently affected by natural disasters, such as floods and storms. This study aimed to assess the quality of life (QoL) of people living in disadvantaged coastal communes (subdivision of Vietnam) and identify their associated factors by using the World Health Organization's quality of life instrument (WHOQOL-BREF). To achieve this, a cross-sectional descriptive study was conducted on 595 individuals aged 18 years and above living in the coastal communes in Thua Thien Hue province, Vietnam, from October 2022 to February 2023. The results showed that the mean overall QoL (mean ± SD) was 61.1 ± 10.8. Among the four domains of QoL, the physical health (57.2 ± 12.3) domain had a lower score than the psychological health (61.9 ± 13.0), social relations (63.4 ± 13.4), and environment (61.9 ± 13.3) domains. The QoL score of the domains for participants affected by flooding was significantly lower than that of those not affected, except for social relations. Multivariable logistic regression showed that subjects with not good QoL had the educational background with no formal education (Odds ratio (OR) = 2.63, 95% CI 1.19-5.83), fairly poor/poor households (OR = 2.75, 95% CI 1.48-5.12), suffered Musculoskeletal diseases (OR = 1.61, 95% CI 1.02-2.56), unsatisfaction with health status (OR = 5.27, 95% CI 2.44-11.37), family conflicts (OR = 4.51, 95%CI 2.10-9.69), and low levels of social support (OR = 2.62; 95% CI 1.14-6.02). The analysis also revealed that workers (OR = 0.17, 95% CI 0.04-0.66) had a better QoL than farmer-fisherman. QoL in disadvantaged coastal communes was low, with the lowest scores in the physical health domain. Based on the socioeconomic factors associated with not good QoL identified here, it is recommended that local authorities take more appropriate and practical measures to increase support, including measures for all aspects of physical health, psychological health, social relations, and the living environment, especially for people affected by floods.

Australian population norms for health-related quality of life measured using the EQ-5D-5L, and relationships with sociodemographic characteristics

BACKGROUND

Measuring health related quality-of-life (HRQoL) of the general population is essential to establish a reference for health outcome evaluations. This study sought to establish EQ-5D-5L population norms in Australia and to investigate the heterogeneity of HRQoL between sociodemographic variables.

METHODS

A cross-sectional study comprising of a representative sample of Australia's general population (n = 9958) aged 18 or older. Recruitment quotas were set for the Australian census population by age, sex, state/territory of residence and rurality. Participants were recruited by Qualtrics through its database of over 800,000 registered panel members and asked to value their own state of health using the EQ-5D-5L domains and the EuroQol-Visual Analogue Scale (EQ-VAS). An Australian value set developed using Discreet Choice Experiment was used to calculate utility scores.

RESULTS

The estimated mean EQ-5D-5L index for Australia's general population was 0.86 (standard deviation [SD] 0.19), and the EQ-VAS score was estimated as 73.2 (SD 21.7). 23.9% of the study population reported being in the best health state (11,111). Younger people, current smokers, people who are unemployed and people with more financial stress reported a lower EQ-5D-5L index score (p < 0.001). Residents in the major cities, inner regional and outer regional Australia reported higher health utility scores than those residing in remote and very remote Australia.

CONCLUSIONS

This is the first Australian study to apply the EQ-5D-5L in a nationally representative sample. The EQ-5D-5L Australian population norms obtained can be used as reference scores for future population health evaluations and comparisons. The findings facilitate a national reference for clinical, economic, and policy decision-making processes and provide a fuller understanding of the Australian population's HRQoL.

Canada population norms for the EQ-5D-5L

OBJECTIVE

In Canada, population norms are only available for 2 provinces, Alberta and Quebec. The objective of this study was to derive the population norms for the EQ-5D-5L based on a representative sample of the Canadian general population.

METHODS

Data from the Canadian EQ-5D-5L valuation study, a cross-sectional study, were used. A quota sampling method was used to recruit a representative sample of the Canadian general population in terms of age, sex, and education. EQ-5D-5L utilities and EQ VAS were summarized using descriptive statistics and the impact of demographic characteristics on the EQ-5D-5L utilities was evaluated using statistical hypothesis testing and Tobit regression.

RESULTS

1207 eligible participants were included in the analysis. Pain/discomfort (53.1%) was the most frequently reported domain with any problem, and self-care (7.6%) domain was the least. The mean (standard deviation [SD]) EQ-5D-5L utility was 0.864 (0.121) and the mean (SD) EQ VAS was 82.3 (14.23). The highest mean EQ-5D-5L utility was 0.881 in age group 25-34 while the lowest was 0.839 in age group 55-64. Participants who had full-time employment, were married, a higher annual household income and no chronic health conditions had significantly higher EQ-5D-5L utilities.

CONCLUSION

This article reports the first Canadian population norms for the EQ-5D-5L and can be used as population references for economic evaluations and clinical research.

Quality of life in south-eastern Australia: normative values for the WHOQOL-BREF in a population-based sample of adults

OBJECTIVES

The abbreviated World Health Organisation Quality of Life tool (WHOQOL-BREF) is a short-form quality of life (QoL) assessment commonly used worldwide in both healthy and ill populations. Normative data for the Australian general population are limited. The objective of this study was to present normative data for the WHOQOL-BREF based on a general population sample. A secondary aim was to explore sociodemographic factors related to QoL.

DESIGN

Population-based cross-sectional study.

PARTICIPANTS

929 men and 830 women aged 24-94 years participating in the Geelong Osteoporosis Study.

OUTCOME MEASURES

The 26-item WHOQOL-BREF.

RESULTS

Means and SD for each domain are presented by age group and sex. Percentile scores were also generated. Mean scores for WHOQOL-BREF domains were 74.52 (SD=16.22) for physical health, 72.07 (SD=15.35) for psychological, 72.87 (SD=18.78) for social relationships and 79.68 (SD=12.55) for environment. We identified significant associations between sociodemographic factors and WHOQOL-BREF domains. Notably, being married or in a relationship was associated with increased odds for high QoL across all four WHOQOL-BREF domains: physical health (women OR 2.46, 95% CI 1.36 to 4.44, p=0.003), psychological (men OR 2.07, 95% CI: 1.20 to 3.55, p=0.009; women OR 2.15, 95% CI 1.21 to 3.81, p=0.009), social relationships (men OR 2.28, 95% CI 1.29 to 4.04, p=0.005; women OR 2.77, 95% CI 1.42 to 5.41, p=0.003) and environment (women OR 2.07, 95% CI 1.13 to 3.80, p=0.019).

CONCLUSIONS

This study provides population norms for the WHOQOL-BREF based on a representative sample of Australian adults. Our results will be useful to researchers and clinicians who can use these data as a reference point for interpreting WHOQOL-BREF scores.

Assessment of health-related quality of life and its determinants among COVID-19 intensive care unit survivors

Background

Health-related quality of life (HRQoL) is a multidimensional concept encompassing the physical, functional, emotional, and social/family well-being of an individual. Recent reports suggest that Covid-19 may lead to poorer HRQoL of the patients infected both in the short and long term. The present study aimed to assess the health-related quality of life and their determinants among COVID-19 intensive care unit (ICU) survivors.

Materials and Methods

In the study, 107 COVID-19 (RTPCR positive) patients admitted to the (ICU) of a tertiary care centre from August 2021-January 2022 were taken from the hospital records. Line listing of all the patients was done, and the study population was selected using the lottery method under a simple random sampling method. The study population was contacted by telephone and requested their willingness to participate in the study. EQ-5D-5L was used to assess quality of life, which is a standard instrument to assess HRQoL (developed by the EuroQol group in 2011). The EQ-5D-5L essentially consists of the EQ-5D descriptive system and the EQ visual analogue scale (EQ-VAS). Data entry was done using Microsoft excel 2019 version and data analysis using MedCalc version 20.015.

Results

The mean EQ-5D-5L utility score was 0.51 ± 0.43. The mean EQ-VAS score was 68.97 ± 22.27. A significant association between co-morbidities and EQ-5D-5L utility score where those with co-morbidities had a lesser EQ-5D-5L score compared to those without co-morbidities. The mean duration of ICU stay in days was 12.29 ± 12.17. A significant negative correlation between the duration of ICU stay and EQ-5D-5L. (r = -0.26, P = 0.0006*).

Conclusion

COVID-19 patients with comorbidities had a significantly poor quality of life. These findings may help healthcare professionals and decision-makers to better understand the consequences of COVID-19 on the HRQoL.

The effect of long-haul COVID-19 toward domains of the health-related quality of life among recovered hospitalized patients

Background

People with long-haul COVID-19 could experience various health problems, from mild to severe. This research aimed to identify the effect of long-haul COVID-19, specifically on the Quality-of-Life domains experienced by COVID-19 patients who have been discharged.

Methods

Data collection was done online, using data from DKI Jakarta hospitalized patients confirmed with and recovered from SARS-CoV-2 infections. We selected patients who have a minimum of 28 days after being hospitalized for COVID-19 positive. The Logistic regression technique was used to analyze the data. The questionnaire used in this research contained questions regarding long-haul COVID-19 symptoms and domains of Quality of Life, which WHOQOL-BREF measured. Before collecting data, we tested the questionnaire with 30 recovered patients hospitalized outside DKI Jakarta.

