Health and Quality of Life Outcomes最新文献

{"title":"Empowerment and quality of life through cancer prevention in people experiencing homelessness: evaluating the Health Navigator Model.","authors":"Tobias Fragner, Tamara Alhambra-Borrás, Ascensión Doñate-Martínez, Vicent Blanes-Selva, Juan M García-Gómez, Julia Gawronska, Maria Moudatsou, Ioanna Tabaki, Katerina Belogianni, Pania Karnaki, Miguel Rico Varadé, Rosa Gómez Trenado, Jaime Barrio-Cortes, Lee Smith, Alejandro Gil-Salmeron, Igor Grabovac","doi":"10.1186/s12955-026-02588-8","DOIUrl":"10.1186/s12955-026-02588-8","url":null,"abstract":"<p><strong>Background: </strong>People experiencing homelessness (PEH) face significant barriers to accessing cancer prevention services. The CANCERLESS project co-developed and implemented the Health Navigator Model (HNM) - a person-centred approach using trained health navigators to provide tailored support, promote cancer awareness, and facilitate access to preventive services - in Austria, Greece, Spain, and the UK. This study examined the HNM's impact on healthcare empowerment, health-related quality of life (HRQoL), and self-rated health among PEH.</p><p><strong>Methods: </strong>This non-randomised, single-arm study included 652 PEH from 16 pilot sites in four European countries between June 2022 and December 2023. Healthcare empowerment, HRQoL, and self-rated health were assessed using the healthcare empowerment questionnaire and the EQ-5D-5L (including the EQ Visual Analogue Scale) when participants entered and completed the intervention. A per-protocol analysis with repeated measures ANOVA revealed changes over time and between countries.</p><p><strong>Results: </strong>Participants were predominantly male (64.1%) and middle-aged (mean 47.4, SD 13.8), with secondary education (58.0%), and varied legal status and experiences of homelessness. Despite a drop-out rate of 57.5%, significant improvements in overall healthcare empowerment (F = 44.325, p<.001, η²=0.026), HRQoL (F = 4.421, p = .036, η²=0.002), and self-rated health (F = 16.945, p<.001, η²=0.011) were observed, particularly in Austria and the UK.</p><p><strong>Conclusions: </strong>The HNM holds promise for improving healthcare empowerment and HRQoL among PEH, but context-specific factors and a considerable drop-out pose challenges.</p><p><strong>Trial registration: </strong>This study was registered retrospectively on June 6, 2022, in the registry of ClinicalTrials.gov under the number NCT05406687.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13670686/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148497517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"EQ-5D vision bolt-on in macular degeneration: associations with visual measures and effect on utility differences and cost-effectiveness of stereotactic radiotherapy.","authors":"Xuemin Zhu, Sarah Wordsworth, Chan Ning Lee, Hatem A Wafa, Yanzhong Wang, Riti Desai, Lisa Ramazzotto, Barnaby C Reeves, Timothy L Jackson, Helen Dakin","doi":"10.1186/s12955-025-02457-w","DOIUrl":"10.1186/s12955-025-02457-w","url":null,"abstract":"<p><strong>Background: </strong>The UK STAR trial [Stereotactic Radiotherapy (SRT) for neovascular age-related macular degeneration (nAMD)] compared 16-Gray SRT (n = 274) with double-masked sham SRT (n = 137) in participants with chronic active nAMD. SRT reduced intravitreal anti-vascular endothelial growth factor (VEGF) re-treatments over two years of pro re nata ranibizumab, followed by two years of routine care. However, this resulted in worse best-corrected visual acuity (BCVA) in Years 3 and 4. This paper describes: associations between the EQ-5D vision bolt-on and visual acuity and patient-reported outcome measures; the impact of SRT on utilities with and without vision bolt-on; how the vision bolt-on affects the cost-effectiveness of SRT plus anti-VEGF versus anti-VEGF alone.</p><p><strong>Methods: </strong>Using data from the entire STAR trial cohort, we compared mean BCVA, EQ-5D-5L, and Visual Function Questionnaire-25 (VFQ-25) scores across the three levels of the EQ-5D vision bolt-on. We examined the relationship between BCVA and EQ-5D (with/without the bolt-on) and VFQ-25. An economic evaluation estimated the cost-effectiveness of SRT from a UK national health service perspective over two years and over four years. This used prospective data on EQ-5D-5L and eye-related direct healthcare use.