Skip to main content

Advertisement

SpringerLink
Log in

Exploration of a cultural-adaptation of the EQ-5D for Thai population: A “bolt-on” experiment

  • Published:
Quality of Life Research Aims and scope Submit manuscript

A Correction to this article was published on 18 October 2021

This article has been updated

Abstract

Purpose

As the EQ-5D was developed in western countries with only five dimensions, it might be insensitive to non-western populations including Thai. This study examined the impact of adding two candidate dimensions, “interpersonal relationships (IR)” and “activities related to bending knees (AK),” to the EQ-5D questionnaire, and evaluated their psychometric properties in a Thai population sample.

Methods

Face-to-face interviews were conducted with 600 Thai. Ceiling effect for the EQ-5D and the EQ-5D-5L+AK+IR were compared. Spearman’s rho correlation was used to determine whether the two new dimensions were redundant with the existing EQ-5D dimensions. Correlations between the two dimensions and similar dimensions of the SF-36v2 were also assessed. Hierarchical multiple regression was performed to evaluate the incremental value of the EQ-5D-5L+AK+IR over the EQ-5D in predicting VAS scores.

Results

The two new dimensions were not redundant with the existing five dimensions of the EQ-5D. The highest correlation (0.371) was found between MO and AK. The overall ceiling effect decreased by 5% (50.5–45.5%) when using the EQ-5D-5L+AK+IR. Moderate correlations were found between the candidate dimensions and similar dimensions of the SF-36v2. Multiple regression indicated that adding AK (adjusted r2 0.329 vs. 0.306) but not IR (adjusted r2 0.307 vs. 0.306) significantly increased ability to predict VAS scores.

Conclusions

Our preliminary results suggested that AK holds promise for making the EQ-5D more relevant to Thai while it is premature to conclude on the impact of IR. Nevertheless, more work is required to carefully assess the value of the new dimensions as well as the trade-off for the modification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Change history

References

  1. Brooks, R. (1996). EuroQol: The current state of play. Health Policy, 37(1), 53–72.

    Article  CAS  Google Scholar 

  2. Kind, P. (1996). The EuroQoL instrument: An index of health-related quality of life. In B. Spilker (Ed.), Quality of life and pharmacoeconomics in clinical trials (2 ed., pp. 191–201). Philadephia: Lippincott-Raven.

    Google Scholar 

  3. Shah, K., Mulhern, B., Longworth, L., & Janssen, B. (2016). Important aspects of health not captured by eq-5d: Views of the UK general public. London, UK. Retrieved September 21, 2018, from https://euroqol.org/wpcontent/uploads/working_paper_series/EuroQol_Working_Paper_Series_Manuscript_16001_-_Koonal_K_Shah.pdf.

  4. Cheung, Y. B., & Thumboo, J. (2006). Developing health-related quality-of-life instruments for use in Asia: The issues. Pharmacoeconomics, 24(7), 643–650.

    Article  Google Scholar 

  5. Yang, Y., Rowen, D., Brazier, J., Tsuchiya, A., Young, T., & Longworth, L. (2015). An exploratory study to test the impact on three “bolt-on” items to the EQ-5D. Value Health, 18(1), 52–60.

    Article  Google Scholar 

  6. Luo, N., Wang, X., Ang, M., Finkelstein, E. A., Aung, T., Wong, T. Y., et al. (2015). A vision “Bolt-On” item could increase the discriminatory power of the EQ-5D index score. Value Health, 18(8), 1037–1042.

    Article  Google Scholar 

  7. Perneger, T. V., & Courvoisier, D. S. (2011). Exploration of health dimensions to be included in multi-attribute health-utility assessment. Internal Journal for Quality in Health Care, 23(1), 52–59.

    Article  Google Scholar 

  8. Hoeymans, N., van Lindert, H., & Westert, G. P. (2005). The health status of the Dutch population as assessed by the EQ-6D. Quality of Life Research, 14(3), 655–663.

    Article  CAS  Google Scholar 

  9. Yang, Y., Brazier, J., & Tsuchiya, A. (2014). Effect of adding a sleep dimension to the EQ-5D descriptive system: A “bolt-on” experiment. Medical Decision Making, 34(1), 42–53.

    Article  Google Scholar 

  10. Kleinman, A., Eisenberg, L., & Good, B. (1978). Culture, illness, and care: Clinical lessons from anthropologic and cross-cultural research. Annals of Internal Medicine, 88(2), 251–258.