Results

172 recovered inpatients who filled out the questionnaire correctly and were aged 18 years and above were randomly selected. Almost one-third (30.2%) of the recovered inpatients had long-haul COVID-19, with 23.8% experiencing one long-haul symptom and 6.4% experiencing more than one symptom. This research also showed that the long-haul effects of COVID-19 affected almost all domains of Quality of Life except the environmental one. Age, gender, and marital status were covariates for the association between long-haul COVID-19 and The Quality of Life.

Conclusion

Continuing health services after the patient is discharged from the hospital is an important program for COVID-19 survivors because it can prevent a decline in the Quality of Life among patients due to the long-haul COVID-19.

Indonesia youth population norms for EQ-5D-Y-3 L, EQ-5D-Y-5 L and the PedsQL generic core scale: lower health related quality of life relates to high economic status and stress

BACKGROUND

The availability of population norms from generic health-related quality of life (HRQoL) instruments can support the interpretation of health outcomes. This study aimed to provide Indonesian youth population norms for the generic HRQoL measures: EQ-5D-Y-3 L, EQ-5D-Y-5 L, and the PedsQL Generic Core Scales. In addition the opportunity arising from the generation of a large representative sample was taken to explore the relationships between HRQoL, health, and socio-economic factors.

METHODS

A representative sample of 1103 Indonesian children (aged 8-16 years) completed EQ-5D-Y-3 L, EQ-5D-Y-5 L, the PedsQL Generic Core Scales, and questions related to demographic data and self-reported health status. A stratified quota sampling design was used to represent Indonesian children in terms of residence, age, gender, and geographical area. Family expenses per capita per month were retrieved from parents to determine a child's economic status.

RESULTS

The total sample was representative of the Indonesian youth general population. The proportions of participants who reported problems were 43.35% (EQ-5D-Y-3 L), 44.10% (EQ-5D-Y-5 L), and 94.93% (PedsQL Generic), with 31.7% of children reporting health complaints. Older children (13-16 years) reported more problems than younger children (8-12 years). Children living in urban areas reported more problems than children living in rural areas. The lowest value health state reported was '12332' (valued at 0.54), and the minimum EQ VAS score was 60.00. Moderate correlations were found between EQ-5D-Y-3 L values to EQ VAS scores and to PedsQL Total Score. Hierarchical regression analysis showed that females, older age, and having health complaints contributed to a lower level of HRQoL as measured by EQ-5D-Y-3 L values, EQ VAS, and PedsQL Total Score. Remarkably, children with high economic status had lower EQ VAS and PedsQL Total Scores. Among symptoms, 'having stress' had the largest influence with respect to lower EQ-5D-Y-3L values, EQ VAS, and PedsQL Total Score.

CONCLUSIONS

Population norms for children's HRQoL as measured by EQ-5D-Y-3 L, EQ-5D-Y-5 L, and the PedsQL Generic Scales are now available for Indonesia. Age, gender, economic status, and health complaints were related to children's HRQoL. These results provide a basis for health studies and health policy for the youth population of Indonesia.

Efficacy of Personalized-Computerized Inhibitory Training program (PCIT) combined with exposure and response prevention on treatment outcomes in patients with contamination obsessive-compulsive disorder

BACKGROUND

Cognitive behavioral therapy (CBT) including exposure and response prevention (ERP) is the most effective and first-line treatment for obsessive-compulsive disorder (OCD). However, a significant number of people leave it or do not respond to it effectively. The present study aimed to examine the efficacy of personalized-computerized inhibitory training (P-CIT) program combined with ERP on treatment outcomes in patients with contamination OCD.

MATERIALS AND METHODS

The present research method was based on an experimental design with pre-test, post-test, and the two intervention and control groups. Thirty patients with contamination OCD were randomly assigned to the two groups of intervention and control based on the inclusion and exclusion criteria. The measures used in this study were Yale-Brown Scale, Stroop task, World Health Organization's Quality of Life Questionnaire, Structured Clinical Interview for DSM-5, and Depression Anxiety and Stress Scales -21.

RESULTS

The results showed a significant reduction in severity of symptoms (F = 0.75, P < 001) and severity of anxiety (F = 0.75, P < 001) for the intervention group. Furthermore, task control (F = 12.44, P < 001), mental health (F = 28.32, P < 001), physical health (F = 2.48, P < 001), and overall quality of life (F = 0.19, P = 001) improved in the intervention group after the intervention.

CONCLUSION

When P-CIT is exerted along with ERP, it may enhance inhibition of compulsions and increase the efficacy of ERP through improved task control, thereby resulting in reduced symptom severity and improved treatment outcomes in patients with contamination OCD.

Normative profile of the EQ-5D-5L dimensions, EQ-5D-5L index and EQ-VAS scores for the general Thai population

PURPOSE

To generate a normative profile for the EQ-5D-5L dimensions, EQ-5D-5L index, and EQ-VAS scores of the general Thai population and to examine the associations between sociodemographic characteristics and their norm-based scores.

METHODS

Data from 2019 general Thai samples were employed to estimate the norm-based scores elicited using the Thai EQ-5D-5L value set. Descriptive statistics were used to estimate the norm-based scores stratified by gender and six age bands to obtain the normative profile for the general Thai population. Multivariable logistic and Tobit regression models were used to investigate the relationships between sociodemographic characteristics and EQ-5D-5L dimensions, EQ-5D-5L index, and EQ-VAS scores.

RESULTS

The mean EQ-5D-5L index and EQ-VAS scores were 0.931 and 82.3, respectively. Approximately 88.9% of the participants reported 19 out of 3125 (3%) possible health states. The odds of having problems with mobility was greatest for the sample aged ≥ 65 years and declined with decreasing age. Women, samples with advancing age, and those with a household income of ≤ 10,000 Baht/month and fair and poor health perceptions were more likely to report a lower EQ-5D-5L index. Furthermore, advanced age and fair and poor health perception were significantly associated with lower EQ-VAS scores.

CONCLUSION

The EQ-5D-5L population norms were established as the benchmark for both EQ-5D-5L index and EQ-VAS scores for the general Thai population. This is expected to support the health service research and inform policymakers on the allocation of limited healthcare resources.

EQ-5D-5L Population Norms for Italy

OBJECTIVES

This study aimed to provide normative data obtained in response to the EQ-5D-5L questionnaire in Italy and compare this with data from other countries.

METHODS

A sample of the Italian adult population (aged ≥ 18 years) was recruited and interviewed online using videoconferencing software (Zoom) between November 2020 and February 2021. The distribution of answers was estimated as per the descriptive system of the EQ-5D-5L, and descriptive statistics were calculated for the EQ VAS score and EQ-5D-5L index value in the whole sample and relevant subgroups. An ordinary least square (OLS) regression was performed to evaluate the impact of sociodemographic variables on EQ-5D-5L results. Lastly, a comparison was made with EQ-5D-5L population norms of other countries. Data analysis was performed using Microsoft Excel and Stata 13.

RESULTS

Overall, 1182 people representative of the Italian population (2020) in terms of sex and geographical area responded to the survey. Of the 3125 potential EQ-5D-5L health states, only 106 (3.4%) were selected, and the '11111' and '11112' states were chosen by half of the participants. In terms of EQ-5D-5L dimensions, the frequency of any problems (from slight to extreme) associated with anxiety and depression was high among the very young (18-24 years, 56.0%) and in women of all ages (49.7%). The mean index value (± standard deviation [SD]) was 0.93 (± 0.11) for the entire sample and gradually decreased with age, moving from 0.95 (± 0.06) in the youngest group (18-24 years) to 0.91 (± 0.13) in the oldest age group (≥ 75 years). Similarly, the mean EQ VAS score (± SD) was 81.8 (± 13.5), and decreased from 87.0 (± 8.9) in the 18-24 years age group to 75.1 (± 16.4) among participants > 75 years of age. The existence of self-reported chronic conditions (e.g., cardiovascular disease), female sex, and social assistance recipiency were negatively associated with the EQ-5D index value, while the EQ VAS score was significantly lower in people with chronic conditions and aged > 55 years. Conversely, higher income levels had a positive impact on both the EQ-5D index value and the EQ VAS score. Lastly, both the EQ-5D index value and EQ VAS score in Italy were, on average, higher than in most European countries.

CONCLUSIONS

EQ-5D-5L population norms provide useful insights into the health status of the Italian population and can be used as a reference for other surveys using the same instrument.

Quality of Life of Cancer Patients during Chemotherapy in Indonesia: A Comparison of EORTC QLQ-C30 and EQ-5D-5L, Based on Patients' Characteristics

One of the important outcomes to define the success of cancer treatment is the health-related quality of life (HRQoL) that can be measured using generic and/or specific instruments. Our study aims to define the cancer patients' HRQoL in some hospitals in Indonesia as measured by the European Organization for Research and Treatment for Cancer (EORTC QLQ-C30) and the EQ-5D-5L, to define the differences of cancer patients' HRQoL referring to patients' characteristics, and to explore determinants of cancer patients' HRQoL. We recruited 451 cancer patients using a cross-sectional design in two referral hospitals in Central Java, Indonesia, using the purposive sampling technique. All subjects, recruited from July 2020 to October 2021, met the inclusion criteria, namely, adult patients diagnosed with cancers in all stages who willingly participated in the study. The Indonesian value set was used to obtain the EQ-5D-5L index score. We further analyzed the data based on cancer stages and compared two questionnaires using independent t test. We highlighted that most of the cancer patients are female (69.4%), young (86%), and at advanced stages of cancer (54.1%). The physical and role functions and global health status of the cancer patients are poor, and the most severe symptom is fatigue. Moreover, most of them experience severe pain and perform daily activities with difficulties. Some patients' characteristics show significant influences on the HRQoL domains in both questionnaires (p < 0.05). Interestingly, both of the questionnaires have shown significant correlations between similar domains and revealed the poor HRQoL of advanced cancer patients (p < 0.05). Our study finds that cancer patients still have poor HRQoL in some domains. We suggest to the health providers that they apply education and psychological intervention to increase their HRQoL.

