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Zhang G, Yang Z, Luo N, Wang P, Busschbach J. Can items derived from international literature be used in national quality of life instruments? A qualitative study conceptualising the EQ-HWB in China. J Patient Rep Outcomes 2024; 8:83. [PMID: 39102010 DOI: 10.1186/s41687-024-00767-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 07/14/2024] [Indexed: 08/06/2024] Open
Abstract
INTRODUCTION The EQ Health and Wellbeing (EQ-HWB) is a new questionnaire for measuring quality of life (QoL) from a broad perspective. The items of the EQ-HWB were derived based on a 'qualitative review' of literature, which reported primarily on Western studies. It can be argued that the QoL is a cultural-related concept and therefore people from China have a different understanding of the QoL. This study aimed to explore whether Chinese citizens could understand the EQ-HWB's candidate items and what they thought of those items. In doing so, we wanted to examine the face validity of the candidate items and explore if further cultural adaptation is necessary. METHODS This research was part of the E-QALY project, in which 36 candidate items were selected for the EQ-HWB from a 97-item pool. In China, three interviewers investigated the face validity of these EQ-HWB candidate items in semi-structured qualitative face-to-face interviews. Respondents were invited to report 'problems' with regard to the interpretation of the items and these problems were grouped into themes. We explored to what extent those themes related to specific cultural aspects in China. We also classified the rates of reported problems for each item into three groups: 1) less than 20%, 2) from 20-50%, and 3) over 50%. RESULTS For 17 items the rate of reported problems was less than 20%, 15 items fell into the second group (with 20 - 50%) and for 4 items the rate of problems reported was more than 50%. The thematic analysis revealed eight themes: ambiguous problems in the interpretation of 16 items; difficult to understand (11); contained a complex negative expression (10); examples used seemed inappropriate (7); misleading connotation in Chinese (2); long and complex (2); complex response options (1); and use of non-colloquial language (1). DISCUSSION Our research shows that EQ-HWB candidate items require careful examination to make them more comprehensible. Most of the reported problem themes were generic problems related to the items, and only a few face validity issues appeared to relate to specific cultural aspects in China, even though most of the items were based on Western studies. Our findings are reassuring for the instrument's international application, especially in China.
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Affiliation(s)
- Guangjie Zhang
- Department of Psychiatry, Section Medical Psychology, Erasmus MC, Rotterdam, The Netherlands
| | - Zhihao Yang
- Department of Psychiatry, Section Medical Psychology, Erasmus MC, Rotterdam, The Netherlands.
- Health Services Management Department, Guizhou Medical University, Guiyang, China.
| | - Nan Luo
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Pei Wang
- School of Public Health, Fudan University, Shanghai, China
| | - Jan Busschbach
- Department of Psychiatry, Section Medical Psychology, Erasmus MC, Rotterdam, The Netherlands
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Ding Y, Mao Z, Luo N, Yang Z, Busschbach J. Differences and common ground in the frameworks of health-related quality of life in traditional Chinese medicine and modern medicine: a systematic review. Qual Life Res 2024; 33:1795-1806. [PMID: 38740639 PMCID: PMC11176225 DOI: 10.1007/s11136-024-03669-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE This systematic review aims to explore the conceptualization of health-related quality of life (HRQoL) in China. With HRQoL influenced by both modern medicine (MM) and traditional Chinese medicine (TCM), the study seeks to identify differences and common ground between the frameworks of MM and TCM as defined in the literature. METHOD A systematic literature search was conducted across three Chinese databases and four English databases. The data was extracted including title, author(s), publication year, region, aim, method, category, and result. When sorting data, we broke down the HRQoL frameworks into concepts, domains and facets, with a focus on overlapped facets between the frameworks of MM and TCM. RESULTS A total of 31 studies were included. In the perspective of TCM, HRQoL is centered around three key 'concepts': (1) 'xingshentongyi' (unity of body and spirit), (2) 'tianrenheyi' (harmony between man and nature), and (3) 'qiqing' (seven emotional forms). In contrast, the MM framework comprises 'physical,' 'mental,' 'social,' and 'environment' domains. Out of the 59 unique facets identified, 28 are common to both TCM and MM, 9 specific to TCM, and 22 specific to MM. 'Appetite,' 'sleep,' and 'energy' are the most frequently mentioned facets in both frameworks. CONCLUSION The concept of HRQoL in China encompasses frameworks rooted in both TCM and MM. While TCM and MM have distinct healthcare approaches, they share overlapping domains when measuring HRQoL through questionnaires. Furthermore, TCM and MM demonstrate considerable convergence in terms of HRQoL facets, showing the potential for utilizing HRQoL instruments across different cultural settings.
