Health And Quality Of Life Outcomes[JOURNAL]
Sun
200 papers
Psychometric evaluation and adaptability of the simplified Chinese version of HOOS-12 in patients undergoing total hip arthroplasty.
He M, Wu L, Gu W … +11 more , Liao D, Song B, Hu H, Cui L, YidaAmu, Li S, Tang Y, Long J, Yin L, Xie Q, Wang W
Health Qual Life Outcomes · 2026 Feb · PMID 41680893 · Full text
INTRODUCTION: Considering the response burden of the full version of the HOOS scale, researchers developed a more concise HOOS-12 scale. Although the HOOS-12 has been verified to have good reliability, validity and respo...
INTRODUCTION: Considering the response burden of the full version of the HOOS scale, researchers developed a more concise HOOS-12 scale. Although the HOOS-12 has been verified to have good reliability, validity and responsiveness in most Western-country studies, it still needs further evaluation in other non-English populations. Therefore, our aim is to assess the content validity, internal consistency, structural validity, test-retest reliability, responsiveness, floor effect and ceiling effect of the Chinese version of HOOS-12 in the patient population whose native language is Chinese. The goal is to provide a high-quality evaluation tool for the global Chinese-using hip joint patient population, promote cross-cultural and cross-regional hip joint research, and ensure the comparability of the data. METHOD: Patients with chronic hip diseases scheduled for total hip arthroplasty were included in the study. Content validity was evaluated using expert review to assess item relevance. CFA was employed to validate the construct validity of the CHOO-12. Convergent and discriminant validity of the CHOOS-12 were assessed using the SF-36, OHS, and WOMAC scales as reference instruments. The first HOOS-12 scores were used to evaluate content validity, internal consistency, and structural validity. The second set of scores was utilized to assess test-retest reliability and ceiling/floor effects. The third set of scores was applied to evaluate responsiveness. RESULT: The CHOOS-12 demonstrated good content validity. No ceiling or floor effects were observed for the CHOOS-12 total scale or its pain, function, and quality of life subscales. The internal consistency among items was high for both the overall CHOOS-12 and all its subscales. CFA indicated satisfactory performance for the pain dimension, though the unidimensionality of the function and quality of life dimensions was challenged. The CHOOS-12 scale exhibited good convergent and discriminant validity. With overall ES and SRM values of 2.08 and 2.42 respectively, the CHOOS-12 also demonstrated good responsiveness. CONCLUSION: CHOOS-12 demonstrated good reliability and validity in this study. In terms of construct validity, the pain subscale performed well, although the unidimensionality of the PF and QOL subscales was challenged, the core items still had measurement potential. Future research needs to conduct further validation in larger and more diverse samples.
German translation, cultural adaptation and linguistic validation of the PedsQL healthcare satisfaction module.
Piltz A, Spiller CH, Zschieschang A … +3 more , Fitze G, Muehlan H, Schultz J
Health Qual Life Outcomes · 2026 Feb · PMID 41680873 · Full text
BACKGROUND: Healthcare satisfaction (HCS) is a crucial patient-reported outcome that is essential for evaluating medical care quality from the patient’s viewpoint and may also significantly impact other patient-reported...
BACKGROUND: Healthcare satisfaction (HCS) is a crucial patient-reported outcome that is essential for evaluating medical care quality from the patient’s viewpoint and may also significantly impact other patient-reported outcome measures. However, currently validated German instruments lack a generic focus, which is essential for treating various diagnoses in pediatric surgery contexts. This study presents the translation and cultural adaptation of the PedsQL Healthcare Satisfaction Generic Module (HCSGM) for Germany. METHODS: The PedsQL 3.0 HCSGM is a 24-item questionnaire assessing six dimensions: information, family inclusion, communication, technical skills, emotional needs, and overall satisfaction. After two independent forward translations and a back translation, a preliminary version was tested with caregivers of 10 patients who provided feedback using the thinking-aloud technique while completing the questionnaire. Interviews were analyzed using qualitative content analysis (QCA), leading to the final German version of the HCSGM. RESULTS: The initial consensus meeting after the forward translations identified five areas for improvement. The backward translation was approved with no further changes. QCA revealed ten major and nine minor issues, which resulted in ten modifications to item wordings, question-wording, verbal anchors of answer options, and layout during a second consensus meeting. Those modifications resulted in the final version also being approved by the original authors. CONCLUSION: The German version of the PedsQL HCSGM is now available to measure HCS, a crucial PROM for clinical research and patient management. While qualitative methods have been employed to ensure equivalence, further studies should evaluate psychometric properties.
Longitudinal validation of the GHQ-12 and PHQ-2 in Chilean social housing populations in urban regeneration contexts.
González-Medina G, Vives A
Health Qual Life Outcomes · 2026 Feb · PMID 41680793 · Full text
BACKGROUND: Brief questionnaires have been applied in poor urban populations to monitor their mental health. Mental health outcomes encompass diverse symptoms that differ in cause and functional impact; however, most stu...