Cost-Effectiveness Analysis of Tobacco Control Strategies in Indonesia

OBJECTIVES

In Indonesia, tobacco smoking is a significant public health problem that continues to grow, with a prevalence among the highest worldwide. This study aimed to assess the cost-effectiveness of government-funded varenicline, smoking bans in public places, and an additional 10% tobacco tax in Indonesia.

METHODS

Markov modeling of Indonesians aged 15 to 84 years was undertaken, with simulated follow-up until age 85 years. Data on demographics, smoking prevalence, and mortality were drawn from the Global Burden of Disease Study 2017. Data regarding the efficacy and costs of the 3 interventions were gathered from published sources. Costs and benefits accrued beyond one year were discounted at 3% per annum. The year value of costing data was 2020.

RESULTS

Government-funded varenicline, smoking bans in public places, and an additional 10% tobacco tax were predicted to save 5.5 million, 1.6 million, and 1.7 million years of life, respectively (all discounted). In terms of quality-adjusted life-years, 3 tobacco interventions were predicted to gain 11.9 million, 3.47 million, and 3.78 million in quality-adjusted life-years, respectively. The savings in smoking-related healthcare costs amounted to US $313.8 billion, US $97.5 billion, and US $106 billion, respectively. Hence, from the perspective of the healthcare system, all 3 interventions were cost saving (dominant).

CONCLUSIONS

In Indonesia, tobacco control measures are likely to be highly cost-effective and even cost saving from the healthcare system's perspective. These cost savings can be balanced against economic losses that would result from the impact on the sizable Indonesian tobacco industry.

Quality of life of low-income adults

BACKGROUND

Quality of life is currently one of the basic conceptual categories in many research disciplines. The authors of the present study are convinced that measurement of quality of life in reference to people living on the poverty line deserves special attention.

OBJECTIVE

The aim of the study was to identify relationships between the quality of life and sociodemographic variables in low-income Wrocław residents.

METHODS

The research was conducted in Wrocław (Poland) and involved 1215 respondents aged 18-64 years, whose monthly gross income per capita in the household did not exceed 1043 PLN. The respondents' quality of life was assessed with the World Health Organization Quality of Life Questionnaire with additional questions on the respondents' social and demographic status.

RESULTS

The Wrocław residents most often assessed their quality of life as average or below average. They rated their health-related quality of life in the social domain as the highest, and in the physical domain as the lowest. Age, household size, stable source of income, savings, and indebtedness were significantly correlated with the quality of life of Wrocław residents under study. Among the respondents, statistically significant relationships between perceived health condition assessment and age, professional status, stable source of income, and debt were also identified.

CONCLUSIONS

The results of the study indicate that public health programs and other activities related to quality of life management should be directed to individuals and social groups particularly threatened by low quality of life, i.e., people living on the income poverty line.

Psychosocial factors associated with mental health and quality of life during the COVID-19 pandemic among low-income urban dwellers in Peninsular Malaysia

Background and aims

Mental well-being among low-income urban populations is arguably challenged more than any other population amid the COVID-19 pandemic. This study investigates factors associated with depression and anxiety symptoms and quality of life among Malaysia’s multi-ethnic urban lower-income communities.

Methods

This is a community-based house-to-house survey conducted from September to November 2020 at the Petaling district in Selangor, Malaysia. Five hundred and four households were identified using random sampling, and heads of eligible households were recruited. Inclusion criteria were age ≥18 years with a monthly household income ≤RM6960 (estimated $1600) without acute psychiatric illness. The PHQ-9, GAD-7 and EQ-5D were used for depression, anxiety, and quality of life, respectively. Multivariable logistic regression was performed for the final analysis.

Results

A total of 432 (85.7%) respondents with a mean age of 43.1 years completed the survey. Mild to severe depression was detected in 29.6%, mild to severe anxiety in 14.7%, and problematic quality of life in 27.8% of respondents. Factors associated with mild to severe depression were younger age, chronic health conditions, past stressful events, lack of communication gadgets and lack of assets or commercial property. While respiratory diseases, marital status, workplace issues, financial constraints, absence of investments, substance use and lack of rental income were associated with mild to severe anxiety. Attributing poverty to structural issues, help-seeking from professionals, and self-stigma were barriers, while resiliency facilitated good psychological health. Problematic quality of life was associated with depression, older age, unemployment, cash shortage, hypertension, diabetes, stressful life events and low health literacy.

Conclusions

A high proportion of the sampled urban poor population reported mild to severe anxiety and depression symptoms. The psychosocial determinants should inform policymakers and shape future work within this underserved population.

The Study of Nutrient Intake and Adolescent Girls' Quality of Life in a Rural Area of Indonesia

An inadequate nutrient intake correlates with malnutrition, a problem affecting many adolescents worldwide. Nutrient intake is associated with quality of life (QoL). Our study analyzed the relationship between nutrient intake and adolescents’ QoL. We conducted a cross-sectional study. Through simple random sampling, 157 adolescent girls were selected. Nutrition status was assessed using anthropometric measurements. Nutrient intake was collected using the food frequency questionnaire (FFQ). WHOQOL BREF was used to explore adolescent girls’ quality of life. The median of nutrient intake: energy (908.25 kcal); protein (24.16 g); carbohydrate (128.89 g); fat (21.89 g); vitamin A (77.10 mg); vitamin E (1.40 mg); vitamin B1 (0.19 mg); vitamin B2 (0.29 mg); vitamin B6 (0.45 mg); folic acid (35.13 mg); vitamin C (12.60 mg); calcium (197.46 mg); magnesium (93.72 mg); iron (2.64 mg); and zinc (2.09 mg). The adolescents’ QoL scores were physical health 44 (25–81), psychological domain 56 (19–94), social relationships 56 (19–94), and environmental domain 56 (31–100). The strongest correlations were between (1) physical health with carbohydrates, vitamin C, and fat; (2) psychological domain with calcium; (3) social relationships with carbohydrates and vitamin C; and (4) environmental domain with BMI and zinc. There was a significant positive correlation between the intake of some nutrients and adolescents’ QoL, despite the observation of some significant negative correlations. The findings of this study indicate that more attention should be focused on adolescents’ nutrient intake in order to improve their QoL.

AYURAKSHA, a prophylactic Ayurvedic immunity boosting kit reducing positivity percentage of IgG COVID-19 among frontline Indian Delhi police personnel: A non-randomized controlled intervention trial

Objective

The world continues to face the COVID-19 crisis, and efforts are underway to integrate traditional medicine interventions for its effective management. The study aimed to determine the efficacy of the "AYURAKSHA" kit in terms of post-interventional percentage of COVID-19 IgG positivity, immunity levels, and quality of life (QoL) against COVID-19.

Method

This was a non-randomized controlled, prospective intervention trial, done after the distribution of 80,000 AYURAKSHA kits (constituent of Sanshamani Vati, AYUSH Kadha, and Anu Taila) among Delhi police participants in India. Among 47,827 participants, the trial group (n = 101) was evaluated with the positivity percentage of IgG COVID-19 and Immune Status Questionnaire (ISQ) scores as a primary outcome and the WHO Quality of Life Brief Version (QOL BREF) scores along with hematological parameters as a secondary outcome in comparison to the control group (n = 71).

Results

The data showed that the percentage of COVID-19 IgG positivity was significantly lower in the trial group (17.5 %) as compared to the control group (39.4 %, p = 0.003), indicating the lower risk (55.6%) of COVID-19 infection in the trial group. The decreased incidence (5.05%) and reduced mortality percentage (0.44%) of COVID-19 among Delhi police officers during peak times of the pandemic also corroborate our findings. The ISQ score and WHO-QOL BREF tool analysis showed the improved scores in the trial group when compared with the controls. Furthermore, no dysregulated blood profile and no increase in inflammation markers like C-reactive protein, erythrocyte sedimentation rate, Interleukin-6 (IL-6) were observed in the trial group. However, significantly enhanced (p = 0.027) IL-6 levels and random blood sugar levels were found in the control group (p = 0.032), compared to a trial group (p = 0.165) post-intervention. Importantly, the control group showed more significant (p = 0.0001) decline in lymphocyte subsets CD3⁺ (% change = 21.04), CD4⁺ (% change = 20.34) and CD8⁺ (% change = 21.54) levels than in trial group, confirming more severity of COVID-19 infection in the control group.

Conclusion

The AYURAKSHA kit is associated with reduced COVID-19 positivity and with a better quality of life among the trial group. Hence, the study encourages in-depth research and future integration of traditional medicines for the prevention of the COVID-19 pandemic.

Clinical trial registration

http://ctri.nic.in/, identifier: CTRI/2020/05/025171.

