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Do Rural Residents in China Understand EQ-5D-5L as Intended? Evidence From a Qualitative Study


  • Fan Yang

    (University of York)

  • Shan Jiang

    (University of British Columbia)

  • Xiao-ning He

    (Tianjin University)

  • Hong-chao Li

    (China Pharmaceutical University)

  • Hong-yan Wu

    (Guizhou Medical University)

  • Tian-tian Zhang

    (Jinan University)

  • Jing Wu

    (Tianjin University)


Background The 5-level EQ-5D (EQ-5D-5L) has been increasingly used in China to measure the health status of the general population and patients. However, its content validity among rural residents in China has not been formally evaluated. This qualitative study aims to assess the content validity of EQ-5D-5L among rural Chinese. Methods Participants were recruited from four regions (North, South, East and West) across China. Eligible participants were those living in the rural area in last three years and making a living by agricultural operations. Semi-structured interviews were conducted. Interview transcripts were analysed to assess the comprehensibility, relevance, clarity and comprehensiveness. Results Sixty-two participants were included, comparable to the national figures regarding age, sex and education. For comprehensibility, participants could understand the ‘mobility’, ‘self-care’ and ‘usual activities’ domains well, but some reported confusions in ‘pain/discomfort’ (n = 42) and ‘anxiety/depression’ (n = 35). Some also reported difficulties in understanding anxiety (n = 6) and depression (n = 9), possibly due to the formal wording used. For relevance, all domains were reported as health-related and participants’ responses were based on their own health. For clarity, all could distinguish the five levels, but suggestions on reducing response levels and alternative wording for ‘slight’ were raised. For comprehensiveness, two aspects (fatigue/energy and appetite) were raised beyond the EQ-5D-5L domains. The ‘mobility’ domain was selected as the most important and ‘anxiety/depression’ as the least important. Conclusion Rural Chinese reported problems on the content validity of Chinese EQ-5D-5L. It might be sensible to consider some revisions to make it more understandable for rural residents.

Suggested Citation

  • Fan Yang & Shan Jiang & Xiao-ning He & Hong-chao Li & Hong-yan Wu & Tian-tian Zhang & Jing Wu, 2021. "Do Rural Residents in China Understand EQ-5D-5L as Intended? Evidence From a Qualitative Study," PharmacoEconomics - Open, Springer, vol. 5(1), pages 101-109, March.
  • Handle: RePEc:spr:pharmo:v:5:y:2021:i:1:d:10.1007_s41669-020-00212-z
    DOI: 10.1007/s41669-020-00212-z

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    References listed on IDEAS

    1. Molero-Simarro, Ricardo, 2017. "Inequality in China revisited. The effect of functional distribution of income on urban top incomes, the urban-rural gap and the Gini index, 1978–2015," China Economic Review, Elsevier, vol. 42(C), pages 101-117.
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    Blog mentions

    As found by, the blog aggregator for Economics research:
    1. Journal round-up: PharmacoEconomics – Open 5(1)
      by Rita Faria in The Academic Health Economists' Blog on 2021-04-29 06:00:05

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