OBJECTIVE: The purpose of this study was to develop and refine holistic health state descriptions of diabetic peripheral neuropathy (DPN) and its complications for a new utility instrument. METHODS: Quality of life domains and health state descriptions related to DPN were developed through a literature review, previous focus group materials, and expert opinion. Potential corresponding photographs were identified by expert opinion. Sixteen veterans with DPN-related complications were recruited to participate in focus group discussions of DPN and its impact on quality of life. Demographic and SF-36 data were also collected. Semi-structured discussion on the health state descriptions and the quality of life domains were used to refine and face validate the health state descriptions. A psychometric analysis was performed on eight additional patients to identify the most appropriate photographs to accompany each health state description. RESULTS: The mean SF-36 Physical and Mental Component Summary scales of the participants were 28.32 and 51.69, respectively. Four broad quality of life domains: symptoms of DPN (numbness, tingling, sensation, pain, temperature detection), physical function (mobility), social function (family, leisure activities, social life) and mental/emotional function (affect, mood, cognition) were identified. Qualitative exploration of these domains in four focus group discussions affirmed that these were the domains of importance to patients. Analysis of the empiric data from the psychometric experiment unequivocally demonstrated the photographs to accompany the health state descriptions. CONCLUSIONS: Eight health state descriptions with photographs were refined and validated by patients. These health state descriptions will be used with U-Titer, a customizable utility elicitation software package, to derive preference weights from an at-risk population in Canada (N=60) and the United Kingdom (N=60).