Cardiometabolic health risks, lifestyle behaviours and quality of life in people diagnosed with early psychosis - A cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and low quality of life (QOL). There is a lack of understanding about CVD-R scores in people diagnosed with early psychosis and no studies have quantified CVD-R using the QRISK^® 3 calculator in this client group. Establishing potential relationships between modifiable lifestyle behaviours/treatment characteristics with CVD-R or QOL may identify targets for early intervention. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: This is the first study to quantify the individual 10-year CVD-R of people diagnosed with early psychosis utilising the QRISK^® 3 calculator. This is also the first study to investigate relationships between QOL and CVD-R and lifestyle factors in a cohort of Thai people diagnosed with early psychosis. We observed low levels of physical health-related QOL and high levels of CVR-R despite participants reporting relatively positive lifestyle behaviours. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: The cardiometabolic health state of this client group warrants as much attention as for those with an enduring severe mental illness; early preventative interventions are warranted. It may be useful to routinely quantify the CVD-R of people diagnosed with early psychosis using the QRISK^® 3 calculator, even in the absence of immediate concerns about lifestyle behaviours. Mental health nurses should utilise evidence-based approaches such as increasing activity levels, dietary counselling and behaviour change interventions to mitigate poor physical health in this client group. ABSTRACT: Introduction People diagnosed with schizophrenia have poor cardiometabolic health, with elevated 10-year cardiovascular disease risk (CVD-R) scores and poor quality of life (QOL). There is lack of understanding of these issues in early psychosis. Aims To quantify CVD-R in people diagnosed with early psychosis and profile their obesity prevalence, lifestyle behaviours and QOL. Secondary aim was to explore associations between lifestyle behaviours/treatment characteristics and CVD-R/QOL. Method Baseline data from 81 RCT participants were used to profile cardiometabolic health risks (QRISK^® 3, BMI and waist circumference). Participants self-reported lifestyle behaviours and QOL. Relationships between modifiable treatment/lifestyle factors and QOL/CVD-R were explored. Results Participants' relative risk for CVD over 10 years was 1.93 times higher than healthy counterparts; 39% also had an obese BMI and physical QOL was poor. No significant associations were observed between CVD-R or QOL with treatment characteristics and lifestyle factors. Discussion Despite positive lifestyle behaviours, participants had elevated CVD-R scores and poor physical health-related QOL. Quantifying CVD-R with QRISK^® 3 may highlight the need for health promotion interventions. Implications for practice Mental health professionals should be aware that elevated CVD-R exists in the context of relatively healthy lifestyle behaviours and utilise evidence-based interventions to address these issues.

Quality of life during the COVID-19 pandemic in Austria

The COVID-19 pandemic has had unprecedented effects on our daily lives. This study aimed to assess the quality of life (QoL) (WHOQOL-Bref physical, social, and environmental domains) at two time points during the COVID-19 pandemic with lockdown restrictions according to gender, age, and urbanization level. Qualtrics^® recruited representative Austrian population samples in April 2020 (t1; N = 1,005) and December 2020/January 2021 (t2; N = 1,505). ANOVAs and the Bonferroni-corrected post-hoc tests were conducted to investigate differences between April and December 2020 and to compare with pre-pandemic data. Although the quality of life (physical, social, and environmental domains) changed from pre-pandemic (mean scores 80, 77, and 81, respectively) to April 2020 (mean scores 72, 65, and 75, all p-values < 0.001), there were no significant changes between April and December (mean scores 75, 65, and 75). Living location (urban vs. rural), gender, and age showed an effect on the quality of life. All domains of quality of life have decreased since the onset of the pandemic, and this decline has been maintained over the course of the first year of the pandemic. Creative measures should be implemented to assist people in improving one or more areas of quality of life, within the lockdown restrictions to improve the overall wellbeing of the population.

A Web-Based Stress Management Intervention for University Students in Indonesia (Rileks): Feasibility Study Using a Pretest-Posttest Design

Background

University students are susceptible to excessive stress. A web-based stress management intervention holds promise to improve stress but is still at a novel stage in Indonesia.

Objective

The aim of this paper was to report the feasibility of the intervention we developed—Rileks—among university students in Indonesia in terms of acceptability and usability, and to propose recommendations for future improvements.

Methods

A single-group pretest and posttest design was used. Participants with scores of 15 or higher on the stress subscale of the 42-item Depression Anxiety Stress Scales were given access to the intervention (N=68). The main outcome measures were the 8-item Client Satisfaction Questionnaire (CSQ-8) score, the System Usability Scale (SUS) score, and intervention uptake. Participants’ experience in each session was evaluated using closed- and open-ended questions for future improvements. Descriptive statistics were used to examine primary outcome and qualitative session evaluations. Participants’ responses to each topic of the open questions were summarized.

Results

The intervention was evaluated as being satisfactory (CSQ-8 mean score 21.89, SD 8.72; range 8-32). However, the intervention’s usability was still below expectation (SUS mean score 62.8, SD 14.74; range 0-100). The core modules were completed by 10 out of 68 participants (15%), and the study dropout rate was 63% (43/68) at postassessment. In general, the module content was rated positively, with some notes for improvement covering content and technical aspects.

Conclusions

This study indicates that Rileks is potentially feasible for Indonesian university students. In order to be optimally applied in such a context and before scaling up web-based interventions in Indonesia, in general, further development and refinement are needed.

International Registered Report Identifier (IRRID)

RR2-10.2196/11493

Population Norms for SF-6Dv2 and EQ-5D-5L in China

OBJECTIVES

To derive the population norms for EQ-5D-5L and SF-6Dv2 among the Chinese general population.

METHODS

Data collected alongside the Chinese SF-6Dv2 valuation study conducted between June and September 2019 were used. SF-6Dv2 and EQ-5D-5L, as well as social-demographic characteristics and self-reported chronic conditions, were collected through face-to-face interviews among a representative sample of the general population stratified by age, gender, education, and area of residence (urban/rural) in China. SF-6Dv2 and EQ-5D-5L responses were converted to utility values using the corresponding Chinese value sets. Utility values for both measures and EQ VAS scores were summarized by age and gender, and then described by different social-demographic characteristics and chronic conditions.

RESULTS

A total of 3397 respondents (51.2% male, age range 18-90 years) were included. 420 (12.4%) and 1726 (50.8%) respondents reported no problems on all SF-6Dv2 and EQ-5D-5L dimensions, respectively. The mean [standard deviation (SD)] utility values were 0.827 (0.143) for SF-6Dv2 and 0.946 (0.096) for EQ-5D-5L. The mean (SD) EQ VAS score was 87.1 (11.5). Respondents who resided in rural areas, were married, and were employed had higher utility values. Respondents with memory-related diseases or stroke had lower utility values than those with other chronic conditions. Utility values decreased with the increase in the number of chronic conditions.

CONCLUSION

This study reports the first Chinese population norms for the EQ-5D-5L and SF-6Dv2 derived using a representative sample of the Chinese general population. The norms can be used as references for economic evaluations and healthcare decision-making in China.

Integration of a multicomponent intervention for hypertension into primary healthcare services in Singapore-A cluster randomized controlled trial

BACKGROUND

Despite availability of clinical practice guidelines for hypertension management, blood pressure (BP) control remains sub-optimal (<30%) even in high-income countries. This study aims to assess the effectiveness of a potentially scalable multicomponent intervention integrated into primary care system compared to usual care on BP control.

METHODS AND FINDINGS

A cluster-randomized controlled trial was conducted in 8 government clinics in Singapore. The trial enrolled 916 patients aged ≥40 years with uncontrolled hypertension (systolic BP (SBP) ≥140 mmHg or diastolic BP (DBP) ≥90 mmHg). Multicomponent intervention consisted of physician training in risk-based treatment of hypertension, subsidized losartan-HCTZ single-pill combination (SPC) medications, nurse training in motivational conversations (MCs), and telephone follow-ups. Usual care (controls) comprised of routine care in the clinics, no MC or telephone follow-ups, and no subsidy on SPCs. The primary outcome was mean SBP at 24 months' post-baseline. Four clinics (447 patients) were randomized to intervention and 4 (469) to usual care. Patient enrolment commenced in January 2017, and follow-up was during December 2018 to September 2020. Analysis used intention-to-treat principles. The primary outcome was SBP at 24 months. BP at baseline, 12 and 24 months was modeled at the patient level in a likelihood-based, linear mixed model repeated measures analysis with treatment group, follow-up, treatment group × follow-up interaction as fixed effects, and random cluster (clinic) effects. A total of 766 (83.6%) patients completed 2-year follow-up. A total of 63 (14.1%) and 87 (18.6%) patients in intervention and in usual care, respectively, were lost to follow-up. At 24 months, the adjusted mean SBP was significantly lower in the intervention group compared to usual care (-3.3 mmHg; 95% CI: -6.34, -0.32; p = 0.03). The intervention led to higher BP control (odds ratio 1.51; 95% CI: 1.10, 2.09; p = 0.01), lower odds of high (>20%) 10-year cardiovascular risk score (OR 0.67; 95% CI: 0.47, 0.97; p = 0.03), and lower mean log albuminuria (-0.22; 95% CI: -0.41, -0.02; p = 0.03). Mean DBP, mortality rates, and serious adverse events including hospitalizations were not different between groups. The main limitation was no masking in the trial.

CONCLUSIONS

A multicomponent intervention consisting of physicians trained in risk-based treatment, subsidized SPC medications, nurse-delivered motivational conversation, and telephone follow-ups improved BP control and lowered cardiovascular risk. Wide-scale implementation of a multicomponent intervention such as the one in our trial is likely to reduce hypertension-related morbidity and mortality globally.

TRIAL REGISTRATION

Trial Registration: Clinicaltrials.gov NCT02972619.