BACKGROUND: Brief questionnaires have been applied in poor urban populations to monitor their mental health. Mental health outcomes encompass diverse symptoms that differ in cause and functional impact; however, most studies combine these symptoms as if they represented a single construct. Longitudinal validation of health instruments requires understanding the psychometric properties and causal structures between measurement points to distinguish measurement error from true change before interpreting intervention effectiveness. However, the longitudinal psychometric properties of the General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ-2) in Latin American social housing populations remain unknown. This study assessed the dimensionality and longitudinal psychometric properties of these instruments in Chilean populations targeted by urban regeneration interventions. OBJECTIVE: To assess the longitudinal psychometric properties of the General Health Questionnaire (GHQ-12) and Patient Health Questionnaire (PHQ-2) in poor Chilean urban populations undergoing urban regeneration interventions. METHODS: We analyzed two waves of mental health data (6-month intervals) from 955 residents of social housing neighborhoods in Santiago and Viña del Mar, Chile. We evaluated item-level and scale-level statistics, confirmatory factor analysis, construct validity, test-retest reliability, and longitudinal measurement invariance. Following recent advances in causal inference methodology, we examined measurement error structures via directed acyclic graph principles to understand the causal implications of psychometric findings. RESULTS: Both instruments demonstrated good psychometric properties and construct validity. The three-factor GHQ-12 structure (dysphoria, social dysfunction, loss of confidence) showed an optimal fit (comparative fit index = 0.996, Tucker‒Lewis index = 0.992, root mean square error of approximation = 0.025). Dysphoria exhibited the strongest correlation with the PHQ-2 (r = 0.65) and highest temporal stability (0.60), whereas social dysfunction showed the lowest stability (0.48), suggesting differential sensitivity to environmental interventions. Evidence of a response shift emerged: while configural and metric invariance held across time, scalar invariance was violated (change in comparative fit index = 0.105), indicating systematic changes in item thresholds rather than true mental health changes. CONCLUSIONS: The GHQ-12 and PHQ-2 are reliable instruments for longitudinal mental health assessment in poor urban populations. However, scalar non-invariance suggests that residents recalibrate their mental health standards while urban regeneration begins, which has important implications for interpreting intervention effects. Future studies should incorporate measurement invariance testing and latent variable approaches when evaluating complex environmental interventions.
Exploring the psychological well-being construct and validating the Comprehensive Inventory of Thriving in Singapore.
Shou Y, Lee JJ, Vaingankar JA … +2 more , Subramaniam M, Luo N
Health Qual Life Outcomes · 2026 Feb · PMID 41673688 · Full text
BACKGROUND: Positive psychological functions are associated with various health and life outcomes. This study examined the construct of psychological well-being in the multi-ethnic Singaporean population and evaluated th...
BACKGROUND: Positive psychological functions are associated with various health and life outcomes. This study examined the construct of psychological well-being in the multi-ethnic Singaporean population and evaluated the Comprehensive Inventory of Thriving (CIT) scale that captures 18 aspects of psychological well-being. METHOD: A two-wave survey study was carried out with 1349 community-dwelling Singaporean adults, of whom 562 completed the second wave. We compared factor structures that have been reported in other populations. The factor model was further tested for replicability in a subsequent household survey sample (N = 1756). RESULTS: A new higher-order factor model emerged in the Singaporean sample consisting of three dimensions: interpersonal well-being, individual well-being, and resistance to threats. The new structure demonstrated gender and age measurement invariance. CIT and the three dimensions had expected associations with mental health symptoms, work/study stress, and participants’ actual social support. The new higher-order factor model was replicated in the subsequent household survey sample. Finally, both CIT and its short form, the Brief Inventory of Thriving (BIT), showed convergent validity, reliability and test-retest reliability in the Singaporean population. CONCLUSIONS: CIT demonstrated some evidence of construct validity and reliability in the current large samples of Singaporean community-dwelling adults. BIT can be an efficient tool to assess and monitor population general well-being.
Health-related quality of life and its determinants among children and adolescents living with HIV in Eastern Uganda: a cross-sectional study.
Kotut S, Tsekpetse P, Chege H … +2 more , Kiprop E, Kirabira J
Health Qual Life Outcomes · 2026 Feb · PMID 41668197 · Full text
BACKGROUND: Children and adolescents living with HIV face unique physical, psychological, and social challenges that can significantly affect their health-related quality of life (HRQoL). Understanding the dimensions and...
BACKGROUND: Children and adolescents living with HIV face unique physical, psychological, and social challenges that can significantly affect their health-related quality of life (HRQoL). Understanding the dimensions and determinants of HRQoL among them is crucial to developing solutions to improve their overall well-being. This research aimed to assess the HRQoL and its determinants among children and adolescents living with HIV in Eastern Uganda. METHODS: A cross-sectional study was conducted with 228 respondents. Sociodemographic and clinical variables were assessed using an investigator-designed questionnaire, and HRQoL was assessed using the World Health Organization HIV Quality of Life - BREF tool. A multiple linear regression model was used to identify independent factors associated with HRQoL. RESULTS: The mean age of the respondents was 13.68 ± 1.95 years, 129 (56.58%) were female, and 182 (79.82%) perceived high support from friends. The mean QoL was highest within the spiritual domain (17.07 ± 3.11), while the independence domain indicated the lowest quality of life (14.57 ± 2.26). Approximately 48.5% attained the mean overall QoL score (96.22). Better financial status (being not well off or quite well off) was significantly associated with higher scores across physical, psychological, independence, environmental, spiritual, and overall QoL (p < 0.05). High perceived family support was also positively associated with higher psychological, environmental, spiritual, and overall QoL scores. In contrast, family history of mental illness and the presence of other chronic illnesses were significantly associated with lower psychological and environmental scores. Being Muslim/other religion was associated with lower physical domain scores, while being in high school or above was linked to better environmental scores. CONCLUSION: Spirituality was a key source of emotional support, reflected in the highest QoL scores, while low independence scores suggest that stigma and overprotection may hinder autonomy and social development. Although overall QoL was generally good, disparities across domains underscore the need for targeted interventions. Improved financial status and strong family support were consistently associated with better QoL outcomes, while comorbid conditions and a family history of mental illness negatively impacted well-being among children and adolescents living with HIV in Eastern Uganda.
Development and validation of the general module of the quality of life instruments for chronic diseases QLICD-GM(V2.0) : a large sample study based on classical test theory and item response theory.
