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. 2023 Mar 9;7(1):22.
doi: 10.1186/s41687-023-00560-4.

Psychometric performance of the Chichewa versions of the EQ-5D-Y-3L and EQ-5D-Y-5L among healthy and sick children and adolescents in Malawi

Lucky G Ngwira  1   2 , Hendramoorthy Maheswaran  3 , Janine Verstraete  4 , Stavros Petrou  5 , Louis Niessen  6   7 , Sarah C Smith  8
Affiliations

Psychometric performance of the Chichewa versions of the EQ-5D-Y-3L and EQ-5D-Y-5L among healthy and sick children and adolescents in Malawi

Lucky G Ngwira et al. J Patient Rep Outcomes. .

Abstract

Objectives: The EuroQol Group has developed an extended version of the EQ-5D-Y-3L with five response levels for each of its five dimensions (EQ-5D-Y-5L). The psychometric performance has been reported in several studies for the EQ-5D-Y-3L but not for the EQ-5D-Y-5L. This study aimed to psychometrically evaluate the EQ-5D-Y-3L and EQ-5D-Y-5L Chichewa (Malawi) versions.

Methods: The EQ-5D-Y-3L, EQ-5D-Y-5L and PedsQL™ 4.0 Chichewa versions were administered to children and adolescents aged 8-17 years in Blantyre, Malawi. Both of the EQ-5D-Y versions were evaluated for missing data, floor/ceiling effects, and validity (convergent, discriminant, known-group and empirical).

Results: A total of 289 participants (95 healthy, and 194 chronic and acute) self-completed the questionnaires. There was little problem with missing data (< 5%) except in children aged 8-12 years particularly for the EQ-5D-Y-5L. Ceiling effects was generally reduced in moving from the EQ-5D-Y-3L to the EQ-5D-Y-5L. For both EQ-5D-Y-3L and EQ-5D-Y-5L, convergent validity tested with PedsQL™ 4.0 was found to be satisfactory (correlation ≥ 0.4) at scale level but mixed at dimension /sub-scale level. There was evidence of discriminant validity (p > 0.05) with respect to gender and age, but not for school grade (p < 0.05). For empirical validity, the EQ-5D-Y-5L was 31-91% less efficient than the EQ-5D-Y-3L at detecting differences in health status using external measures.

Conclusions: Both versions of the EQ-5D-Y-3L and EQ-5D-Y-5L had issues with missing data in younger children. Convergent validity, discriminant validity with respect to gender and age, and known-group validity of either measures were also met for use among children and adolescents in this population, although with some limitations (discriminant validity by grade and empirical validity). The EQ-5D-Y-3L seems particularly suited for use in younger children (8-12 years) and the EQ-5D-Y-5L in adolescents (13-17 years). However, further psychometric testing is required for test re-test reliability and responsiveness that could not be carried out in this study due to COVID-19 restrictions.

Trial registration: ClinicalTrials.gov NCT02426112.

Keywords: Adaptation; Childhood; EQ-5D-Y; EQ-5D-Y-5L; HRQoL; Health-related quality of life; Ranking exercise; Sub-Saharan Africa; Translation.

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Conflict of interest statement

JV is a member of the EuroQol Group and the study received some funding from the EuroQol Research Foundation. However, neither the EuroQol Group nor the EuroQol Research Foundation influenced the findings of this work. SP received grants as a NIHR Senior Investigator (NF-Sl-0616-10103), and from the NIHR Applied Research Collaboration Oxford and Thames Valley during the conduct of the study.

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