Evaluating Performance of the Experimental EQ-TIPS (V3) for Assessing Infants and Toddlers With Acute Infections: A Mixed-Methods Approach of Cognitive Debriefing and Psychometric Testing
Author(s)
Yap Xin Yi, BSS (Honours)1, Nicholas Ng, Dr2, Woonli Seo, Dr2, Celeste Yong, Dr2, Daryl Yeo, Dr2, Aureliano Paolo Paolo Finch, PhD3, Janine Verstraete, PhD4, Ling Jie Cheng, PhD5, Nan Luo, PhD1.
1National University of Singapore, Singapore, Singapore, 2National University Hospital Singapore, Singapore, Singapore, 3EuroQol Research Foundation, Amsterdam, Netherlands, 4University of Cape Town, Cape Town, South Africa, 5University of Oxford, Oxford, United Kingdom.
1National University of Singapore, Singapore, Singapore, 2National University Hospital Singapore, Singapore, Singapore, 3EuroQol Research Foundation, Amsterdam, Netherlands, 4University of Cape Town, Cape Town, South Africa, 5University of Oxford, Oxford, United Kingdom.
OBJECTIVES: The EuroQol Toddler and Infant Populations (EQ-TIPS) was developed to assess health-related quality of life (HRQoL) in children aged 0-3 years. While the earlier 6-item, 3-level EQ-TIPS (V2) has been tested, the experimental 7-item version (V3) with 3- or 5-level response scales (EQ-TIPS-3L and EQ-TIPS-5L) has not yet been evaluated. This study assessed the updated experimental EQ-TIPS among caregivers of infants and toddlers with acute infections in Singapore.
METHODS: We used a mixed-methods design, comprising cognitive interviews and psychometric testing. Primary caregivers of children participated in interviews exploring clarity, comprehensiveness, and interpretation of EQ-TIPS items and the visual analogue scale (VAS), which were then analysed thematically. For psychometric testing, caregivers of children with acute infections such as rhinorrhoea or tachypnoea were recruited from a tertiary hospital’s emergency department. At baseline, caregivers completed EQ-TIPS-3L, EQ-TIPS-5L, and PedsQL to assess ceiling and floor effects, as well as convergent validity. Two weeks later, follow-up assessments were conducted via Zoom to evaluate responsiveness to clinical change using standardized response means (SRM) of EQ-TIPS-3L and EQ-TIPS-5L level sum scores (LSS).
RESULTS: Caregivers (n=10) found EQ-TIPS acceptable, relevant, and easy to complete, although some ambiguity was noted in emotion and sleep items, with suggestions to extend the recall period and simplify the VAS. For the data from 77 caregivers of children (40 reassessed), ceiling effects (1111111) were 28.6% (3L) and 16.9% (5L), while floor effects were 0%. Both versions demonstrated strong convergent validity (ρ = 0.71). At follow-up, large SRMs among caregivers reporting HRQoL improvements indicated good responsiveness: -0.82 (EQ-TIPS-3L LSS), -0.81 (EQ-TIPS-5L LSS), and 1.47 (VAS).
CONCLUSIONS: Both EQ-TIPS-3L and EQ-TIPS-5L demonstrated good content and construct validity, as well as responsiveness to recovery, for assessing acutely ill young children. Despite some item ambiguity, findings support their use in evaluating HRQoL in this population.
METHODS: We used a mixed-methods design, comprising cognitive interviews and psychometric testing. Primary caregivers of children participated in interviews exploring clarity, comprehensiveness, and interpretation of EQ-TIPS items and the visual analogue scale (VAS), which were then analysed thematically. For psychometric testing, caregivers of children with acute infections such as rhinorrhoea or tachypnoea were recruited from a tertiary hospital’s emergency department. At baseline, caregivers completed EQ-TIPS-3L, EQ-TIPS-5L, and PedsQL to assess ceiling and floor effects, as well as convergent validity. Two weeks later, follow-up assessments were conducted via Zoom to evaluate responsiveness to clinical change using standardized response means (SRM) of EQ-TIPS-3L and EQ-TIPS-5L level sum scores (LSS).
RESULTS: Caregivers (n=10) found EQ-TIPS acceptable, relevant, and easy to complete, although some ambiguity was noted in emotion and sleep items, with suggestions to extend the recall period and simplify the VAS. For the data from 77 caregivers of children (40 reassessed), ceiling effects (1111111) were 28.6% (3L) and 16.9% (5L), while floor effects were 0%. Both versions demonstrated strong convergent validity (ρ = 0.71). At follow-up, large SRMs among caregivers reporting HRQoL improvements indicated good responsiveness: -0.82 (EQ-TIPS-3L LSS), -0.81 (EQ-TIPS-5L LSS), and 1.47 (VAS).
CONCLUSIONS: Both EQ-TIPS-3L and EQ-TIPS-5L demonstrated good content and construct validity, as well as responsiveness to recovery, for assessing acutely ill young children. Despite some item ambiguity, findings support their use in evaluating HRQoL in this population.
Conference/Value in Health Info
2025-11, ISPOR Europe 2025, Glasgow, Scotland
Value in Health, Volume 28, Issue S2
Code
EPH92
Topic
Epidemiology & Public Health, Methodological & Statistical Research, Patient-Centered Research
Topic Subcategory
Public Health
Disease
Pediatrics