Wan C, Zhang X, Qiao L … +6 more , Li W, Chen Y, Ma W, Xue H, Quan P, Wang D
Health Qual Life Outcomes · 2026 Feb · PMID 41654896 · Full text
OBJECTIVE: The quality of life(QoL) of patients with chronic diseases is a greater concern for both patients and clinicians. This study was aimed to develop and evaluate the second version of the General Module of Qualit...
OBJECTIVE: The quality of life(QoL) of patients with chronic diseases is a greater concern for both patients and clinicians. This study was aimed to develop and evaluate the second version of the General Module of Quality of Life Instruments for Chronic Diseases (QLICD-GM(V2.0)) by Classical Test Theory (CTT) and Item Response Theory (IRT) . METHODS: Building upon QLICD-GM(V1.0), the scale was developed and validated through a structured process combining qualitative and quantitative methods. The psychometric properties of QLICD-GM(V2.0) were assessed in a sample of 1953 patients with ten chronic diseases, evaluating reliability, validity, responsiveness, and item characteristics under CTT and IRT frameworks. RESULTS: The final QLICD-GM(V2.0) comprises 28 items across 3 domains and 9 facets. Item-domain correlations were highest for each item within its intended domain, except one. Confirmatory factor analysis indicated good model fit. Criterion validity against SF-36 showed correlations of 0.56 (physical), 0.54 (psychological), and 0.46 (social). Internal consistency was high (Cronbach's α: 0.79-0.98). Significant pre- to post-treatment score differences were found (all p < 0.001), with standardized response means of 0.24 (physical), 0.17 (psychological), and 0.07 (social). IRT analysis indicated all items had discrimination parameters between 1.11 and 1.41, with monotonically increasing location parameters. Average item information amount was approximately 0.33 (physical), 0.54 (psychological), and 0.44(social). CONCLUSIONS: QLICD-GM(V2.0) provides a psychometrically sound, clinically interpretable and responsive measure of generic QoL in chronic patients. It can be used alone or combined with disease-specific modules to monitor benefit and guide treatment and rehabilitation planning.
Implementing electronic Patient-Reported Outcome Measures in Chronic Kidney Disease: a qualitative systematic review of barriers, enablers, and mechanisms.
Zheng X, Zhang Y, Xie L … +5 more , Liu Y, Yu Q, Zhang H, Li Y, Wang A
Health Qual Life Outcomes · 2026 Feb · PMID 41652416 · Full text
OBJECTIVES: This systematic review investigates the barriers, enablers and mechanisms affecting ePROMs implementation in CKD (chronic kidney disease) management, with a focus on the perspectives of patients and healthcar...
OBJECTIVES: This systematic review investigates the barriers, enablers and mechanisms affecting ePROMs implementation in CKD (chronic kidney disease) management, with a focus on the perspectives of patients and healthcare providers. METHODS: A qualitative systematic review was conducted using the UK Medical Research Council's Process Evaluation Framework to analyze studies on ePROM implementation in CKD care. We systematically searched databases for peer-reviewed qualitative studies published from inception to October 2025. Thematic analysis, guided by the Process Evaluation Framework, was used to synthesize the findings. Studies from PubMed, Embase, Scopus, CINAHL, and APA PsycINFO were included. RESULTS: Results Eleven studies met the inclusion criteria. The synthesis identified distinct barriers and mechanisms of impact. Key barriers included structural and technical obstacles: digital literacy gaps, cognitive overload in vulnerable populations, misalignment with clinical IT systems, interface usability issues, and inconsistent implementation protocols. Regarding Enablers and Mechanisms, the review revealed a paradox. While ePROMs acted as enablers for personalized treatment and improved symptom awareness, their effectiveness was mediated by complex relational mechanisms. Both patients and clinicians expressed skepticism regarding utility in routine care. Furthermore, relational tensions arose when patient input was perceived as overlooked, highlighting that patient empowerment is conditional on the quality of the therapeutic alliance. CONCLUSION: ePROMs have the potential to enhance CKD care by providing valuable insights into patient experiences. However, their adoption is hindered by digital literacy, technological issues, and inconsistent protocols. To optimize adoption, policymakers must prioritize IT integration and standardized protocols, while clinicians should actively incorporate results into consultations to validate patient input. Future research should focus on mixed-methods studies in diverse populations to ensure equitable and effective implementation.
Quality of life scores using SF-12 and SF-36v2 questionnaires for patients with multidrug-resistant tuberculosis in Vietnam.
Ha NTL, Hoa NB, Yapa M … +5 more , Anh NT, Li Q, Dang VH, Fox GJ, Dat VQ
Health Qual Life Outcomes · 2026 Feb · PMID 41645204 · Full text
BACKGROUND: The health-related quality of life (QoL) assessed by the 12-item Short Form (SF-12) offers a time-efficient alternative to the 36-item version 2 (SF-36 v2). This study aimed to compare the performance of SF-1...