</p><p><strong>Results: </strong>Participants reporting vision problems on the bolt-on had significantly worse BCVA, EQ-5D-5L, and VFQ-25 scores than those who did not. EQ-5D utilities (with and without the bolt-on) increased with BCVA but showed weaker correlations than VFQ-25 composite scores. Quality-adjusted life years (QALYs) did not differ significantly between treatment groups, with or without the bolt-on. The economic evaluation suggested SRT would reduce healthcare costs by £404 (95% CI: -£1282 to £2092) per patient at a four-year time horizon. The probability of SRT plus anti-VEGF being cost-effective at a £20,000 per QALY threshold was 65% at a four-year time horizon. Sensitivity analyses confirmed the robustness of incorporating the vision bolt-on did not alter the cost-effectiveness conclusion.</p><p><strong>Conclusions: </strong>Resource use data from the trial and routine follow-up could be used for future economic models. The vision bolt-on captured quality of life differences between participants but may not be sufficiently responsive to visual acuity decline in trials where only one eye is treated.</p><p><strong>Trial registration: </strong>ISRCTN12884465, registration date 01/12/2014.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":"24 1","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13371251/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative testing of potential modifications to the EQ-HWB-9 in the United Kingdom.","authors":"Tessa Peasgood, Victoria Gale, Aisha Moolla, Jill Carlton, Clara Mukuria","doi":"10.1186/s12955-026-02578-w","DOIUrl":"10.1186/s12955-026-02578-w","url":null,"abstract":"<p><strong>Background: </strong>The Experimental EQ Health and Wellbeing 9 (EQ-HWB-9) is a generic measure developed to assess the impact of health, social care and informal caregiving on quality of life. Several modifications have been proposed based on emerging evidence. This study aimed to assess the content validity of these modifications and user preferences.</p><p><strong>Method: </strong>Individuals with a long-standing physical or mental health condition or disability were invited from an online panel ensuring gender balance and age coverage. Two interviewers conducted semi-structured cognitive interviews to assess comprehensibility, relevance, and comprehensiveness of the modified experimental EQ-HWB-9 v1.2. Participants' views on differences between the modified and original experimental versions, as well as their preferences, were explored. Interviews were conducted via videoconferencing, recorded and transcribed verbatim. Framework analysis was used to code interviews, with themes drawn from the literature and data.</p><p><strong>Results: </strong>Twenty-six interviews were completed. Half the participants were female; participant age ranged from 24 to 68 years. Six of the nine items ('activities', 'exhausted', 'lonely', 'difficulty concentrating/thinking clearly', 'anxious', 'sad/depressed') were understood as intended by all participants. Some comprehension issues arose with the 'mobility' and 'pain_severity' items. Participants generally preferred the modified version, though a clear majority was not always observed. Justifications focused on item appropriateness, readability and distress.</p><p><strong>Discussion and conclusion: </strong>As a generic measure, EQ-HWB-9 v1.2 performed well for comprehension, relevance and comprehensiveness. Modifications were well accepted and, except for the use of item stem, preferred over the original version. These findings will be combined with other international evidence to support finalising the instrument.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13647529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148446044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cough burden in progressive pulmonary fibrosis: a systematic review with narrative synthesis.","authors":"Ningxia Yu, Shuguang Yang, Zhihui Liang, Haiyang Hu, Yi Zhang, Luguang Li, Xueqing Yu","doi":"10.1186/s12955-026-02585-x","DOIUrl":"10.1186/s12955-026-02585-x","url":null,"abstract":"<p><strong>Background: </strong>Cough is a common and burdensome symptom in patients with progressive pulmonary fibrosis (PPF), yet existing evidence remains fragmented. This systematic review provides a synthesis of available evidence on cough in PPF, specifically examining its association with health-related quality of life (HRQoL), the instruments used to assess cough, current treatment evidence, and identifies priorities for future research.</p><p><strong>Methods: </strong>We searched the Embase, PubMed, Cochrane, and Web of Science (WOS) databases from their inception to January 12, 2026, for studies focusing on the burden of cough in patients with PPF. We extracted information on study details, participant features, and outcome measures, and assessed the risk of bias in the included studies. A narrative synthesis was then performed to summarize the evidence.