    Article  CAS  Google Scholar 

  11. Sakthong, P. (2008). Measurement of clinical-effect: Utility. Journal of the Medical Association of Thailand, 91(Suppl 2), S43–S52.

    PubMed  Google Scholar 

  12. Thavorncharoensap, M. (2014). Measurement of utility. Journal of the Medical Association of Thailand, 97(Suppl 5), S43–S49.

    PubMed  Google Scholar 

  13. Xie, F., Li, S. C., Fong, K. Y., Lo, N. N., Yeo, S. J., Yang, K. Y., et al. (2006). What health domains and items are important to patients with knee osteoarthritis? A focus group study in a multiethnic urban Asian population. Osteoarthritis Cartilage, 14(3), 224–230.

    Article  CAS  Google Scholar 

  14. Benfayed, R., Hamilton, D., Moran, M., Simpson, A., & Macdonald, D. (2017). Interpretation of kneeling. Orthopedic & Muscular System, 06, 240.

    Google Scholar 

  15. Hampton, N. Z., & Qin-Hilliard, D. B. (2004). Dimensions of quality of life for Chinese adults with spinal cord injury: A qualitative study. Disability and Rehabilitation, 26(4), 203–212.

    Article  Google Scholar 

  16. Schwartz, S. H. (1990). Individualism-collectivism: Critique and proposed refinements. Journal of Cross-Cultural Psychology, 21(2), 139–157.

    Article  Google Scholar 

  17. Zhang, W., & Ta, V. M. (2009). Social connections, immigration-related factors, and self-rated physical and mental health among Asian Americans. Social Science & Medicine, 68(12), 2104–2112.

    Article  Google Scholar 

  18. Die, A. H., & Seelbach, W. C. (1988). Problems, sources of assistance, and knowledge of services among elderly Vietnamese Immigrants1. The Gerontologist, 28(4), 448–452.

    Article  CAS  Google Scholar 

  19. Kim, H. K., & McKenry, P. C. (1998). Social networks and support: A comparison of African Americans, Asian Americans, Caucasians, and Hispanics. Journal of Comparative Family Studies, 29(2), 313–334.

    Article  Google Scholar 

  20. Kramer, E. J., Kwong, K., Lee, E., & Chung, H. (2002). Cultural factors influencing the mental health of Asian Americans. Western Journal of Medicine, 176(4), 227–231.

    PubMed Central  Google Scholar 

  21. Rotheram-Borus, M. J., Stein, J. A., Jiraphongsa, C., Khumtong, S., Lee, S. J., & Li, L. (2010). Benefits of family and social relationships for Thai parents living with HIV. Prevention Science, 11(3), 298–307.

    Article  Google Scholar 

  22. Whitehead, S. J., & Ali, S. (2010). Health outcomes in economic evaluation: The QALY and utilities. British medical bulletin, 96, 5–21.

    Article  Google Scholar 

  23. Liem, Y. S., Bosch, J. L., Arends, L. R., Heijenbrok-Kal, M. H., & Hunink, M. G. (2007). Quality of life assessed with the Medical Outcomes Study Short Form 36-Item Health Survey of patients on renal replacement therapy: A systematic review and meta-analysis. Value Health, 10(5), 390–397.

    Article  Google Scholar 

  24. Ware, J. E. Jr., & Gandek, B. (1998). Methods for testing data quality, scaling assumptions, and reliability: the IQOLA Project approach. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 945–952.

    Article  Google Scholar 

  25. Coons, S. J., Rao, S., Keininger, D. L., & Hays, R. D. (2000). A comparative review of generic quality-of-life instruments. Pharmacoeconomics, 17(1), 13–35.

    Article  CAS  Google Scholar 

  26. Anderson, R. T., Aaronson, N. K., & Wilkin, D. (1993). Critical review of the international assessments of health-related quality of life. Quality of Life Research, 2(6), 369–395.

    Article  CAS  Google Scholar 

  27. Cohen P (1974). Regression and correlation. Statistic in medicine. Boston: Little Brown and Company.

  28. US Department of Health and Human Services Food and Drug Administration (2009). Guidance for industry: Patient-reported outcome measures: Use in medical product development to support labeling claims. Retrieved June 6, 2018, from http://www.fda.gov/downloads/Drugs/Guidances/UCM193282.pdf.

  29. Aekplakorn, W. (2016). Thai National Health Examination Survey, NHES V. Nonthaburi: Health Systems Research Institute.

    Google Scholar 

  30. Pattanaphesaj, J., & Thavorncharoensap, M. (2015). Measurement properties of the EQ-5D-5L compared to EQ-5D-3L in the Thai diabetes patients. Health and Quality of Life Outcomes, 13, 14.