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Affiliation(s)
- Yifan Ding
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Zhuxin Mao
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China
| | - Jan Busschbach
- Department of Psychiatry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Mao Z, Fan J, Rencz F, Yang Z, Luo N, Wang P. Developing and testing culturally relevant bolt-on items for EQ-5D-5L in Chinese populations: a mixed-methods study protocol. BMJ Open 2024; 14:e081140. [PMID: 38286698 PMCID: PMC10826542 DOI: 10.1136/bmjopen-2023-081140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/04/2024] [Indexed: 01/31/2024] Open
Abstract
INTRODUCTION EQ-5D is one of the most frequently used health-related quality of life (HRQoL) measures but has been found to be insensitive in detecting differences in health status in some general populations and disease groups. For example, the appropriateness of applying EQ-5D in the Chinese cultural setting has been widely discussed. Adding additional HRQoL dimensions (bolt-on items) can be a solution to both retain the original descriptive system of EQ-5D, while enhancing its sensitivity to the local context. To date, no studies have proposed culturally relevant bolt-ons for China or examined the psychometric properties of such bolt-on items. This protocol documents the identification, development, selection and psychometric testing of culturally relevant bolt-on items for EQ-5D-5L in China. METHODS AND ANALYSIS We will identify and develop candidate bolt-on items that are most relevant in the Chinese culture, through former literature reviews on health concepts important for the Chinese population, conducting expert consultations and qualitative interviews. We will quantitatively test the acceptability and measurement properties (including distributional characteristics and construct validity) of the candidate items in both general and disease populations in a cross-sectional setting. The patient group will be followed up to collect two-time-point data to assess test-retest reliability of the candidate items. Bolt-on item selection will consider both the qualitative and quantitative evidence gathered. This protocol outlines a comprehensive mixed-methods process for identifying, developing, selecting and testing bolt-on items that are relevant and culturally appropriate in China. This study may serve as a guide for similar initiatives in other cultural contexts. ETHICS AND DISSEMINATION This study received ethics approval from the Institutional Review Board of School of Public Health, Fudan University (IRB number: 2022-TYSQ-03-154). Study findings will be disseminated through international peer-reviewed journal articles as well as public, academic presentations at national and international conferences.
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Affiliation(s)
- Zhuxin Mao
- University of Antwerp, Antwerpen, Belgium
| | | | - Fanni Rencz
- Corvinus University of Budapest, Budapest, Hungary
| | - Zhihao Yang
- Health Services Management Department, Guizhou Medical University, Guiyang, China
| | - Nan Luo
- National University Singapore Saw Swee Hock School of Public Health, Singapore
| | - Pei Wang
- Fudan University, Shanghai, China
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Zhu W, Zhang M, Pan J, Shi L, Gao H, Xie S. Valuing Chinese medicine quality of life-11 dimensions (CQ-11D) health states using a discrete choice experiment with survival duration (DCE TTO). Health Qual Life Outcomes 2023; 21:99. [PMID: 37612664 PMCID: PMC10463386 DOI: 10.1186/s12955-023-02180-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 08/04/2023] [Indexed: 08/25/2023] Open
Abstract
OBJECTIVE To explore generating a health utility value set for the Chinese medicine Quality of life-11 Dimensions (CQ-11D), a utility instrument designed to assess patients' health status while receiving TCM treatment, among the Chinese population. METHODS The study was designed to recruit at least 2400 respondents across mainland China to complete one-to-one, face-to-face interviews. Respondents completed ten discrete choice experiment with survival duration (DCETTO) tasks during interviews. The conditional logit models were used to generate the health utility value set for the CQ-11D using the DCETTO data. RESULTS A total of 2,586 respondents were invited to participate in the survey and 2498 valid interviews were completed (a completion rate of 96.60%). The modified conditional logit model with combing logically inconsistent levels was ultimately selected to construct the health utility value set for the CQ-11D instrument. The range of the measurable health utility value was -0.868 ~ 1. CONCLUSION The study provides the first utility value set for the CQ-11D among the Chinese population. The CQ-11D and corresponding utility value set can be used to measure the health utility values of patients undergoing traditional Chinese medicine interventions, and further facilitate relevant cost-utility analyses. The application of the CQ-11D can support TCM resource allocation in China.