The Effectiveness of Eye Movement Desensitization for Post-traumatic Stress Disorder in Indonesia: A Randomized Controlled Trial

Objective

Post-traumatic stress disorder (PTSD) may affect individuals exposed to adversity. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based trauma-focused psychotherapy for PTSD. There is still some debate whether the eye movements (EMs) are an effective component of EMDR. The primary aim of this study was to investigate the effectiveness of Eye Movement Desensitization (EMD) treatment in reducing PTSD symptoms compared to a retrieval-only active control condition. We also investigated whether PTSD symptom reduction was associated with reductions in depression and anxiety, and improvements in quality of life.

Methodology

Adult PTSD patients (n = 91) were recruited at public psychological services in Jakarta, Bandung and Cimahi, Indonesia. PTSD was diagnosed with the Structured Clinical Interview for DSM-5 disorders (SCID-5). Participants were randomized into: EMD (n = 47) or retrieval-only (n = 44). EMD consisted of clinical history and treatment planning, preparation, assessment, EMs, closure, whereas retrieval-only consisted of the same elements except EMs. Data were collected at baseline (T0), 1-week post-treatment (T1), 1-month follow-up (T2), and 3-months follow-up (T3). Outcome measures included the PTSD Checklist for DSM-5 (PCL-5), Hopkins Symptoms Checklist-25 (HSCL-25), and the World Health Organization Quality of Life-BREF (WHOQoL-BREF). Data were analyzed with linear mixed model analysis in R Statistics.

Results

Although there were main effects of time indicating reductions for both EMD and retrieval-only in PCL-5 and HSCL-25 scores, and improvements in WHOQoL-BREF scores at T1, T2, and T3, no significant differences in PCL-5, HSCL-25, and WHOQoL-BREF total scores between the EMD and retrieval-only groups at T1, T2, and T3 were found (all group x time interaction p's > 0.005).

Conclusion

Within a clinical sample of PTSD patients in Indonesia, both EMD and retrieval-only was associated with reductions in symptoms of PTSD, anxiety and depression, and improvements in quality of life, although EMs did not add to the efficacy of the treatments. Further research to examine the underlying mechanisms of EMDR's effective treatment elements in clinical samples is needed.

Clinical Trial Registration

[www.ClinicalTrials.gov], identifier [ISRCTN55239132].

Mediating Effects of Coping Strategies on Quality of Life Following Extremity Injury

BACKGROUND

Few researchers have explored the self-regulation process in patients with extremity injuries. Knowledge about the role of coping in the postinjury self-regulation process remains scarce.

OBJECTIVES

We examined the relationships between illness representations, coping, and quality of life based on the self-regulation framework, assuming adaptive and maladaptive coping strategies play mediating roles between illness representation and quality of life (QoL) in patients with extremity injuries.

METHODS

A cross-sectional survey with a correlational model testing design was used. A sample of 192 patients with extremity injury was recruited before hospital discharge at trauma centers in Indonesia. Validated questionnaires were used to assess patients' illness representations, coping, and QoL. Hierarchical regressions were carried out, and multiple analyses were used to identify the mediating role of coping.

RESULTS

Patients with extremity injuries who harbored negative illness representations were less focused on using adaptive coping strategies, were more focused on using maladaptive coping strategies, and tended to experience reduced QoL. The mediating effects of coping, which manifested as parallel mediations of adaptive and maladaptive coping strategies, could significantly explain the QoL variance.

DISCUSSION

In postinjury self-regulation, coping has a similar mediating role that can facilitate the effect of illness representations and directly influence postinjury QoL. Enhancing adaptive coping strategies, reducing maladaptive coping techniques, and reframing negative illness representations during the early recovery phase could improve postinjury QoL. Early screening and preventive efforts using psychologically driven interventions may help redirect patients' focus toward adaptive coping strategies and reframe their illness representations before they transition back into the community.

Economic evaluations of inactivated COVID-19 vaccines in six Western Pacific and South East Asian countries and regions: A modeling study

Objective

The present study aimed to document the economic profiles of inactivated COVID-19 vaccines in Hong Kong SAR, Indonesia, mainland China, Philippines, Singapore, and Thailand, the evidence on which is currently absent.

Methods

Decision tree models were developed to assess the cost-effectiveness of two doses of inactivated COVID-19 vaccines at a population vaccination rate of 50% in the base case, which was an estimate of feasible vaccination coverage according to previous studies. Epidemiological, mortality, cost, and health state utility information were sourced from the literature. Vaccine efficacy against COVID-19 cases by severity were estimated using meta-analyses of publicly accessible phase 3 trial results of inactivated vaccines. The health outcomes were quantified as quality-adjusted life years (QALYs) and compared across the vaccination and no vaccination strategies. In scenario analyses, incidence and vaccination rates were changed semi-continuously over spectrums, the results of which were presented as contour lines informing the efficiency frontiers of vaccination strategies. One-way and probabilistic sensitivity analyses were also conducted.

Results

The vaccination strategy was dominant in all jurisdictions in the base case by producing 105.18, 98.15, 99.70, 60.48, 112.00, and 103.47 QALYs while saving US$40.26 million, US$5.26 million, US$7.60 million, US$5.91 million, US$21.33 million, and US$7.18 million in Hong Kong SAR, Indonesia, mainland China, Philippines, Singapore, and Thailand per every 100,000 vaccinated individuals, respectively. Results were robust in alternative model specifications.

Conclusions

Inactivated COVID-19 vaccines may be cost-saving options in Hong Kong SAR, Indonesia, mainland China, Philippines, Singapore, and Thailand. Mass vaccination programs using inactivated COVID-19 vaccines should be considered in these jurisdictions.

EQ-5D-Y Population Norms for Japanese Children and Adolescents

OBJECTIVE

This study was aimed at establishing population norms of EQ-5D-Y in Japan by a nationwide large sample survey.

METHODS

We performed a door-to-door survey by visiting the homes of children/adolescents aged 8-15 years selected by random sampling. The planned sample size was 3600 from 100 districts in Japan. Children/adolescents were asked to respond to the EQ-5D-Y instrument, and their parents, to background questions on themselves and their children. Summary statistics by age/sex were calculated to obtain the Japanese population norms. A multiple linear regression model was used to examine the relationships between the EQ-5D-Y index and their parents' demographic factors, the children/adolescents' diseases/symptoms and the family environment.

RESULTS

We collected 3636 responses from 100 districts. The overall EQ-5D-Y index values (all sexes, ages) ranged from 0.90 to 0.95. The percentage of respondents reporting full health ranged from 40 to 60%. In regard to the influence of the children/adolescents' diseases/symptoms on disutility, developmental disability showed the largest disutility values of 0.090. Sleeplessness and body pain were the symptoms that exerted the greatest influence on the EQ-5D-Y index; the effect sizes ranged from - 0.030 to - 0.098 for sleeplessness, and from - 0.023 to - 0.079 for body pain. The EQ-5D-Y index of children/adolescents with parents who reported severe stress was lower by 0.072 (p < 0.001), as compared with that of children/adolescents with parents reporting no stress.

CONCLUSIONS

Population norms of EQ-5D-Y were established for the first time. We also clarified the relationship between the EQ-5D-Y index value and the children/adolescents' diseases/symptoms and the family environment.

EQ-5D-5L in Schizophrenia: differences between patients and nurses' reports

Purpose

To examine the differences between patient-reports and proxy-reports by nurses of EQ-5D-5L responses among patients with schizophrenia.

Methods

This study was conducted in June–September 2019 in Duren Sawit Regional Public Hospital in Jakarta, Indonesia. The self-report data were obtained by interviewing the patients and the proxy-report data were obtained from the psychiatric nurses. The patients’ Positive and Negative Syndrome Scale (PANSS) scores were obtained from their medical records. The data were collected in two time points: (1) when the patients moved from the acute to the quiet rooms (first-test) and (2) when they were discharged from the hospital (second-test). The self and proxy report scores were analysed by the Wilcoxon matched-pairs signed-ranks test and their relationship with the PANSS scores using Spearman's rank correlation coefficient.

Results

There were 206 patients in the final sample. The majority are male (56.8%) with a mean age of 37.5 years (SD = 12.05). Significant differences between the two reports were found in three domains (i.e., self-care, usual activities, and pain/discomfort) in the first-test and two domains (i.e., usual activities and pain/discomfort) in the second-test. Concerning the relationship with the PANSS scores, only three significant correlations were found, all in the proxy-version and in the second-test: mobility (r = 0.139), anxiety/depression (r = 0.2523), and utility scores (r = − 0.176).

Conclusions

The poor-to-fair agreement between patients and nurses reports and the poor correlation with the PANSS scores suggested that it is difficult to decide which report best represents the patients’ health status.

Inequality and heterogeneity in health-related quality of life: findings based on a large sample of cross-sectional EQ-5D-5L data from the Swedish general population

Purpose

This study aimed to investigate inequality and heterogeneity in health-related quality of life (HRQoL) and to provide EQ-5D-5L population reference data for Sweden.

Methods

Based on a large Swedish population-based survey, 25,867 respondents aged 30‒104 years, HRQoL is described by sex, age, education, income, economic activity, health-related behaviours, self-reported diseases and conditions. Results are presented by EQ-5D-5L dimensions, respondents rating of their overall health on the EQ visual analogue scale (EQ VAS), VAS index value and TTO (time trade-off) index value allowing for calculation of quality-adjusted life years (QALYs). Ordinary Least Squares and multivariable logistic regression analyses were used to study inequalities in observed EQ VAS score between socioeconomic groups and the likelihood to report problems on the dimensions, respectively, adjusted for confounders.