</p><p><strong>Results: </strong>Of 11,683 records, 9 studies met inclusion criteria. Cough was most frequently assessed using VAS and LCQ, while HRQoL was primarily measured with SGRQ and L-PF. Two studies highlighted wearable devices for objective cough monitoring. Antifibrotic therapy showed no consistent or statistically significant benefit on cough in descriptive synthesis. Qualitative studies revealed substantial cough‑related burden, including daily activity limitations, fatigue, and social embarrassment. Regarding economic impact, although no dedicated studies exist, one study indicated that cough severity was associated with workplace productivity loss.</p><p><strong>Conclusions: </strong>Cough negatively impacts HRQoL in PPF, but evidence is limited by heterogeneous tools and lack of economic studies. Standardized assessment and targeted research on cough management and its economic impact are urgently needed.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644078/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Individual preferences for the design of a health coaching-based lifestyle promotion program among middle-aged adults in Hong Kong: a discrete choice experiment.","authors":"Kailu Wang, Cassie Cheuk Ling Lee, Gengcong Qu, Cyrus Tak Ka Tang, Hei Hang Edmund Yiu, Xue Yang, Carmen Ka Man Wong, Samuel Yeung-Shan Wong, Benjamin Hon Kei Yip","doi":"10.1186/s12955-026-02584-y","DOIUrl":"10.1186/s12955-026-02584-y","url":null,"abstract":"<p><strong>Objectives: </strong>Health coaching is an effective approach to motivating lifestyle modifications and preventing the onset of non-communicable diseases. This study aims to examine middle-aged adults' preferences for health coaching programs to improve public acceptance of these programs.</p><p><strong>Methods: </strong>A discrete choice experiment (DCE) was conducted among adults aged 35-59 years in Hong Kong who were recruited from a population-based cohort established to evaluate outcomes related to long COVID. The DCE attributes and levels were selected based on a literature review and qualitative interviews (n = 10) with users and providers from a local health coaching program. The selected attributes included program duration, delivery mode of coaching sessions, frequency of coaching sessions, availability of blood tests, core program format, smartwatch usage, and out-of-pocket payment. An online survey with 10 choice sets was conducted to collect participants' choices regarding health coaching services with (copayment scenario, 10 choices) and without out-of-pocket payment (no copayment scenario, 10 choices). A mixed logit model and a latent class model were used for the analysis.</p><p><strong>Results: </strong>A total of 912 responses were collected, of which 554 valid records were included in the analysis. In the copayment scenario, participants preferred programs that provided a smartwatch and a lower copayment rate. In the no copayment scenario, participants preferred a moderate coaching frequency, communication via phone calls or text messages, and provision of a smartwatch. Distinct preference groups were identified, including those who preferred face-to-face versus remote modes of delivery, high versus low contact frequency, and those who were sensitive versus insensitive to cost.</p><p><strong>Conclusions: </strong>Lower copayment and smartwatch provision improve acceptance of health coaching programs. Substantial preference heterogeneity for program duration, health coaching frequency, and delivery mode was found. While material incentives are important for improving acceptance of health coaching, considerable preference heterogeneity for non-monetary attributes suggests that options for health coaching program intensity can be offered along with subsidies or lower out-of-pocket payment to promote these services.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13644059/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404489","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative testing of potential modifications to the EQ-HWB EMV2.1 in adults with mobility problems in the United Kingdom.","authors":"Aisha Moolla, Jill Carlton, Tessa Peasgood","doi":"10.1186/s12955-026-02577-x","DOIUrl":"10.1186/s12955-026-02577-x","url":null,"abstract":"<p><strong>Background: </strong>The EQ-Health and Wellbeing (EQ-HWB) is a generic measure assessing the impact of health, social care, and informal caregiving on quality of life. The 9-item short form, the EQ-HWB-9 v1.1 (experimental, 2022), underwent international validation, with subsequent modifications to item wording, response options, layout, and item order resulting in the EQ-HWB EMV2.1 (experimental modified, 2025). This study aimed to assess the content validity of this version in individuals with mobility problems.