BACKGROUND: The health-related quality of life (QoL) assessed by the 12-item Short Form (SF-12) offers a time-efficient alternative to the 36-item version 2 (SF-36 v2). This study aimed to compare the performance of SF-12 and SF-36 v2 among patients with rifampicin-resistant/multidrug-resistant tuberculosis (RR/MDR-TB) in Vietnam. METHODS: A cross-sectional survey was conducted among RR/MDR-TB patients treated in seven provinces between October 2020 and March 2023. Participants completed the SF-36 v2 questionnaire at enrollment. Physical (PCS) and mental component summary (MCS) scores were compared between SF-12 and SF-36 v2. Linear regression assessed the ability of PCS-12 and MCS-12 to predict PCS-36 and MCS-36. Discriminative ability was assessed via receiver operating characteristic (ROC) curves. RESULTS: This study included 565 participants with a median age of 45.4 years (IQR 44.2–46.5) and a male proportion of 71.7%. 64.1% (362/565) had PCS-36 and 88.3% (499/565) had MCS-36 scores well below and below population norms. The mean scores of PCS-12 and MCS-12 were higher than those of PCS-36 (45.1; 95% CI 44.1–46.1 vs. 43.6; 95% CI 43.1–44.1), and MCS-36 (45.2; 95% CI 43.8–46.6 vs. 34.6; 95% CI 33.9–35.4; p < 0.001), respectively. The Intraclass Correlation Coefficients (ICCs) between PCS and MCS scores of SF-12 and SF-36 v2 were 0.6 (95% CI: 0.5–0.6) and 0.5 (95% CI: 0.4–0.5) respectively. The AUC values for comparing the performance of PCS and MCS of two scales were 0.89 and 0.99, respectively. We found the excellent linear correlation between PCS-12 and PCS-36 (r = 0.8; p < 0.001) and between MCS-12 and MCS-36 scores (r = 0.9; p < 0.001). CONCLUSION: SF-12 had moderate correlation to SF-36 v2 for QoL assessment in RR/MDR-TB patients, though it tends to overestimate QoL in older and male individuals.
A synthesis of dimensions of wellbeing among adolescents and young people living with HIV from Sub-Saharan Africa for measurement in economic evaluation: a qualitative overview of reviews.
Carries S, Nyasulu J, Moyo A … +3 more , Davids EL, Odendaal W, Govindasamy D
Health Qual Life Outcomes · 2026 Feb · PMID 41639684 · Full text
BACKGROUND: Adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa (SSA) face intersecting structural and psychosocial challenges that compromise their wellbeing, yet these realities are poorly capt...
BACKGROUND: Adolescents and young people living with HIV (AYPLHIV) in sub-Saharan Africa (SSA) face intersecting structural and psychosocial challenges that compromise their wellbeing, yet these realities are poorly captured by generic wellbeing measures used in economic evaluations. This overview of reviews synthesised evidence from SSA to identify key determinants of social wellbeing to inform the co-development of a contextually relevant wellbeing scale suitable for economic evaluations in the region. METHODS: We searched reviews published between January 2000 and September 2023 across ten databases on EBSCOhost, Ovid, and Web of Science. The conduct and reporting of this overview followed the Preferred Reporting Items for Overviews of Reviews guidelines. Eligible reviews included quantitative, qualitative, and mixed-methods studies examining wellbeing or mental health among AYPLHIV aged 10–24 years in SSA. Review quality was assessed using the Joanna Briggs Institute Critical Appraisal Checklist. Data were synthesised thematically, mapped onto Keyes Social Wellbeing framework, and study selection presented with a PRISMA flow diagram. RESULTS: Sixteen medium-to-high quality reviews were included. South Africa (n = 15) and Uganda (n = 14) were the most represented countries. Most reviews focused on adolescents aged 10–19 years (n = 11). Our analysis identified five recurring themes central to the social wellbeing of AYPLHIV: social support, acceptance and belonging, self-acceptance, aspirations and goals, and coping. These themes aligned with Keyes’ Social Wellbeing model, with social support and acceptance and belonging reflecting social integration, and aspirations and goals reflecting social contribution. Key psychological wellbeing constructs identified included positive relationships, self-acceptance, purpose in life, and environmental mastery. CONCLUSIONS: These domains reflect both personal experiences and structural realities yet remain underrepresented in commonly used wellbeing measures. This is a critical limitation, as economic evaluations often rely on generic instruments that fail to capture what matters most to AYPLHIV in SSA. Future research should develop a wellbeing scale that incorporates these domains, is sensitive to socioeconomic context, and can be collected alongside socioeconomic status indicators. Embedding such a measure into evaluation systems would improve the accuracy, equity, and policy relevance of economic evaluations and ensure that investments reflect AYPLHIV’s lived realities.
Validation of the Japanese version of boredom proneness scale and derivation of its short version among older adults: a cross-sectional study.
Takayama A, Uehara I, Yoshioka T … +7 more , Takeshima T, Omae K, Shimizu S, Nakagawa H, Ozaka A, Hamaguchi S, Fukuhara S
Health Qual Life Outcomes · 2026 Feb · PMID 41639676 · Full text
BACKGROUND: Boredom proneness is a common yet underexplored psychological trait among older adults, linked to depression, loneliness, and reduced quality of life. Despite its clinical relevance, validated instruments for...
BACKGROUND: Boredom proneness is a common yet underexplored psychological trait among older adults, linked to depression, loneliness, and reduced quality of life. Despite its clinical relevance, validated instruments for assessing boredom in this population are scarce. This study aimed to validate the Japanese version of the Boredom Proneness Scale (JBPS) and to develop a short form specifically designed for older adults (s-BPSO). METHODS: We conducted two cross-sectional surveys in Japan. The first, a paper-based survey (n = 5,382; mean age = 82), targeted community-dwelling older adults aged ≥ 75 years in Sukagawa City. The second, an internet-based national survey (n = 4,124; mean age = 66), recruited participants aged ≥ 50 years. Structural validity of the JBPS was assessed via exploratory and confirmatory factor analysis. Reliability was evaluated using internal consistency and test–retest analysis. The s-BPSO was derived using item response theory and validated independently using data from the second survey. Convergent validity was examined through correlations with validated measures of mental and physical health. RESULTS: The JBPS demonstrated good internal consistency (Cronbach’s α = 0.87) and test–retest reliability (ICC = 0.84). Exploratory factor analysis supported a three-factor structure, though model fit in confirmatory analysis was modest. The JBPS showed strong correlations with depressive symptoms, loneliness, and HRQOL measures. Existing short versions of the BPS performed poorly in this older sample. A newly developed 6-item short version (s-BPSO) based on a two-factor structure exhibited acceptable model fit (CFI = 0.987, RMSEA = 0.056), high internal consistency (α = 0.80), and strong correlation with the full JBPS (r = 0.86). Higher boredom scores were associated with older age, lower income and education, reduced IADL, and lower HRQOL. CONCLUSIONS: The JBPS and s-BPSO are valid and reliable instruments for assessing boredom proneness among older Japanese adults. The s-BPSO provides a concise alternative for use in epidemiological surveys and clinical practice. These tools may inform interventions aimed at promoting active and mentally healthy aging, and support future cross-cultural research on aging-related psychological traits.