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Affiliation(s)
- Wentao Zhu
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China.
| | - Mengpei Zhang
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Jie Pan
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Lizheng Shi
- Tulane University, 1440 Canal Street Suite 1900, New Orleans, LA, 70112, USA
| | - Hailiang Gao
- Beijing University of Chinese Medicine, Higher Education Zone in LiangXiang Town, FangShan District, Beijing, 102488, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, 300072, China
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Dong X, He X, Wu J. Cost Effectiveness of the First-in-Class ARNI (Sacubitril/Valsartan) for the Treatment of Essential Hypertension in a Chinese Setting. PHARMACOECONOMICS 2022; 40:1187-1205. [PMID: 36071264 DOI: 10.1007/s40273-022-01182-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE The aim of this study was to model the potential long-term disease progression and pharmacoeconomic value of sacubitril/valsartan for the treatment of essential hypertension from a Chinese healthcare system perspective. METHODS A Markov cohort model with five health states was constructed to simulate the incidence of acute cardiovascular events and cost per quality-adjusted life-year (QALY) gained with sacubitril/valsartan compared with allisartan isoproxil and valsartan over a lifetime horizon with an annual cycle. Multivariable risk regression models derived from China-PAR data accompanied by hazard ratios were used to transform the dual mechanism of sacubitril/valsartan to lower blood pressure and left ventricular mass index into long-term fatal and non-fatal cardiovascular risks. Efficacy data were calculated using a network meta-analysis integrated by the results of clinical trials. Healthcare costs were determined from a real-world study and published literature, supplemented by expert opinion. Utilities were derived from literature. Both costs and health outcomes were discounted at 5.0% annually, and prices corresponded to 2021. Model validation, deterministic and probabilistic sensitivity analyses were conducted to test the robustness of results. RESULTS For simulated patients with hypertension, sacubitril/valsartan reduced the rates of myocardial infarction by 6.67% and 6.39%, stroke by 9.38% and 8.98%, and heart failure hospitalization by 9.92% and 9.62% relative to allisartan isoproxil and valsartan, respectively. It was also associated with gains in life expectancy among hypertensive individuals of 0.362-0.382 years. Eventually, lifetime costs per patient were CN¥59,272 (US$9187) for sacubitril/valsartan, CN¥54,783 (US$8492) for allisartan isoproxil, and CN¥56,714 (US$8791) for valsartan; total QALYs were 11.38, 11.24, and 11.25, respectively. The incremental cost-effectiveness ratio was CN¥31,805/QALY (US$4930/QALY) compared with allisartan isoproxil, and CN¥19,247/QALY (US$2983/QALY) compared with valsartan, both of which are below the one time per-capita GDP of CN¥80,976/QALY (US$12,551/QALY) in China. Similar results were obtained in various extensive sensitivity analysis scenarios. CONCLUSIONS This was the first study to evaluate the cost effectiveness of sacubitril/valsartan in the treatment of hypertension. Sacubitril/valsartan compares favorably with allisartan isoproxil and valsartan in the Chinese setting, which is mainly due to its higher efficacy resulting in fewer cardiovascular events and ultimately less related mortality over time. The results could inform deliberations regarding reimbursement and access to this treatment in China and may provide reference for facilitating more reasonable and efficient allocation of limited resources in such low- and middle-income countries.
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Affiliation(s)
- Xinyue Dong
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China.