</p><p><strong>Methods: </strong>Twelve adults in the UK with self-reported health conditions and mobility problems participated in semi-structured interviews. Participants described their health experiences, reviewed each EQ-HWB EMV2.1 item, and compared potential further modifications to the 'mobility' item wording and 'cognition' response options. Comprehension, relevance, comprehensiveness and preferences were explored using verbal probing. Interviews were transcribed and analysed using framework analysis, guided by content validity domains, with double-coding for 25% of transcripts to ensure alignment.</p><p><strong>Results: </strong>Participants (age 35-79 years) reported 35 health conditions. Eight items were understood as intended by all participants. The 'mobility' item presented varied interpretations (home-based limitations, daily activities, or aid use, n = 4), highlighting the need for an illustrative example, though no single wording was universally preferred. For 'cognition', participants understood both frequency and difficulty response scales; preferences were split, indicating no required modifications. Some overlap between items was noted ('mobility'-'activities', 'cognition'-'exhaustion'/'anxiety'/'pain'), but participants did not perceive redundancy and valued separate items for nuanced measurement. Most items were considered relevant, and participants suggested additional content on medical management, support, mental health impact, and free-text contextualisation. The seven-day recall period and instructions were generally well understood.</p><p><strong>Conclusion: </strong>The EQ-HWB EMV2.1 demonstrates good content validity in a sample of patients with mobility problems, with most items comprehensible and relevant. The 'mobility' item would benefit from an example to reduce interpretive variability, while 'cognition' response options are appropriate. Some item overlap is expected in complex health populations, yet distinctions between items are meaningful. Participants highlighted the importance of healthcare experiences in quality-of-life assessment. These results inform instrument refinement, but final changes should integrate broader evidence from global validation studies across other populations and languages.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13546503/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148404499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Content validity of the modified EQ-HWB-9 in a sample of Argentinean patients, informal caregivers, and members of the general public.","authors":"Maria Belizan, Natalí Ini, Fernando Argento, Michael Herdman, Clara Mukuria, Federico Augustovski","doi":"10.1186/s12955-026-02581-1","DOIUrl":"10.1186/s12955-026-02581-1","url":null,"abstract":"<p><strong>Background: </strong>In response to the challenge of measuring the impact of health, social care, and informal caregiving on quality of life, the EuroQol Group developed the Experimental EuroQol Health and Wellbeing (EQ-HWB-9). Evidence from preliminary testing informed a series of revisions to improve the instrument's performance. This study aimed to assess the content validity of the Argentina (Spanish) EQ-HWB-9 Experimental Modified Paper Self-Complete v1.2 (modified EQ-HWB-9), to explore whether its modifications represented an improvement over the earlier experimental version, and to examine how participants ranked the frequency scale response options.</p><p><strong>Methods: </strong>Qualitative cognitive interviews were conducted using a semi-structured guide with open-ended questions and targeted probes to assess comprehensibility, relevance, and comprehensiveness of the modified EQ-HWB-9. Participants were recruited through purposive sampling via patient associations, retirement centers, and social media. Thematic content analysis was guided by an a priori framework. Participants also completed a response option ordering exercise to compare their rankings with the instrument's frequency scale.