    Article  Google Scholar 

  31. Swinburn, P., Lloyd, A., Boye, K. S., Edson-Heredia, E., Bowman, L., & Janssen, B. (2013). Development of a disease-specific version of the EQ-5D-5L for use in patients suffering from Psoriasis: Lessons learned from a feasibility study in the UK. Value Health, 16(8), 1156–1162.

    Article  Google Scholar 

  32. Martin-Fernandez, J., Ariza-Cardiel, G., Polentinos-Castro, E., Sanz-Cuesta, T., Sarria-Santamera, A., & Del Cura-Gonzalez, I. (2018). Explaining differences in perceived health-related quality of life: A study within the Spanish population. Gaceta Sanitaria, 32(5), 447–453.

    Article  Google Scholar 

  33. Leidl, R., & Reitmeir, P. (2017). An experience-based value set for the EQ-5D-5L in Germany. Value Health, 20(8), 1150–1156.

    Article  Google Scholar 

  34. Jelsma, J., & Ferguson, G. (2004). The determinants of self-reported health-related quality of life in a culturally and socially diverse South African community. Bulletin of the World Health Organization, 82(3), 206–212.

    PubMed  PubMed Central  Google Scholar 

  35. Bleichrodt, H., & Johannesson, M. (1997). An experimental test of a theoretical foundation for rating-scale valuations. Medical Decision Making, 17(2), 208–216.

    Article  CAS  Google Scholar 

  36. Schwartz, A. (1998). Rating scales in context. Medical Decision Making, 18(2), 236–236.

    Article  CAS  Google Scholar 

  37. Robinson, A., Loomes, G., & Jones-Lee, M. (2001). Visual analog scales, standard gambles, and relative risk aversion. Medical Decision Making, 21(1), 17–27.

    Article  CAS  Google Scholar 

  38. Whynes, D. K. (2013). Does the correspondence between EQ-5D health state description and VAS score vary by medical condition? Health and Quality of Life Outcomes, 11, 155.

    Article  Google Scholar 

  39. Sakthong, P., Sonsa-Ardjit, N., Sukarnjanaset, P., & Munpan, W. (2015). Psychometric properties of the EQ-5D-5L in Thai patients with chronic diseases. Quality of Life Research, 24(12), 3015–3022.

    Article  Google Scholar 

Download references

Acknowledgements

This publication is a part of the degree of Doctor of Philosophy in Social, Economic and Administrative Pharmacy, Faculty of Graduate Studies, Mahidol University. This project was also funded through the Royal Golden Jubilee (RGJ) Ph.D. Programme in Thailand (Grant No. PHD/0115/2556) provided by the Thailand Research Fund (TRF) and Mahidol University. The results and opinions in this report have not been endorsed by the above funding agency. We would like to express our gratitude to the EuroQoL group for allowing us to conduct this study. We are grateful to Dr. A. Simon Pickard for his invaluable advice and comments regarding the data analyses of this study. We are thankful to the National Statistical Office (NSO) in Thailand for their help with the sampling method. Special thanks also to all local village leaders and participants from the provinces of Chumporn, Chachoengsao, Bangkok, Chaing-Mai, and Loei in Thailand who facilitated or participated in the data collection process.

Author information

Authors and Affiliations

  1. Division of Social and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, 447 Sri-Ayuthaya Rd., Rajathevi, Bangkok, 10400, Thailand

    Krittaphas Kangwanrattanakul, Montaya Sunantiwat & Montarat Thavorncharoensap

  2. Faculty of Pharmaceutical Sciences, Burapha University, 169 Long-Hard Bangsean Rd., Sansuk Sub-district, Mueang District, Chonburi, 20131, Thailand

    Krittaphas Kangwanrattanakul

  3. Department of Experimental and Clinical Pharmacology, College of Pharmacy, University of Minnesota, Minneapolis, USA

    Cynthia R. Gross

Authors
  1. Krittaphas Kangwanrattanakul
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Cynthia R. Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Montaya Sunantiwat
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Montarat Thavorncharoensap
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Montarat Thavorncharoensap.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interests in this study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kangwanrattanakul, K., Gross, C.R., Sunantiwat, M. et al. Exploration of a cultural-adaptation of the EQ-5D for Thai population: A “bolt-on” experiment. Qual Life Res 28, 1207–1215 (2019). https://doi.org/10.1007/s11136-018-2072-4

Download citation

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11136-018-2072-4

Keywords

Search

Navigation