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
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Wu J, He X, Chen P, Xie S, Li X, Hu H, Zhao K, Xie F. China Health Related Outcomes Measures (CHROME): Development of a New Generic Preference-Based Measure for the Chinese Population. PHARMACOECONOMICS 2022; 40:957-969. [PMID: 35844001 PMCID: PMC9288864 DOI: 10.1007/s40273-022-01151-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/25/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Existing generic preference-based measures were all developed in Western countries. Evidence shows that the Chinese population may have different perceptions about health and health-related quality of life. This study aimed at developing a descriptive system of a new generic preference-based measure under the initiative of China Health Related Outcomes Measures (CHROME). METHODS Qualitative data were collected through semi-structured interviews conducted in-person or online. Respondents were recruited from both the general public and populations with chronic diseases. Open-ended questions about the respondent's perception of general health and important aspects of health-related quality of life were asked. Probing questions based on a systematic review of existing generic preference-based measures were also used. The framework analysis was used to synthesize the qualitative data. Candidate items for the descriptive system were selected following the ISPOR and COSMIN guidelines. Expert panel review and cognitive debriefings were conducted for further revisions. RESULTS Qualitative interviews were conducted among 68 respondents, with 48.5% male and a mean age of 47.8 years (range 18-81 years). In total, 1558 codes were identified and then aggregated to 31 sub-themes and corresponding six themes to inform the development of the initial version of the descriptive system. Feedback from the expert panel survey and meeting (n = 15) and the cognitive debriefing interviews (n = 30) was incorporated into the revised version of the measure. Finally, the generic version of CHROME (CHROME-G) included 12 items across six domains, namely, pain, fatigue, appetite, mobility, vision, hearing, sleeping, daily activities, depression, worry, memory, and social interactions. The descriptive system used a mix of four-level and five-level response options and a 7-day recall period. CONCLUSIONS The CHROME-G is the first generic preference-based measure to be developed based on the inputs from the Chinese populations.
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Affiliation(s)
- Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Pinan Chen
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Shitong Xie
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
| | - Xue Li
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada
- Department of Health Technology Assessment, China National Health Development Research Centre, Beijing, China
| | - Hao Hu
- Liaoning Institute of Basic Medicine, Liaoning, China
| | - Kun Zhao
- Vanke School of Public Health, Tsinghua University, Haidian District, Beijing, 100084, China.
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada.
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Zhang M, He X, Wu J, Wang X, Jiang Q, Xie F. How Do Treatment Preferences of Patients With Cancer Compare With Those of Oncologists and Family Members? Evidence From a Discrete Choice Experiment in China. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2022; 25:1768-1777. [PMID: 35710892 DOI: 10.1016/j.jval.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 03/29/2022] [Accepted: 05/02/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES This study aimed to compare the treatment preference among oncologists, patients with lung cancer, and their family members in China. METHODS A face-to-face discrete choice experiment survey was conducted among oncologists, patients, and their family members. Participants completed 13 choice sets describing 6 key attributes, namely, overall survival time, risk of severe adverse effect, severity of pain, appetite, physical functioning status, and monthly cost. Mixed logit model and latent class analysis were used to estimate attribute level preference weights and the relative importance (RI) for attributes. The willingness to pay (WTP) and maximum acceptable risk (MAR) were also estimated. The RI, WTP, and MAR of oncologists, patients, and family members were compared. RESULTS A total of 121 oncologists and 161 dyads of patients and family members completed the survey. Overall survival time, physical functioning status, and pain were the 3 most important attributes across all 3 groups. Oncologists and family members had higher RI on overall survival time than patients (48% and 51% vs 38%). Patients had higher RI on physical functioning status and pain (23% and 14%) than oncologists (13% and 12%) and family members (16% and 11%). For extending survival, patients had the least WTP, and family members had the highest MAR. The latent class analysis identified 2 classes in the patient group and 3 classes in oncologist and family member groups. CONCLUSIONS There were differences in preferences for survival, risk, quality of life, and costs associated with cancer treatments among patients, oncologists, and family members. This finding highlights the need of involving patients in treatment decision making in China.
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Affiliation(s)
- Mengqian Zhang
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China; Center for Social Science Survey and Data, Tianjin University, Tianjin, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China; Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China; Center for Social Science Survey and Data, Tianjin University, Tianjin, China.