Results

In total, 896 different health states were reported; 24.1% did not report any problems. Most problems were reported with pain/discomfort. Women reported worse HRQoL than men, and health deteriorated with age. The strongest association between diseases and conditions and EQ VAS score was seen for depression and mental health problems. There was a socioeconomic gradient in HRQoL; adjusting for health-related behaviours, diseases and conditions slightly reduced the differences between educational groups and income groups, but socioeconomic inequalities largely remained.

Conclusion

EQ-5D-5L population reference (norms) data are now available for Sweden, including socioeconomic differentials. Results may be used for comparisons with disease-specific populations and in health economic evaluations. The observed socioeconomic inequality in HRQoL should be of great importance for policy makers concerned with equity aspects.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02982-3.

Mental Health, Work Satisfaction and, Quality of Life Among Healthcare Professionals During the COVID-19 Pandemic in an Indonesian Sample

BACKGROUND

During the COVID-19 pandemic, healthcare professionals (HCP) might experience mental health problems and work-related stress, which can lead to less satisfaction at work and decreased health and quality of life in the long period. This study aims to explore the role of mental health and workplace satisfaction on the quality of life in health professionals who are involved in handling the COVID-19 pandemic.

METHODS

This study was a cross-sectional approach using purposive sampling techniques. The online survey was conducted from May through September 2020. A total of 200 respondents from the West Java province in Indonesia were included. Data on mental health, work satisfaction, and quality of life were analyzed using descriptive statistics, Pearson's correlation coefficient, and multivariate regression analysis. Responses to open questions regarding concerns and strengths were analyzed using thematic analysis.

RESULTS

An increased mental health symptom experienced by healthcare professionals was associated with decreased health status (β=-0.724, p=0.001) and self-perceived health (β=-0.59, p=0.001). Further, serving patients with COVID-19 (β=-0.133, p=0.024) was related to lower health status. Five themes emerged regarding concerns about being exposed to COVID-19, namely 1) fear of transmitting the virus, 2) the impact of COVID-19 on family life, 3) death and isolation, 4) personal safety, and 5) social stigma. Five themes emerged regarding the source of encouragement and strength, ie. 1) religiosity, 2) social support systems, 3) the moral responsibility of the profession, 4) following health and safety protocols, and 5) acceptance and positive attitudes towards the future.

CONCLUSION

Mental health problems impacted the quality of life. Serving patients with COVID-19 could predict lower health status. HCPs' concerns and sources of strength when exposed to COVID-19 are discussed. Our results give a better understanding of the factors that can decrease and improve HCPs' quality of life, therefore can be used to design psychological interventions to lower HCP's psychological problems and improving their quality of life.

Marriage and quality of life during COVID-19 pandemic

COVID-19 pandemic has impacted people around the globe. Countries, including Indonesia, implemented large-scale social restrictions. Since marriage is found to be beneficial to people's quality of life (QoL), the study aimed to examine the QoL of married people in Indonesia during a large-scale social restriction of the COVID-19 pandemic. An online cross-sectional survey using Qualtrics was conducted in June 2020. Respondents' sociodemographic data, spouse data (as reported by the respondents), and pandemic-related data were collected, followed by QoL data, measured by WHQOOL-BREF. WHOQL-BREF consists of 26 questions grouped into four domains: physical, psychological, social relationships, and environmental. Mann-Whitney U, Kruskal-Wallis H and Spearman correlation analyses were employed to compare QoL between groups of sociodemographic characteristics. In total, 603 respondents were recruited. The respondents' mean age is 35.3 years (SD = 7.61), most are females (82%), bachelor degree graduate (95%), Islam (78%), employed (69%), and assigned to work from home during the pandemic (76%). Married men reported better QoL in almost all domains than women; employed respondents reported higher QoL scores than unemployed; higher educated respondents reported higher QoL than those with lower education; respondents with higher income reported higher QoL than those with lower income. We found significant positive correlations between the QoL scores and age, spouse's age, and marriage length, although they were considered small. Compared to Indonesian population normative scores pre-pandemic, our sample reported no difference in physical and social domains, lower in the psychological domain, but higher in the environmental domain. Indonesian married people, especially women, those with low level of education, currently out of work, and below-average financial condition are the ones who reported worse quality of life during the lockdown. These results can help direct the Indonesian government efforts in dealing with psychosocial problems during the COVID-19 pandemic, especially for married couples.

Reference data among general population and known-groups validity among hypertensive population of the EQ-5D-5L in Vietnam

Purpose

This study aims to provide EQ-5D-5L population norms among the general population in Vietnam and to test EQ-5D-5L’ construction validity among people living with hypertension there.

Methods

Descriptive statistics of the five dimensions and five levels, EQ-VAS and EQ-5D-5L indexes were categorised into gender and age groups for the EQ-5D-5L population norms. Known-groups testing was set for lower EQ-5D-5L outcomes among people who were aware of their hypertensive status, females, people with more comorbidities, less education, older ages, and higher body mass indexes. Level of confident interval was 95%.

Results

The mean EQ-VAS and EQ-5D-5L indexes were 81.10 (SD: 13.35) and 0.94 (SD: 0.09) among the general population. The EQ-5D-5L outcomes were better among younger people, males, people with more education, employees, and single people. Respondents reported fewer problems with self-care and usual activities and tend to have problems at higher levels across older ages. The known-group testing showed statistically significant results. The mean EQ-VAS and EQ-5D-5L indexes of people in the diagnosed hypertensive group (71.48 and 0.94, respectively) were statistically significantly smaller than they were in the non-hypertensive and undiagnosed hypertensive group (76.65 and 0.97; 76.95 and 0.96 accordingly). Statistically significant associations of lower EQ-5D-5L indexes and EQ-VAS were found among people diagnosed for hypertension, people suffering from an incremental comorbidity, and obese people.

Conclusion

This study has provided EQ-5D-5L population norms for the general population and evidence for known-groups validity of the EQ-5D-5L instrument among hypertensive people in Vietnam.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02959-2.

Perceived caregiving preparedness and quality of life among Indonesian family caregivers of patients with life-limiting illness

BACKGROUND

Family caregivers play an important role in palliative care. However, family caregivers often report that they felt insufficiently prepared to become a caregiver. This lack of preparedness may lead to a decline in the caregiver's quality of life (QoL), and they may not be able to provide sufficient palliative care to their family member.

AIMS

To investigate the preparedness of family members to become caregivers alongside their QoL.

METHOD

A correlational cross-sectional study design was used. A sample of 104 family caregivers completed a World Health Organization Quality of Life Brief to assess the QoL of participants. The Caregiving Inventory (CGI) was used to assess how prepared family members felt to become care-givers, and the CGI also included questions related to the patient's socio-demographic status and illness. Correlation analysis was used to address the research questions. Caregivers were caring for a family member with a life-limiting illness in a suburban district of Indonesia.

FINDINGS

The 104 family caregivers had a relatively low score for both QoL and caregiving preparedness. A caregiver feeling more prepared was associated with a higher QoL. The study also found a positive correlation (r value, between 0.236-0.481) between perceived caregiving preparedness, including its factors, and domains of QoL.

CONCLUSION

A person's preparedness to become a caregiver is significantly associated with all QoL domains: physical, psychological, social and environmental. Family members can be better prepared to become a caregiver with training and information about personal care and symptom management.

Measurement Properties of the EQ VAS Around the Globe: A Systematic Review and Meta-Regression Analysis

OBJECTIVES

This study aimed to synthesize and evaluate published evidence on the measurement properties of the EQ VAS, a component of all EQ-5D questionnaires.

METHODS

This systematic review followed the Consensus-Based Standards for the Selection of Health Measurement Instruments guidelines. Five electronic databases were searched for EQ-5D-3L and EQ-5D-5L validation articles published from January 1, 2009, to November 5, 2019. Evidence for construct validity, test-retest reliability, and responsiveness was extracted from individual studies before being aggregated for evaluation of the populations represented by the studied samples. Multivariable logistic meta-regression was conducted to explore the effects of potential covariates on construct validity.

RESULTS

A total of 50 articles containing 488 studies, using samples drawn from 12 different populations, were identified. Generally, the quality of evidence was high for construct validity studies (n = 397) but only moderate for both test-retest reliability studies (n = 21) and responsiveness studies (n = 70). "Sufficient" construct validity of EQ VAS was found in 8 of 12 populations, "sufficient" test-retest reliability was found in 3 of 11 populations, and "sufficient" responsiveness was found in 5 of 12 populations. Meta-regression analyses suggested that construct validity studies from the Asian-Pacific region were more likely to show a negative rating compared with studies from Europe and North America.

CONCLUSION

The EQ VAS exhibits "sufficient" construct validity, "inconsistent" test-retest reliability, and "inconsistent" responsiveness across a broad range of populations. Additional studies are needed to explore the suboptimal validity of the EQ VAS in the Asian-Pacific region, whereas more high-quality validation studies are needed to assess its reliability and responsiveness.

Norwegian population norms for the EQ-5D-5L: results from a general population survey

Purpose

To provide the first Norwegian EQ-5D-5L and EQ VAS population norms for the adult general population.

