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The validity and reliability of the interviewer-administered EQ-5D-Y-3L version in young children
Razia Amien1, Desiree Scott2, Janine Verstraete3
1Division of Physiotherapy, Faculty of Health and Rehabilitation Sciences, University of Cape Town, Cape Town, South Africa. AMNRAZ001@myuct.ac.za.
Insights
The EQ-5D-Y-3L interviewer-administered (IA) version is valid and reliable for children aged 5-7 years. Younger children reported more self-care difficulties, suggesting a need for age-appropriate examples in the measure.
Area of Science:
- Pediatric Health Outcomes Research
- Health Measurement in Children
- Psychometrics in Pediatric Populations
Background:
- The EQ-5D-Y-3L is a widely used health outcome measure for children and adolescents.
- Assessing the validity and reliability of interviewer-administered (IA) versions is crucial for diverse populations.
- South African children present unique developmental and socio-economic contexts for health measurement.
Purpose of the Study:
- To evaluate the validity and reliability of the EQ-5D-Y-3L IA version in South African children.
- To compare the performance of the EQ-5D-Y-3L IA between younger (5-7 years) and older (8-10 years) children.
- To assess the comprehensibility and test-retest reliability of the EQ-5D-Y-3L IA in pediatric populations.
Main Methods:
- A cohort of 388 South African children aged 5-10 years, across four condition groups, completed the EQ-5D-Y-3L IA.
- Concurrent measures included the Moods and Feelings Questionnaire (MFQ), Faces Pain Scale-Revised (FPS-R), and WeeFIM.
- Cognitive debriefing and test-retest reliability (48h) using Cohen's kappa were performed.
Main Results:
- Younger children (5-7 years) reported significantly more problems in 'Looking After Myself' compared to older children (8-10 years).
- Known-group validity was demonstrated, with children on orthopedic management reporting more physical problems.
- Convergent validity was moderate to high between EQ-5D-Y-3L self-care items and WeeFIM, with higher correlations in older children.
Conclusions:
- The EQ-5D-Y-3L IA demonstrates acceptable validity and reliability for children aged 5-7 years in South Africa.
- Increased self-care difficulties in younger children may stem from developmental needs (e.g., dressing) rather than physical limitations.
- Modifications, such as age-appropriate examples and reduced recall burden for 'Usual Activities', could enhance measurement in younger children.
Objectives:
The aim of this study was to determine the validity and reliability of the EQ-5D-Y-3L interviewer-administered (IA) version in South African children aged 5-7-years compared to 8-10-years.
Methods:
Children aged 5-10-years (n = 388) were recruited from healthcare facilities, schools for learners with special educational needs and mainstream schools across four known condition groups: chronic respiratory illnesses, functional disabilities, orthopaedic conditions and the general population. All children completed the EQ-5D-Y-3L IA, Moods and Feelings Questionnaire (MFQ), Faces Pain Scale-Revised (FPS-R) and a functional independence measure (WeeFIM) was completed by the researcher. Cognitive debriefing was done after the EQ-5D-Y-3L IA to determine comprehensibility. Test-retest of the EQ-5D-Y-3L IA was done 48 h later and assessed using Cohen's kappa (k).
Results:
Results from children aged 5-7-years (n = 177) and 8-10-years (n = 211) were included. There were significantly higher reports of problems in the Looking After Myself dimension in the 5-7-year-olds (55%) compared to the 8-10-year-olds (28%) (x2 = 31.021; p = 0.000). The younger children took significantly longer to complete the measure (Mann-Whitney U = 8389.5, p < 0.001). Known-group validity was found at dimension level with children receiving orthopaedic management reporting more problems on physical dimensions across both age-groups. Convergent validity between Looking After Myself and WeeFIM items of self-care showed moderate to high correlations for both age-groups with a significantly higher correlation in the 8-10-year-olds for dressing upper (z = 2.24; p = 0.013) and lower body (z = 2.78; p = 0.003) and self-care total (z = 2.01; p = 0.022). There were fair to moderate levels of test-retest reliability across age-groups.
Conclusion:
The EQ-5D-Y-3L IA showed acceptable convergent validity and test-retest reliability for measuring health in children aged 5-7-years. There was more report of problems with the dimension of Looking After Myself in the 5-7-year group due to younger children requiring help with dressing, including buttons and shoelaces due to their developmental age, rather than their physical capabilities. Therefore, it may be useful to include examples of age-appropriate dressing tasks. There was further some reported difficulty with thinking about the dimensions in the younger age-group, most notably for Usual Activities which includes a large number of examples. By decreasing the number of examples it may reduce the burden of recall for the younger age-group.