Health-related quality of life and associated factors among patients living with epilepsy of Mekelle City Hospitals, Northern Ethiopia: a multicenter observational study.
Kahsay GG, Gidey K, Berha AB
Health Qual Life Outcomes · 2026 Feb · PMID 41634696 · Full text
BACKGROUND: Epilepsy profoundly affects the physical, emotional, cognitive, and socioeconomic well-being of patients living with epilepsy. In resource-limited settings, patients living with epilepsy experience markedly r...
BACKGROUND: Epilepsy profoundly affects the physical, emotional, cognitive, and socioeconomic well-being of patients living with epilepsy. In resource-limited settings, patients living with epilepsy experience markedly reduced health-related quality of life (HRQoL) due to treatment gaps, stigma, social isolation, and misconceptions about the disease and its management. Despite the significant impact of epilepsy on HRQoL, data on its magnitude and determinants remain scarce in Ethiopia, especially within the current study setting. Thus, this study aimed to assess the HRQoL and its predictors among adult patients living with epilepsy in three selected hospitals. METHOD: A multicenter observational study was conducted from June 1 to September 30, 2023, to assess HRQoL among adult patients living with epilepsy. Participants were recruited using systematic random sampling. Data were collected via face-to-face interviews employing the European Quality of Life Five-Dimension Five-Level (EQ-5D-5L) and European Quality of Life Visual Analog Scale (EQ-VAS) instruments. Descriptive and a multivariate Tobit regression model were used to analyze the data . RESULTS: The majority of study participants (248, 70.7%) were aged 18–44 years, with a mean age of 37.98 ± 14.27 years (mean ± SD). The Cronbach’s alpha for the five EQ-5D-5L dimensions was 0.744, indicating acceptable internal consistency reliability.Over half of the participants (179, 51%) reported poor HRQoL. The median (interquartile range, IQR) values for the EQ-5D-5L utility score and EQ-VAS were 0.774 (0.56–0.85) and 65 (50–80), respectively. In the EQ-5D-5L descriptive system, anxiety/depression was the most frequently reported health problem (342, 97.4%). Age over 60 years (β = -0.21, 95% CI: -0.402 to -0.017) and frequent seizure episodes before treatment (β = -0.0054, 95% CI: -0.0102 to -0.006) were identified as negative predictors of HRQoL. Conversely, the absence of comorbidities (β = 0.095, 95% CI: 0.012 to 0.178) and the lack of seizure relapse (β = 0.062, 95% CI: -0.0007 to 0.125) were positively associated with improved HRQoL. CONCLUSION: A considerable proportion of patients living with epilepsy experience poor HRQoL, particularly due to anxiety and depression. Key socio-demographic and clinical factors, including age, employment status, comorbidities, seizure frequency, and seizure control, significantly influence quality of life, highlighting the need for comprehensive and patient-centered epilepsy care.
Health utility values associated with pharmaceutical treatment process attributes: a systematic review and meta-analysis.
Liu Y, Du X, Rong Z … +5 more , Guo Z, Chang F, Lu Y, Dai Z, Lu Y
Health Qual Life Outcomes · 2026 Feb · PMID 41622212 · Full text
BACKGROUND: In cases where clinical efficacy and safety profiles are similar, patient preferences for the treatment process become a critical determinant of therapeutic adherence and health-related quality of life (HRQoL...
BACKGROUND: In cases where clinical efficacy and safety profiles are similar, patient preferences for the treatment process become a critical determinant of therapeutic adherence and health-related quality of life (HRQoL). However, current research on the utility of treatment process attributes (such as administration route, frequency, and time) show significant heterogeneity. Moreover, the results are often influenced by confounding factors, making it difficult to quantify their independent utility impact. OBJECTIVES: This study aims to deconstruct prevalent confounding biases through a systematic review and multivariable meta-regression. The goal is to isolate the independent effects of various treatment process attributes on health utility values, thereby providing more precise evidence for pharmacoeconomic evaluations. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, this study systematically searched PubMed, Cochrane Library, Web of Science, and EBSCO databases for relevant English-language literature published up to December 2024. Original research reporting health utility values (on a 0-1 scale) associated with pharmaceutical treatment process attributes was included. Extracted disutility values, defined as Disutility=Utility - 1, were analyzed using random-effects models. Univariate, bivariate, and multivariable meta-regression models were constructed to control for key confounders, such as disease type and respondent population (patients vs. general public), and to investigate the independent effects of administration route, frequency, and duration on utility values. RESULTS: Nineteen studies (providing 81 utility values) met inclusion criteria. In fully adjusted models, administration route emerged as a primary determinant of utility. Injection (versus oral) conferred a significant disutility (β = - 0.092; 95% CI - 0.127 to - 0.056; p < 0.001). Administration durations > 1 h also imposed significant disutility (β = - 0.172; 95% CI - 0.289 to - 0.055; p < 0.005). Disease severity was the strongest predictor overall: utilities for neoplasms were over 0.4 lower than for metabolic conditions (p < 0.001). Patients consistently reported higher utilities than the general public. An apparent "frequency paradox" (greater disutility for lower dosing frequency) emerged in unadjusted analysis, but this effect disappeared after adjusting for route, indicating it was a statistical artifact of confounding by route. No independent effect of dosing frequency remained in multivariable analysis. CONCLUSION: Injectable route and prolonged administration duration are significant, independent drivers of health disutility. The apparent negative effect of dosing frequency is a statistical artifact of confounding by the administration route, which carries the actual disutility. These findings highlight the interconnectedness of treatment attributes and underscore that a holistic, multivariable measurement approach is necessary to avoid erroneous conclusions from confounding bias in pharmacoeconomic evaluations.