</p><p><strong>Results: </strong>Twenty participants were included: patients (n = 12), informal carers (n = 4), and members of the general public (n = 4); nine were also social care users. The median age was 64.5 years (range 25-88) and 12 were women. All participants found the questionnaire easy to understand, items were deemed relevant, and response options appropriate. Some participants noted missing content related to leisure, social relationships, financial situation, and environment, and suggested minor wording revisions. The modified EQ-HWB-9 was generally preferred over the earlier version, supporting better comprehension and alignment with local language and context. In the frequency scale task, \"none of the time\" and \"most or all of the time\" were consistently placed at the expected extremes (90% and 85%, respectively), while intermediate labels showed greater variability, with overall ordering showing good alignment with the instrument's scale.</p><p><strong>Conclusion: </strong>This study, conducted as part of an international multi-language effort, represents the first content validity assessment of the modified EQ-HWB-9 in Spanish and Latin America. Findings support the instrument's utility, though further refinements to item wording are recommended. Ongoing iterative testing will help ensure the tool reliably measures health and wellbeing to inform policy and practice.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13602713/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381967","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pre-illness reference reminder alters cross-sectional patient-reported outcome responses: evidence from EQ-5D-5L and EQ-HWB-9.","authors":"Xun Ran, Qimeng Mu, Qiaomei Wang, Zhihao Yang","doi":"10.1186/s12955-026-02580-2","DOIUrl":"10.1186/s12955-026-02580-2","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to evaluate whether a brief pre-survey reminder prompting patients to reflect on their pre-illness health was associated with altered response patterns in cross-sectional patient-reported outcome measures (PROMs).</p><p><strong>Methods: </strong>A cross-sectional study was conducted among 244 inpatients in a hepatobiliary surgery department. Participants were assigned to a control group (standard recall instructions for the EQ-5D-5L and EQ-HWB-9) or a reminder group (identical instructions, preceded by the reminder). Response distributions were compared descriptively, and adjusted ordered logistic regression models were used to assess the association between the reminder and reported problem severity.</p><p><strong>Results: </strong>A total of 244 inpatients participated, with 123 in the control group and 121 receiving the pre-illness reminder. There were no missing data for the EQ-5D-5L or EQ-HWB-9 items, and EQ VAS data were missing for three participants only. The reminder group reported lower ceiling effects and higher problem severity across both instruments. In adjusted analyses, the reminder was associated with higher odds of reporting more severe problems across all EQ-5D-5L dimensions, with odds ratios ranging from 1.90 to 3.13, and across seven of the nine EQ-HWB-9 items, with odds ratios ranging from 1.94 to 5.43. The reminder group also reported a lower mean EQ VAS score than the control group: 78.23 versus 82.03, p = 0.002.</p><p><strong>Conclusions: </strong>The brief reminder was associated with more severe and differentiated PROM responses. These findings suggest that a pre-illness reference reminder may influence respondents' appraisal of current health in cross-sectional PROM assessment. However, without an objective benchmark for true health status, the findings should be interpreted as consistent with, but not definitive evidence of, a recalibration-related response process.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13613790/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148381948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative exploration of EQ-5D-5L bolt-on variants for fatigue, sleep, and vision in a general population sample.","authors":"Richard Huan Xu, Yixuan Ma, Chenxi Yang, Fanni Rencz","doi":"10.1186/s12955-026-02582-0","DOIUrl":"10.1186/s12955-026-02582-0","url":null,"abstract":"<p><strong>Objective: </strong>Fatigue, sleep, and vision are among the most commonly used EQ-5D-5 L bolt-ons, with multiple alternative wordings. This study aimed to evaluate and compare the psychometric performance of the following bolt-on variants: (1) fatigue (FA) vs. tiredness (TI); (2) vision (VI) vs. VI with reference to vision aids (VI-A); and (3) sleep (SL) vs. sleep with examples in the dimension title (SL-E).