CONTENT VALIDITY OF THE EQ-HWB-9 IN PATIENTS WITH ADVANCED ILLNESSES: A COGNITIVE DEBRIEFING STUDY
Author(s)
See Mieng Tan, PhD1, Clara Mukuria, PhD2, Nan Luo, PhD3, Eric Finkelstein, MHA, PhD4, Yin Bun Cheung, PhD5, Felicia Ang, PhD1, Mihir Gandhi, PhD6;
1Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore, 2CM HE Consulting, Sheffield, United Kingdom, 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, 4Duke-NUS Medical School Singapore, Lien Centre for Palliative Care, Singapore, Singapore, 5Duke-NUS Medical School, Centre for Biomedical Data Science, Singapore, Singapore, 6Duke-NUS Medical School, Lien Centre for Palliative Care and Centre for Biomedical Data Science, Singapore, Singapore
1Duke-NUS Medical School, Lien Centre for Palliative Care, Singapore, Singapore, 2CM HE Consulting, Sheffield, United Kingdom, 3Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore, 4Duke-NUS Medical School Singapore, Lien Centre for Palliative Care, Singapore, Singapore, 5Duke-NUS Medical School, Centre for Biomedical Data Science, Singapore, Singapore, 6Duke-NUS Medical School, Lien Centre for Palliative Care and Centre for Biomedical Data Science, Singapore, Singapore
OBJECTIVES: To evaluate the content validity of the 9-item EQ Health and Wellbeing (EQ-HWB-9), UK (English) EMV2.1, instrument among patients with advanced illnesses.
METHODS: Semi-structured in-person cognitive debriefing interviews were conducted with 12 patients with advanced illnesses (3 cancer, 3 lung, 2 heart, 3 renal, and 1 autoimmune disease) recruited from tertiary hospitals and hospices in Singapore. A "think-aloud" approach and concurrent verbal probing were employed to assess how items were understood and reported. Qualitative content analysis was used to identify themes regarding how length, recall period, terminology, response options, comprehensiveness, and item order sequence affected instrument performance.
RESULTS: All patients were comfortable with the instrument length. Five patients found the instrument easy to understand as they were able to substantiate their responses with personal examples to demonstrate their understanding. The seven-day recall period was generally deemed appropriate, though two patients suggested its omission for specific items. In the item description, terminology issues emerged; phrases regarding mobility "inside and outside" were perceived as abstract by two patients, with suggestions for location-specific contexts like "at home". Interpretations of "sad" and "depressed" varied, with five patients viewing them as interchangeable while four perceived them as distinct clinical states. Two patients opined that the response options should be reduced from five to three, while the majority were comfortable with five. Regarding comprehensiveness, four patients suggested including more items on emotional wellbeing. Three patients had overlooked the italicized examples below the item description, intended to clarify complex constructs like "control" and "thinking clearly," unless prompted. Three patients recommended revising the order sequence to group related items.
CONCLUSIONS: The EQ-HWB-9 instrument demonstrated good relevance and acceptability amongst patients with advanced illnesses in Singapore. While core dimensions resonate with patient experiences, findings suggest that refining item specificity, reordering questions, and including more emotional wellbeing questions.
METHODS: Semi-structured in-person cognitive debriefing interviews were conducted with 12 patients with advanced illnesses (3 cancer, 3 lung, 2 heart, 3 renal, and 1 autoimmune disease) recruited from tertiary hospitals and hospices in Singapore. A "think-aloud" approach and concurrent verbal probing were employed to assess how items were understood and reported. Qualitative content analysis was used to identify themes regarding how length, recall period, terminology, response options, comprehensiveness, and item order sequence affected instrument performance.
RESULTS: All patients were comfortable with the instrument length. Five patients found the instrument easy to understand as they were able to substantiate their responses with personal examples to demonstrate their understanding. The seven-day recall period was generally deemed appropriate, though two patients suggested its omission for specific items. In the item description, terminology issues emerged; phrases regarding mobility "inside and outside" were perceived as abstract by two patients, with suggestions for location-specific contexts like "at home". Interpretations of "sad" and "depressed" varied, with five patients viewing them as interchangeable while four perceived them as distinct clinical states. Two patients opined that the response options should be reduced from five to three, while the majority were comfortable with five. Regarding comprehensiveness, four patients suggested including more items on emotional wellbeing. Three patients had overlooked the italicized examples below the item description, intended to clarify complex constructs like "control" and "thinking clearly," unless prompted. Three patients recommended revising the order sequence to group related items.
CONCLUSIONS: The EQ-HWB-9 instrument demonstrated good relevance and acceptability amongst patients with advanced illnesses in Singapore. While core dimensions resonate with patient experiences, findings suggest that refining item specificity, reordering questions, and including more emotional wellbeing questions.
Conference/Value in Health Info
2026-05, ISPOR 2026, Philadelphia, PA, USA
Value in Health, Volume 29, Issue S6
Code
PCR9
Topic
Patient-Centered Research
Topic Subcategory
Instrument Development, Validation, & Translation, Patient-reported Outcomes & Quality of Life Outcomes
Disease
SDC: Cardiovascular Disorders (including MI, Stroke, Circulatory), SDC: Oncology, SDC: Respiratory-Related Disorders (Allergy, Asthma, Smoking, Other Respiratory), SDC: Urinary/Kidney Disorders, STA: Multiple/Other Specialized Treatments