The association between disease status and health-related quality of life: evidence from a cross-sectional survey across mainland China.
Li X, Ma X, Shi C … +3 more , Qin W, Wu Y, Liu L
Health Qual Life Outcomes · 2026 Jan · PMID 41620732 · Full text
BACKGROUND: This study aimed to assess the health-related quality of life (HRQoL) among Chinese adults with varying disease statuses. METHODS: A cross-sectional study was conducted between June 20 and August 31, 2023 acr...
BACKGROUND: This study aimed to assess the health-related quality of life (HRQoL) among Chinese adults with varying disease statuses. METHODS: A cross-sectional study was conducted between June 20 and August 31, 2023 across China. HRQoL was measured using the EQ-5D-5L utility index (UI) and EQ-Visual Analogue Scale (EQ-VAS). Kruskal-Wallis tests compared HRQoL across disease groups, chi-square tests compared problem prevalence within each EQ-5D-5L dimension across disease groups, and Tobit regression examined associations between disease status and HRQoL. Subgroup and interaction analyses assessed effect modification by age, gender, education, employment, and smoking status. RESULTS: A total of 42,447 participants were included (healthy: 33,408; single chronic disease: 5,084; multimorbidity: 3,955). HRQoL showed a clear gradient: median UI and EQ-VAS scores were 1 (0.95-1) and 80 (64–90) in healthy individuals, 0.95 (0.89-1) and 75 (61–83) in the single chronic disease group, and 0.89 (0.73-1) and 69 (54–81) in the multimorbidity group (all P [Formula: see text] 0.001). Problem prevalence differed significantly among groups for all EQ-5D-5L dimensions. Age, education, smoking, and employment status modified associations between disease status and UI, yet single chronic disease and multimorbidity remained consistently linked to lower UI across all subgroups. CONCLUSIONS: HRQoL declined from healthy individuals to those with single chronic disease and multimorbidity. The modifying effects of age, education, smoking, and employment status highlight priority subgroups for targeted interventions. STUDY REGISTRATION: Chinese Clinical Trial Register (ChiCTR), ChiCTR2300072573. Registration Date: June 16, 2023 [Observational study].
Exploring relative health spillover effects within the context of dementia using the EQ-HWB-9.
Sokolova V, Faller J, Thai T … +1 more , Engel L
Health Qual Life Outcomes · 2026 Jan · PMID 41620600 · Full text
BACKGROUND: Dementia does not only impact the quality of life of the affected individual but also their family and informal caregivers, often referred to as health spillover effects. Increasing attention is being given t...
BACKGROUND: Dementia does not only impact the quality of life of the affected individual but also their family and informal caregivers, often referred to as health spillover effects. Increasing attention is being given to the inclusion of informal caregiver spillover effects in economic evaluations, given their potential to directly influence funding recommendations. OBJECTIVE: The objective of this study was to estimate the relative health spillover effects of dementia caregiving on informal caregivers using the EQ Health and Wellbeing 9-items (EQ-HWB-9) questionnaire. METHODS: A cross-sectional survey was conducted involving informal caregivers of people with dementia residing in Australia. Informal caregivers completed the experimental version of EQ-HWB to rate their own health and wellbeing and proxy reported for the person with dementia using the EQ-HWB-9. To estimate the relative spillover, univariate and multiple linear regressions modeled caregiver's EQ-HWB-9 scores (derived from the EQ-HWB) as a function of the person with dementia health and wellbeing (based on the EQ-HWB-9), adjusting for demographic and caregiving characteristics. RESULTS: In total, 202 informal caregivers completed the survey. The average age of caregivers was 60.4 (SD = 13.7), with 63.2% being female. The univariate analysis revealed a positive relative spillover effect coefficient of 0.23 (p < 0.001, R-squared = 0.10), demonstrating a significant positive association between caregiver's and person's with dementia health and wellbeing using the EQ-HWB-9. This relationship remained significant (p < 0.001, adj R-squared = 0.26) when adjusting for caregiver's chronic conditions in the multiple linear regression model yielding a spillover coefficient of 0.22. Most impacted domains of caregiving included exhaustion, loneliness and lack of control over day-to-day life. CONCLUSIONS: There is evidence of associative relative health spillovers associated with providing informal care for a person with dementia. It is essential to include health effects on informal caregivers into economic evaluations to account for the burden of dementia posed beyond the affected individual.
A comparative study of EQ-5D-5L and SF-6D scales based on patients receiving oral anticoagulant therapy.
Dong S, Li Y, Liao Z … +5 more , Lin Q, Yiu HHE, Ming WK, Li L, Zhao R
Health Qual Life Outcomes · 2026 Jan · PMID 41618291 · Full text
OBJECTIVE: Oral anticoagulant therapy is widely used for the prevention and treatment of thromboembolic diseases, yet it imposes significant burdens on patients’ health-related quality of life (HRQoL). This study aimed t...