</p><p><strong>Methods: </strong>A representative sample of 1,262 adults in Hong Kong completed an online survey including the EQ-5D-5 L and bolt-ons. The following psychometric properties were assessed: ceiling/floor, informativity (Shannon's indices), convergent validity (correlations with conceptually related items of PROMIS-29 + 2), agreement (Kendall's tau), explanatory power (regression on EQ VAS and PROMIS-29 + 2 Level Sum Scores), and known-group validity (effect sizes).</p><p><strong>Results: </strong>Bolt-ons reduced EQ-5D-5 L's ceiling from 35% to 20-24% and improved relative informativity from 0.33 to 0.35-0.36. FA, TI, SL and SL-E demonstrated moderate-to-strong convergent validity (r = 0.55-0.67) with PROMIS-29 + 2 items. All bolt-ons with the exception of VI-A enhanced explanatory power for both EQ VAS and PROMIS-29 + 2. Agreements between TI and FA (0.71), SL and SL-E (0.74), and VI and VI-A (0.78) were strong. For each of the three bolt-on pairs, differences in reducing the EQ-5D-5 L's ceiling, relative informativity and convergent validity were generally small. In known-group comparisons, FA and SL-E outperformed their counterparts, whereas the difference between VI and VI-A was minimal.</p><p><strong>Conclusion: </strong>All six bolt-on items showed good validity in a general population sample, with minimal differences between items belonging to the same bolt-on pair. These findings inform item development for the experimental EQ-5D Bolt-on Toolbox.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13595729/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148368194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the EQ-HWB-9 in a mental health sample and an investigation of modifications to items.","authors":"Cate Bailey, Karen Trapani, Jonathan N Davies, Nicholas T Van Dam, Julieta Galante, Tessa Peasgood","doi":"10.1186/s12955-026-02579-9","DOIUrl":"10.1186/s12955-026-02579-9","url":null,"abstract":"<p><strong>Background: </strong>The EQ Health and Wellbeing (EQ-HWB) is a new, generic instrument designed to evaluate quality-of-life across health, public health, and social care settings. The short form comprises nine items (EQ-HWB-9) and validation across diverse populations and contexts is required. We aimed to investigate the validity of the EQ-HWB-9 in an international sample of adults experiencing poor mental health who downloaded a meditation app. We further examined the impact of four item-level modifications on psychometric performance, including investigating a potential ordering effect for the 'activities' item (hypothesised in prior studies) and three minor changes to response options.</p><p><strong>Methods: </strong>The current study was embedded in a larger trial examining engagement with meditation via a free, downloadable app. Participants were randomised to complete the original (2022) and modified (2024) experimental version of the EQ-HWB-9. Psychometric evaluation included analyses of item distribution, known group and convergent validity, and responsiveness to change.</p><p><strong>Results: </strong>There were no differences in demographic characteristics between the EQ-HWB original and modified versions at baseline (n = 865) or follow-up (n = 130). All psychometric tests supported the validity of the EQ-HWB-9 in this population. We found an ordering effect for the activities item, where the activities item showed a greater level of difficulty and a wider distribution over response options when asked before the mobility item, rather than after. There were no observable differences between versions for the other modifications.</p><p><strong>Conclusions: </strong>These findings add to growing literature supporting the EQ-HWB-9 as a suitable instrument for measuring quality-of-life across a range of settings. When the 'activities' item was presented first, as in the modified version, participants appeared to interpret the item more broadly, in line with the developers' intentions. Accordingly, our results support changing the item order of the first two items. Other modifications had little impact on outcomes, suggesting that further qualitative research will be required to inform decisions about their inclusion. Results from this study provide support towards finalisation of the instrument. The development of country-specific value-sets is now critical to support its application in economic evaluation.</p>","PeriodicalId":12980,"journal":{"name":"Health and Quality of Life Outcomes","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2026-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13587447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148360521","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}