Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Sep;18(5):523-537.
doi: 10.1007/s40271-025-00743-9. Epub 2025 May 16.

Determining the Content Validity of the EQ-5D-5L, EQ-5D-Y-3L, and CHU9D Instruments for Assessing Generic Child and Adolescent Health-Related Quality of Life: A Qualitative Study

Jill Carlton  1 , Philip A Powell  2 , Andrew Kirkcaldy  2 , Donna Rowen  2
Affiliations

Determining the Content Validity of the EQ-5D-5L, EQ-5D-Y-3L, and CHU9D Instruments for Assessing Generic Child and Adolescent Health-Related Quality of Life: A Qualitative Study

Jill Carlton et al. Patient. 2025 Sep.

Abstract

Background: Health technology assessment agencies typically recommend generic measures of health to generate quality-adjusted life-years. Most agencies provide recommendations on which measure to use for adults, whereas few make recommendations for children. Two widely used preference-weighted measures of child and adolescent health that have evidence of good psychometric performance are the EQ-5D-Y-3L and the Child Health Utility 9D Index (CHU9D). The EQ-5D-5L has also been used to assess adolescent health. However, evidence on their content validity-a core measurement property-is limited. The objective of this study was to explore the content validity of the EQ-5D-5L, EQ-5D-Y-3L, and CHU9D measures, including their relevance, comprehensiveness, and comprehensibility.

Methods: We assessed the content validity of the EQ-5D-5L, EQ-5D-Y-3L, and CHU9D using online semi-structured cognitive interviews in the UK. Participants were asked to comment on the relevance, comprehensibility, and comprehensiveness of the measures, including response options, recall period, and completion instructions. Interviews were informed by a topic guide. Purposive sampling allowed for appropriate breadth in the sample, with variation in gender, and presence of health conditions, disease, or disability. Interviews were recorded and transcribed verbatim before thematic content analysis.

Results: In total, we conducted 49 interviews between August 2022 and June 2023: 21 children/adolescents aged 8-17 years and 28 parents/guardians of children aged 4-17 years. The mean duration of the interviews was 45 min. Relevance was broadly supported, but issues were identified. Comprehensibility was inconsistent on some items, and participants expressed difficulty with grouped items (e.g., 'anxiety/depression'). Participants had difficulty distinguishing qualitatively between some response options (e.g., 'a little bit/a bit'). Some participants noted that instrument comprehensiveness was insufficient.

Conclusions: Although the content of the EQ-5D-5L, EQ-5D-Y-3L, and CHU9D was broadly supported, potential problems were identified in aspects of comprehensibility, relevance, and comprehensiveness. These present opportunities for future research and refinement to ultimately improve the content validity of these measures for assessing child and adolescent health.

PubMed Disclaimer

Conflict of interest statement

Declarations. Funding: This research is funded through the National Institute for Health and Care Research (NIHR) Policy Research Unit in Economic Methods of Evaluation in Health and Social Care Interventions (reference NIHR206111). The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in data collection, interpretation, and reporting. Conflicts of Interest: Jill Carlton, Philip Powell, and Donna Rowen have received funding from the EuroQol Research Foundation. Donna Rowen is a member of the EuroQol Group. The CHU9D instrument is owned and licensed by the University of Sheffield. Andrew Kirkcaldy has no conflicts to declare. Ethics Approval: Ethical approval was obtained from the University of Sheffield (Ref: 045650). All participants gave informed consent before interviews were conducted. Consent to participate: Informed consent was obtained from all individual participants included in the study. Consent for publication: All participants consented to their anonymised data being used to support publication. Availability of Data and Materials: Data are provided in the manuscript and accompanying supplementary files. Code availability: All data supporting the findings of this study are available within the paper and its Supplementary Information. CRediT Authorship Contribution Statement: JC: study conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, supervision, visualisation, writing—original draft, and writing—revisions. PAP: study conceptualisation, data curation, formal analysis, funding acquisition, investigation, methodology, visualisation, writing—original draft, and writing—revisions. AK: formal analysis and writing—revisions. DR: study conceptualisation, funding acquisition, methodology, and writing—revisions.

Similar articles

See all similar articles

References

    1. UK National Institute for Health and Care Excellence. NICE Health Technology Evaluations: the manual. NICE process and methods [PMG36]. 31 January 2022. https://www.nice.org.uk/process/pmg36
    1. Hill H, Rowen D, Pennington B, Wong R, Wailoo A. A review of the methods used to generate utility values in NICE technology assessments for children and adolescents. Value Health. 2020;23(7):907–17. 10.1016/j.jval.2020.02.011. - PubMed
    1. Wille N, Badia X, Bonsel G, et al. Development of the EQ-5D-Y: a child-friendly version of the EQ-5D. Qual Life Res. 2010;19(6):875–86. 10.1007/s11136-010-9648-y. - PMC - PubMed
    1. Stevens K. Developing a descriptive system for a new preference-based measure of health-related quality of life for children. Qual Life Res. 2009;18(8):1105–13. 10.1007/s11136-009-9524-9. - PubMed
    1. Mokkink LB, Terwee CB, Patrick DL, et al. The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Qual Life Res. 2010;19(4):539–49. 10.1007/s11136-010-9606-8. - PMC - PubMed