OBJECTIVE: Oral anticoagulant therapy is widely used for the prevention and treatment of thromboembolic diseases, yet it imposes significant burdens on patients’ health-related quality of life (HRQoL). This study aimed to compare the performance of two generic preference-based measures (GPBMs), the EQ-5D-5 L and SF-6D, in assessing HRQoL among patients receiving oral anticoagulant therapy, and to further explore the factors influencing their HRQoL. METHODS: A multicenter, cross-sectional survey was conducted across 14 hospitals in China. Patients receiving oral anticoagulant therapy were enrolled and completed the EQ-5D-5 L, SF-6D, anticoagulation satisfaction (assessed by DASS), health literacy (assessed by HLS-SF9), and self-efficacy (assessed by NGSES-SF). Ceiling and floor effects, the association and agreement between the two measures, known-group validity and multi-factor analysis were assessed. RESULTS: A total of 379 patients receiving oral anticoagulant therapy were included in the analysis. The mean (standard deviation) utility scores were 0.837 (0.187) for the EQ-5D-5 L and 0.729 (0.132) for SF-6D. The EQ-5D-5 L demonstrated a higher ceiling effect (21.11%) compared with SF-6D (1.32%). The Pearson’s correlation coefficient between EQ-5D-5 L and SF-6D was 0.724, and the intraclass correlation coefficient (ICC) was 0.557. Patients with higher anticoagulation satisfaction, health literacy, and self-efficacy reported significantly better quality of life. The EQ-5D-5 L showed better ability to distinguish differences in a wider range of clinical factors, including the type of thrombotic diseases, anticoagulant medications, and comorbidities, compared with the SF-6D, which only detected differences in the duration of anticoagulation, number of medications, and history of thrombotic events. CONCLUSION: Both EQ-5D-5 L and SF-6D demonstrated satisfactory construct validity in assessing patients undergoing oral anticoagulant therapy, with EQ-5D-5 L showing a higher ceiling effect and superior discriminative ability for disease-specific differentiation. Given the distinct characteristics and performance of the EQ-5D-5 L and SF-6D, these instruments should not be used interchangeably in patients receiving anticoagulant therapy. These findings offer valuable insights for optimizing HRQoL assessment and management in patients receiving oral anticoagulant therapy.
Individualized nutritional care including adherence support improves health-related quality of life in individuals with severe chronic obstructive pulmonary disease: a randomized controlled trial.
Hegelund MH, Ritz C, Olsen MF … +8 more , Mølgaard C, Nielsen TL, Jensen AV, Søborg C, Braagaard L, Krogh-Madsen R, Lindegaard B, Faurholt-Jepsen D
Health Qual Life Outcomes · 2026 Jan · PMID 41612405 · Full text
BACKGROUND: Undernutrition and reduced health-related quality of life (HRQoL) are common in severe chronic obstructive pulmonary disease (COPD) and may exacerbate functional decline. This study evaluated whether individu...
BACKGROUND: Undernutrition and reduced health-related quality of life (HRQoL) are common in severe chronic obstructive pulmonary disease (COPD) and may exacerbate functional decline. This study evaluated whether individualized nutritional care with adherence support improves HRQoL in individuals with severe COPD at risk of undernutrition. Secondary outcomes included physical function, anthropometry, body composition, and dietary intake. METHODS: In this 3-month, single-center, open-label randomized controlled trial, 87 adults with severe COPD were randomized 1:1 to individualized nutritional care or standard care. The intervention comprised tailored dietary plans, adherence support (phone calls, reminders), optional oral nutritional supplements and weight diary. The primary outcome was HRQoL (EQ-5D-5 L). Secondary outcomes were disease-specific HRQoL (CAT), chair stand test, grip strength, anthropometry, body composition, and protein and energy intake. Analyses followed an intention-to-treat approach using linear mixed-effects models. RESULTS: Of 674 individuals screened, 91 were enrolled; of whom 87 completed the baseline visit; 44 received the intervention and 43 standard care, with 78 (90%) completing follow-up. At 3 months, the intervention improved HRQoL versus standard care (mean difference in EQ-5D-5 L utility index 0.053; 95% CI 0.003–0.103), driven by better mobility, self-care, and usual activities. Functional gains were supported by more chair stands (mean difference 0.80; 95% CI 0.05–1.55). Protein (+ 16 g/day) and energy intake (+ 326 kcal/day) increased, while no significant differences were observed in disease-specific HRQoL, anthropometry, or body composition. Benefits were greater in undernourished, frail, solitary-living participants, and men. CONCLUSION: Individualized nutritional care with adherence support improved HRQoL, particularly physical functioning, in individuals with severe COPD at risk of undernutrition, supporting its consideration in clinical practice. TRIAL REGISTRATION: The study was registered on ClinicalTrials (NCT04873856) in April 2021.
Validation of the Danish version of the Carer Experience Scale in family caregivers of people with dementia.
Pedersen EK, Øksnebjerg L, Waldemar G … +3 more , Janbek J, Nielsen A, Nielsen TR
Health Qual Life Outcomes · 2026 Jan · PMID 41612321 · Full text
BACKGROUND: The Carer Experience Scale (CES) measures the caring experience, focusing on caregiver-related quality of life (QoL) rather than health-related QoL. We aimed to validate the Danish language version of CES in...