Methods

Postal survey of a random sample of 12,790 Norwegians identified through the National Registry of the Norwegian Tax Administration. Norms, weighted for Norwegian general population characteristics, are shown for the five EQ-5D-5L dimensions, EQ-5D index, and EQ VAS scores for seven age categories, females, males, and education level.

Results

There were 3200 (25.9%) respondents to 12,263 correctly addressed questionnaires. The EQ-5D-5L dimensions, EQ VAS, and background questions were completed by 3120 (24.6%) respondents. The mean age (SD) was 50.9 (21.7) and range was 18–97 years. The youngest age group of 18–29 years and oldest of 80 years and over had the highest (n = 691) and lowest (n = 239) number of respondents, respectively. Compared to the general population, the respondents comprised a greater number of females, younger and older ages, and had a higher education level. 32% of respondents reported no health problems on the EQ-5D-5L. From the youngest to oldest age groups, there was a general decline in health as assessed by the EQ-5D-5L. The exception was for anxiety/depression, where the youngest age groups had the poorest health. Apart from self-care, women reported poorer health than men, as assessed by the EQ-5D-5L; EQ VAS scores were similar for men and women. Higher levels of health (EQ-5D index, EQ VAS scores) were found with increasing levels of education.

Conclusion

The population norms will improve interpretation of EQ-5D-5L and EQ VAS scores in Norwegian applications including clinical practice, clinical and health services research, and national quality registers where EQ-5D-5L is the most widely used patient-reported instrument.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-02938-7.

Health related quality of life among postmenopausal woman with hormone responsive HER2- breast cancer in Indonesia

OBJECTIVES

Breast cancer (BC) in women could decrease health-related quality of life (HRQoL). HRQoL becomes important to be assessed to design a relevant treatment that could improve patient outcomes. Furthermore, assessing HRQoL by measuring health state utilities becomes pivotal for health economic evaluation. This study aimed to describe the HRQoL of postmenopausal women with hormone responsive (HR+) HER2- BC using the EQ5D5L instrument in Indonesia.

METHODS

A cross-sectional study was conducted among 126 patients in Dr. Sardjito Hospital in Indonesia. The HRQoL was assessed by interviewing BC patients using the EQ5D5L questionnaire, and the utility index was calculated using the Indonesian value set. Information regarding clinical characteristic and socio-demographic were gained from patient medical records. One-way ANOVA and post-hoc Scheffe's test was performed to compare the utility score within the health state.

RESULTS

Of the 126 patients, a mean ± SD for the age of 59.2 ± 6.1 years. The major problems of patients were pain/discomfort (75.4%) followed by anxiety/depression (54.8%). The mean (SD) of EQ5D VAS was 76.64 (14.91). Mean (SD) of utility score was 0.87 (0.10), 0.77 (0.19) and 0.58 (0.44) for free metastasis (FM), locoregional metastasis (LM) and distant metastasis (DM), respectively. Poor QoL was observed at DM health state (p<0.05).

CONCLUSIONS

HRQoL of postmenopausal women with HR+ HER2- BC was low. The major reported problems were pain/discomfort and anxiety/depression.

Assessment of cytokines, microRNA and patient related outcome measures in conversion disorder/functional neurological disorder (CD/FND): The CANDO clinical feasibility study

BACKGROUND

Conversion disorder/functional neurological disorder (CD/FND) occurs often in neurological settings and can lead to long-term distress, disability and demand on health care services. Systemic low-grade inflammation might play a role, however, the pathogenic mechanism is still unknown.

AIM

1) To explore the feasibility to establish and assess a cohort of CD/FND with motor symptoms, involving persons with lived experience (PPI). 2) To generate proof of concept regarding a possible role for cytokines, microRNA, cortisol levels and neurocognitive symptoms in patients with motor CD/FND.

METHOD

Feasibility study.

RESULTS

The study showed active involvement of patients despite high clinical illness burden and disability, neurocognitive symptoms, childhood adverse experiences (ACE) and current life events. The study provided valuable knowledge regarding the feasibility of conducting a study in these patients that will inform future study phases. In the sample there were elevated levels of IL6, IL12, IL17A, IFNg, TNFa and VEGF-a, suggesting systemic low-grade inflammation. Also, microRNAs involved in inflammation and vascular inflammation were correlated with TNFa and VEGFa respectively, suggesting proof of concept for an epigenetic mechanism. Owing to the COVID-19 outbreak, the patient sample was limited to 15 patients.

CONCLUSION

It is a novelty that this study is conducted in the clinical setting. This innovative, translational study explores stress-related SLI in CD/FND patients and the feasibility of a larger project aiming to develop new treatments for this vulnerable population. Given the positive findings, there is scope to conduct further research into the mechanism of disease in CD/FND.

Benefits of STRENOLD Program on Health-Related Quality of Life in Adults Aged 60 Years or Older. In Common Sport Study

Background: The proportion of older adults is increasing worldwide and, with it, the physical inactivity common to this age group. Therefore, the promotion of active aging is a strategic factor in health policies for older people. The aim of this study was to identify the benefits and viability of the strength training program (STRENOLD) in health-related quality of life in adults over 60. Methods: A controlled experimental study was carried out with a sample of 181 people over 60 years old from different European countries belonging to the European project IN COMMON SPORTS. A pair work strength program was administered (STRENOLD) over a period of 24 months, consisting of two single sessions per week. Their health status was evaluated (EQ-5D-5L) before and after the interventions. Results: The adherence rate was over 89% and the tolerability rate over 100% in all participating countries. Significant improvements in the participants’ health were demonstrated in the areas of mobility, usual activities, pain/discomfort, and anxiety/depression. Conclusions: The regular practice of physical exercise, through the partnered STRENOLD strength program, has benefits on mobility, usual activities, pain/discomfort, and anxiety/depression, in short, health benefits for older adults.

EQ-5D-5L reference values for the German general elderly population

Background

Reference values are a helpful tool to facilitate comparisons of sampled values against a specified reference population. The aim is to describe the health profile and to provide visual analogue scale (EQ VAS) and utility reference values for the EQ-5D-5L from a normative sample of the general elderly population (65+) in Germany.

Methods

We analysed a sub-set of data from the German EQ-5D-5L valuation study using self-reported information based on EQ-5D-5L. We examined the share of respondents in each severity level per dimension as well as means, standard deviations (SD) and 95% confidence intervals for the index and EQ VAS values stratified by age groups and gender. Age was categorised in four groups (65–69, 70–74, 75–79 and > 79 years) to facilitate a more detailed examination of age-related health-related quality of life (HRQoL).

Results

The average index and EQ VAS scores were 0.84 (SD 0.22) and 73.2 (SD 18.5), respectively. In total, 21.4% reported no problems in all dimensions. With higher age, health problems were reported more frequently, which, in turn, lead to monotonically decreasing index and EQ VAS values. Overall, men reported fewer problems than women and this difference was largest beyond the age of 80.

Conclusion

HRQoL in the oldest old appears to be less stable and differs from the young elderly. However, the conventional age categorisation of earlier population norms studies seems to mask these differences. Hence, the more detailed provision of EQ-5D-5L reference values for the elderly population seems helpful for future German studies.

Eye Movement Desensitization (EMD) to reduce posttraumatic stress disorder-related stress reactivity in Indonesia PTSD patients: a study protocol for a randomized controlled trial

Background

Posttraumatic stress disorder (PTSD) may develop after exposure to a traumatic event. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based psychological treatment for PTSD. It is yet unclear whether eye movements also reduce stress reactivity in PTSD patients. This study aims to test whether eye movements, as provided during Eye Movement Desensitization (EMD), are more effective in reducing stress reactivity in PTSD patients as compared to a retrieval-only control condition.

Methods

The study includes participants who meet criteria of PTSD of the public psychological services in Jakarta and Bandung, Indonesia. One hundred and ten participants are randomly assigned to either an (1) Eye Movement Desensitization group (n = 55) or (2) retrieval-only control group (n = 55). Participants are assessed at baseline (T0), post-treatment (T1), 1 month (T2), and at 3 months follow-up (T3). Participants are exposed to a script-driven imagery procedure at T0 and T1. The primary outcome is heart rate variability (HRV) stress reactivity during script-driven imagery. Secondary outcomes include heart rate (HR), pre-ejection period (PEP), saliva cortisol levels, PTSD symptoms, neurocognitive functioning, symptoms of anxiety and depression, perceived stress level, and quality of life.

Discussion

If the EMD intervention is effective in reducing stress reactivity outcomes, this would give us more insight into the underlying mechanisms of EMDR’s effectiveness in PTSD symptom reduction.

Trial registration

ISRCTN registry ISRCTN55239132. Registered on 19 December 2017.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13063-021-05100-3.

Test-retest reliability of the EQ-5D-5L and the reworded QOLIBRI-OS in the general population of Italy, the Netherlands, and the United Kingdom

PURPOSE

To assess the test-retest reliability of the EQ-5D-5L and the reworded Quality of Life After Traumatic Brain Injury Overall Scale (QOLIBRI-OS) for the general population of Italy, the Netherlands, and the United Kingdom (UK).

METHODS

The sample contains 1864 members of the general population (aged 18-75 years) of Italy, the Netherlands, and the UK who completed a web-based questionnaire at two consecutive time points. The survey included items on gender, age, level of education, occupational status, household annual income, chronic health status, and the EQ-5D-5L and reworded QOLIBRI-OS instrument. Test-retest reliability of the EQ-5D-5L dimensions, EQ-5D-5L summary index, EQ VAS, reworded QOLIBRI-OS dimensions and reworded QOLIBRI-OS level sum score was examined by Gwet's Agreement Coefficient (Gwet's AC) and Intraclass Correlation Coefficient (ICC).