| | - Xinyue Wang
- Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin, China; Tianjin's Clinical Research Center for Cancer, Tianjin, China; Department of Thoracic Oncology, Tianjin Lung Cancer Center, Tianjin Cancer Institute and Hospital, Tianjin Medical University, Tianjin, China
| | - Qian Jiang
- Department of Clinical Pharmacy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Centre, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Feng Xie
- Department of Health Research Methods, Evidence and Impact and Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
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Fan YJ, Feng YJ, Meng Y, Su ZZ, Wang PX. The relationship between anthropometric indicators and health-related quality of life in a community-based adult population: A cross-sectional study in Southern China. Front Public Health 2022; 10:955615. [PMID: 36249240 PMCID: PMC9554305 DOI: 10.3389/fpubh.2022.955615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023] Open
Abstract
Background This study was designed to analyze the relationship of waist circumference (WC), body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), relative fat mass (RFM), lipid accumulation product (LAP) and health-related quality of life (HRQoL) in the community-dwelling population of southern China and to explore the independent contribution of socio-demographic characteristics, number of chronic diseases and anthropometric indicators to HRQoL in that population. Methods This community-based cross-sectional survey studied 2,663 adults aged 18 years and older. HRQoL was assessed by the 3-level EuroQol 5-dimensional scale (EQ-5D-3L), and HRQoL were calculated using the Chinese EQ-5D-3L value set. The outcome variable was the EQ-5D-3L score (HRQoL). Cluster regression was used to analyse the independent contribution of each obesity indicator to HRQoL. Results A total of 2,663 people participated in this study, and their mean EQ-5D-3L score was 0.938 ± 0.072. In this study, according to the results of the one-way ANOVA, HRQoL was significantly different between the groups of WHtR, WHR, RFM and LAP, respectively. The independent contributions of socio-demographic factors, number of chronic diseases and anthropometric measures to HRQoL in the whole population accounted for 76.2, 7.9, and 15.9% of the total effect, respectively. Conclusion RFM and LAP were found to have a previously unreported negative impact on HRQoL in a community-dwelling population. In future studies, RFM and LAP could be used as new indicators of obesity to predict quality of life in humans.
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Affiliation(s)
- Yu-Jun Fan
- School of Nursing and Health, Institute of Chronic Disease Risks Assessment, Henan University, Kaifeng, China
| | - Yi-Jin Feng
- School of Nursing and Health, Institute of Chronic Disease Risks Assessment, Henan University, Kaifeng, China,General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China
| | - Ya Meng
- School of Medical, Huanghe Science and Technology University, Zhengzhou, China
| | - Zhen-Zhen Su
- School of Nursing and Health, Institute of Chronic Disease Risks Assessment, Henan University, Kaifeng, China
| | - Pei-Xi Wang
- School of Nursing and Health, Institute of Chronic Disease Risks Assessment, Henan University, Kaifeng, China,General Practice Center, The Seventh Affiliated Hospital, Southern Medical University, Foshan, China,*Correspondence: Pei-Xi Wang
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Mao Z, Ahmed S, Graham C, Kind P. The Unfolding Method to Explore Health-Related Quality of Life Constructs in a Chinese General Population. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:846-854. [PMID: 34119083 DOI: 10.1016/j.jval.2020.12.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 10/29/2020] [Accepted: 12/06/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQOL) is a complicated concept that can be measured using multiple health items. Although HRQOL is closely associated with people's subjective assessment of their own health, a limited number of studies have investigated which health items are considered most important and relevant by the general population. Even fewer empirical studies have investigated how HRQOL is understood in non-Western populations. This study used multidimensional unfolding analysis in a Chinese general population to explore the constructs of HRQOL. METHODS A scoping review of Chinese generic HRQOL measures and a series of qualitative interviews produced a list of 42 potentially important health items in a Chinese cultural setting; 110 Chinese participants in face-to-face interviews ranked the health items from most important to least important. Responses were coded into a rectangular 110 × 42 matrix, and multidimensional unfolding was conducted to analyze participants' preferences for health items. RESULTS It was found that demographic characteristics and one's health condition affected views of HRQOL. Meanwhile, 3 health items were considered to be most important across the whole sample: sleep quality, body constitution, and spiritual appearance. CONCLUSION This study used a novel approach to explore how people coming from a Chinese cultural setting may perceive HRQOL and which aspects of HRQOL are most important to them. The study shows that multidimensional unfolding is a feasible approach to assess preferences in a general population. Future studies using this approach are recommended to further explore the constructs of HRQOL in other general populations.
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Affiliation(s)
- Zhuxin Mao
- School of Insurance, Southwestern University of Finance and Economics, Sichuan, China.
| | - Shenaz Ahmed
- Institute of Health Sciences, University of Leeds, Leeds, England, UK
| | - Christopher Graham
- Department of Psychology, Queen's University Belfast, Belfast, England, UK
| | - Paul Kind
- Institute of Health Sciences, University of Leeds, Leeds, England, UK
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