Validation of EQ-HWB-9 among Chinese college students based on a nationwide survey

The EQ Health and Wellbeing Short Version (EQ-HWB-9) is a 9-item instrument capturing multidimensional health or well-being. This study aimed to evaluate its psychometric properties in Chinese college students-a high-risk group for mental health problems.

A nationwide online cross-sectional survey was conducted across eastern, central, and western China between January and February 2025. Ceiling and floor effects of the EQ-HWB-9 were evaluated based on the response distributions of its items. Convergent validity of EQ-HWB-9 items, as well as its level sum score (LSS) and utility score was assessed according to their correlations with EQ-VAS score using Spearman correlations. Known-group validity of LSS and utility score was evaluated by comparing the mean difference and effect sizes of six pairs of college students with different status. Sensitivity of the two scores was further tested by comparing its efficiency to detect the differences with EQ-VAS score using relative efficiency (RE).

A total of 3,589 college students participated in the survey, with females being 53.4% and mean age of 20.7 years. Two EQ-HWB-9 items-daily activities (75.8%) and mobility exhibited (74.6%) ceiling effects. All EQ-HWB-9 items demonstrated statistically significant correlations with the EQ-VAS score ranging from - 0.421 to -0.312, and both the EQ-HWB-9 LSS and utility score showed moderate correlations (LSS: -0.522; Utility: 0.522). Differences in mean values of LSS and utility score were statistically significant in five out of six known-groups (except for gender). The two scores generally demonstrated larger RE values compared to EQ-VAS score (LSS range: 1.049-51.590; Utility range: 0.715-61.143).

Despite the high ceiling effect in physical-related dimensions, it appears that the EQ-HWB-9 is a valid instrument in assessing health and well-being among Chinese college student.