RESULTS

Gwet's AC ranged from 0.64 to 0.97 for EQ-5D-5L dimensions. The ICC ranged from 0.73 to 0.84 for the EQ-5D-5L summary index and 0.61 to 0.68 for EQ VAS in the three countries. Gwet's AC ranged from 0.35 to 0.55 for reworded QOLIBRI-OS dimensions in the three countries. The ICC ranged from 0.69 to 0.77 for reworded QOLIBRI-OS level sum score.

CONCLUSION

Test-retest reliability of the EQ-5D-5L administered via a web-based questionnaire was substantial to almost perfect for the EQ-5D-5L dimensions, good for EQ-5D-5L summary index, and moderate for the EQ VAS. However, test-retest reliability was less satisfactory for the reworded QOLIBRI-OS. This indicates that the web-based EQ-5D-5L is a reliable instrument for the general population, but further research of the reworded QOLIBRI-OS is required.

Psychometric properties of the EQ-5D-5L: a systematic review of the literature

PURPOSE

Although the EQ-5D has a long history of use in a wide range of populations, the newer five-level version (EQ-5D-5L) has not yet had such extensive experience. This systematic review summarizes the available published scientific evidence on the psychometric properties of the EQ-5D-5L.

METHODS

Pre-determined key words and exclusion criteria were used to systematically search publications from 2011 to 2019. Information on study characteristics and psychometric properties were extracted: specifically, EQ-5D-5L distribution (including ceiling and floor), missing values, reliability (test-retest), validity (convergent, known-groups, discriminate) and responsiveness (distribution, anchor-based). EQ-5D-5L index value means, ceiling and correlation coefficients (convergent validity) were pooled across the studies using random-effects models.

RESULTS

Of the 889 identified publications, 99 were included for review, representing 32 countries. Musculoskeletal/orthopedic problems and cancer (n = 8 each) were most often studied. Most papers found missing values (17 of 17 papers) and floor effects (43 of 48 papers) to be unproblematic. While the index was found to be reliable (9 of 9 papers), individual dimensions exhibited instability over time. Index values and dimensions demonstrated moderate to strong correlations with global health measures, other multi-attribute utility instruments, physical/functional health, pain, activities of daily living, and clinical/biological measures. The instrument was not correlated with life satisfaction and cognition/communication measures. Responsiveness was addressed by 15 studies, finding moderate effect sizes when confined to studied subgroups with improvements in health.

CONCLUSIONS

The EQ-5D-5L exhibits excellent psychometric properties across a broad range of populations, conditions and settings. Rigorous exploration of its responsiveness is needed.

Population norms of health-related quality of life in Moscow, Russia: the EQ-5D-5L-based survey

Purpose

To develop population norms for the EQ-5D-5L questionnaire based on a representative sample of Moscow citizens.

Methods

We used quota sampling accounting for sex, age group and administrative district of residence. Respondents in randomly selected outdoor and indoor locations were surveyed with the official Russian paper-and-pencil version of the EQ-5D-5L questionnaire and a set of socio-demographic questions. We estimated four types of EQ-5D results: the distribution of limitations according to EQ-5D-5L dimensions, the perception of the health-related quality of life (HRQoL) with a visual analogue scale (EQ VAS), the unweighted score for a respondent’s health state (Level Sum Score, LSS) and the Russian health preferences-based weighted score (EQ index). In order to estimate the EQ-5D-5L index, we used a newly developed Russian EQ-5D-3L value set, together with EuroQol Group cross-over methodology.

Results

A total of 1020 respondents (18–93 years old) from the general Moscow adult population completed the EQ-5D-5L questionnaire. HRQoL domains with the largest number of identified health limitations were pain/discomfort (48.6%) and anxiety/depression (44.1%). Two hundred seventy-nine respondents (27.0%) did not report any health restrictions. The mean EQ VAS and EQ-5D-5L index were 74.1 (SD 17.3) and 0.907 (0.106) respectively. Multivariate analysis showed that female sex, advanced age and lack of access to the Internet had a negative influence on HRQoL, whereas residence in certain districts had a positive impact.

Conclusions

The study provides population norms of health-related quality of life in Moscow, measured according to the EQ-5D-5L questionnaire. These reference values can be used to optimise the effectiveness of resource allocation in healthcare.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02705-0) contains supplementary material, which is available to authorised users.

EQ-5D-5L Bulgarian population norms

OBJECTIVES

The present study aimed to provide normative data for the EQ-5D-5L questionnaire in Bulgaria, based on a nationally representative sample.

METHODS

Random sampling was used. In September 2018, a total of 1005 respondents (aged 18-89 years) completed the self-administered paper-based EQ-5D-5L questionnaire, including a visual analogue scale (EQ VAS). Health state utility index scores were derived using the directly measured Polish value set.

RESULTS

The study sample was representative of the general Bulgarian population in terms of age, sex, geographical region, educational level, social and professional status. Mean EQ-5D-5L and EQ VAS values decreased from 0.986 and 89.7 (age group 18-24 years) to 0.789 and 53.6 (age group ≥ 75 years), respectively. Perfect health (the "11,111" health state) was reported by half of the population (50.1%), more often by men than women (55.8% vs 44.9%). The most frequently reported complaints characterised pain/discomfort dimension (39.1%), followed by anxiety/depression (34.5%). Although the least commonly reported health limitations concerned the self-care dimension, their frequency (13.6%) was the highest among the seventeen identified EQ-5D-5L population norm studies. The mean severity index score for the whole study sample was 6.96. EQ-5D-5L index was higher in respondents from lower age groups and with a higher average income per household member.

CONCLUSIONS

Bulgarian population norms, which were developed for the descriptive part of the EQ-5D-5L and EQ VAS, can be used as reference values. The availability of such normative data should encourage the use of the EQ-5D-5L questionnaire in health-related quality-of-life studies in Bulgaria.

EQ-5D-5L Slovenian population norms

BACKGROUND

The study aims to present Slovenian EQ-5D-5L population norms for different age and gender subgroups that can be used as reference values in future studies concerning health status. The secondary aim is to compare those norms with population norms from some other countries in Europe and elsewhere.

METHODS

The cross-sectional survey was conducted between November 2019 and February 2020 via online panel. 1071 adults aged 18+ were included in the survey. The general population was sampled using quota sampling in terms of age, gender, and NUTS2 region. In the study, the EQ-5D-5L Slovenian online version was used. Descriptive statistics was used to present health status by age groups and genders for the EQ-5D-5L descriptive system, EQ VAS and the EQ-5D-5L index score. The latter was derived from Slovenian EQ-3D-3L tariff, transformed to five levels using the crosswalk methodology.

RESULTS

The mean EQ VAS score in the Slovenian population was 79.9, mean utility index was 0.808. 28.2% of the population did not have problems on any dimension and 3.9% of the population had problems on all dimensions. Persons residing in Western Slovenia had, on average, 0.016 higher utility score, compared to Eastern Slovenia. Effect of gender was not significant. Age was negatively associated with both utility index and EQ VAS score. Education was positively correlated to health status. Problems on dimensions were generally increasing with age, except for anxiety/depression dimension, where youngest group (ages 18-29) reported more anxiety/depression compared to older counterparts. Self-reported anxiety/depression was more pronounced in women.

CONCLUSIONS

Similarly to other countries, the health generally deteriorates with age, except for the anxiety/depression dimension where the share of respondents reporting no problems was lowest in the youngest age group. The open question for the future remains, whether population norms from this online sample differ significantly from the actual EQ-5D-5L health status data of the Slovenian general population.

US population norms for the EQ-5D-5L and comparison of norms from face-to-face and online samples

Purpose

Normative scores (norms) allow for comparisons between population(s) of interest and the general population, which is useful for burden of disease studies and cost-effectiveness analysis. The primary aim of this study was to estimate US visual analogue scale (EQ VAS) and utility-based norms for the EQ-5D-5L using the face-to-face sample. The secondary aim was to compare norms estimated in the face-to-face and online populations.

Methods

This study estimated population norms from two general population surveys: (a) face-to-face and (b) online. In these surveys, respondents provided their health state using the EQ-5D-5L health classifier and the EQ VAS. Descriptive statistics, including mean, standard deviation (SD), 95% confidence interval, and median for the 5L utility and EQ VAS were estimated for each sample and across relevant respondent characteristics to serve as the basis for US EQ-5D-5L norms

Results

Face-to-face sample respondents (n = 1134) were representative of the US adult general population. In this sample, mean (SD) utility decreased with increasing age until age 45 or greater (age 45–54: 0.816 (0.249) age 55–64: 0.815 (0.243) age 65–74: 0.824 (0.217) age 75 + : 0.811 (0.218)). With increasing age, more problems were reported on all dimensions except anxiety/depression; a smaller proportion of respondents age 65 and older reported problems with anxiety/depression (23.8%) as compared to the youngest respondents (42.1%). Online (n = 2018) mean utility and EQ VAS values were consistently lower than the face-to-face sample.

Conclusions

The availability of US EQ-5D-5L norms facilitates interpretation and understanding of general population and patient health.

Electronic supplementary material

The online version of this article (10.1007/s11136-020-02650-y) contains supplementary material, which is available to authorized users.