BACKGROUND: The Carer Experience Scale (CES) measures the caring experience, focusing on caregiver-related quality of life (QoL) rather than health-related QoL. We aimed to validate the Danish language version of CES in family caregivers of people with dementia in Denmark by assessing CES discriminative and convergent validity. Further, we aimed to establish the internal consistency and test-retest reliability of CES. METHODS: A baseline questionnaire from the Danish DemTool intervention trial, including CES and five other measures of QoL and wellbeing was completed by 375 family caregivers of people with dementia. Discriminative validity was assessed by the ability of CES to discriminate between different caring contexts and levels of caregiver strain, as determined by Mann-Whitney U and Kruskal-Wallis H tests. Convergent validity was assessed by analyzing correlations using Spearman's rank correlation coefficients between the CES index and domain scores, and the 5-level EQ-5D version (EQ-5D-5L), European Quality of life visual analog scale (EQ VAS), Neuropsychiatric Inventory Caregiver Distress Scale (NPI-D), World Health Organization Wellbeing Index (WHO-5), and the University of California, Los Angeles Three-Item Loneliness Scale (UCLA 3-item). Internal consistency was assessed using Cronbach's α and test-retest reliability was assessed using intraclass correlation coefficient (ICC) between two different time points. RESULTS: The CES effectively distinguished between different levels of caregiver strain. Further, the CES was not affected by different caregiver and care recipient characteristics. Supporting convergent validity, the CES index was moderately correlated with NPI-D (ρ=-0.42), WHO-5 (ρ = 0.44), and UCLA 3-item (ρ=-0.40). The CES index was weakly correlated with EQ-5D-5L (ρ = 0.27), and EQ-VAS (ρ = 0.26). The CES showed low internal consistency (α = 0.53), but high test-retest reliability (ICC = 0.76). CONCLUSION: The Danish version of CES demonstrated discriminative validity and acceptable psychometric properties, providing further evidence for its use in family caregivers of people with dementia.
Examining the face validity of the EQ-HWB-9 in dementia: caregiver interpretation across "Today" and "7-Day" recall periods.
Buchholz M, Engel L, Xie F … +1 more , Michalowsky B
Health Qual Life Outcomes · 2026 Jan · PMID 41606591 · Full text
BACKGROUND: This study aimed to assess the face validity of the EQ Health and Wellbeing 9 (EQ-HWB-9) for use as a proxy by informal caregivers of community-dwelling people living with dementia (PlwD). It explored how car...
BACKGROUND: This study aimed to assess the face validity of the EQ Health and Wellbeing 9 (EQ-HWB-9) for use as a proxy by informal caregivers of community-dwelling people living with dementia (PlwD). It explored how caregivers understand and interpret the EQ-HWB-9 items when using two different recall periods (today vs. 7-days). METHODS: Qualitative interviews were conducted with 73 informal caregivers of PlwD in Germany. Participants were randomly assigned to one of two recall period groups of the EQ-HWB-9 ("today" vs. "7 days"), and underwent an interview, designed to evaluate the appropriateness of the EQ-HWB-9. Interviews were audio-recorded, transcribed verbatim, and analyzed using qualitative content analysis. RESULTS: Caregivers were, on average, 70.6 years old and mainly female (72.6%). Most caregivers found the EQ-HWB-9 acceptable, highlighting its broad health coverage, clear structure, and suitability of the five-point response scale. Criticisms included the brevity and insufficient depth to capture the PlwD's health status fully. Caregivers tended to focus on observable aspects, such as daily activities, concentration, and mobility, while internal states, like loneliness, sadness, and anxiety, were more challenging to assess, often relying on indirect cues. The 7-day recall period was associated with lower adherence and more frequent deviations from recall instructions compared to the "Today" recall. Overall, caregivers adhered well to the instructed proxy-proxy perspective but reported uncertainty in selecting the most appropriate responses. CONCLUSIONS: The EQ-HWB-9 is generally acceptable and feasible for proxy assessments in PlwD. However, challenges regarding recall periods, proxy interpretation, and response certainty require further investigation.
Health utility values associated with vision impairment among the elderly in Hong Kong: a community-based study using EQ-5D-5 L and time trade-off.
Yu M, Lian J, McGhee SM … +3 more , So C, Sum RWM, Yap MKH
Health Qual Life Outcomes · 2026 Jan · PMID 41578397 · Full text
BACKGROUND: To estimate health utility decrements associated with correctable and uncorrectable vision impairment (VI) in community-dwelling older adults in Hong Kong using the EQ-5D-5 L and time trade-off (TTO), and to...
BACKGROUND: To estimate health utility decrements associated with correctable and uncorrectable vision impairment (VI) in community-dwelling older adults in Hong Kong using the EQ-5D-5 L and time trade-off (TTO), and to compare the sensitivity of these utility instruments in detecting VI's quality-of-life impacts. METHODS: A random sample of 999 older adults, previously screened in a community-based eye care programme between 2015 and 2017 and not referred for eye specialist care, completed follow-up eye examinations and questionnaire surveys between 2022 and 2024. Distance VI was defined as presenting visual acuity worse than 6/12 in the better-seeing eye, and categorized as correctable (due to uncorrected refractive error, URE) or uncorrectable (due to pathology), based on best-corrected visual acuity. Health utility was measured using the EQ-5D-5 L questionnaire and the TTO method. Associations between VI type and utility scores were analyzed using multivariable linear regression. RESULTS: The prevalence of VI was 19.1%, with 15.4% correctable and 3.7% uncorrectable. Mean EQ-5D-5L utility scores were 0.91 (standard deviation [SD] = 0.15) for those without VI, 0.90 (SD = 0.12) for correctable VI, and 0.85 (SD = 0.22) for uncorrectable VI (p < 0.05). Mean TTO scores followed a similar pattern: 0.95 (SD = 0.14), 0.94 (SD = 0.15), and 0.89 (SD = 0.22), respectively. In adjusted models, uncorrectable VI was significantly associated with a 0.052 decrease in TTO utility (95% confidence interval: -0.103 to -0.002; p < 0.05), while correctable VI showed no significant utility loss in either measure. CONCLUSIONS: There were generally lower utility values for community dwelling elders with VI compared to no VI, with significant reductions of uncorrectable VI due to eye diseases in health utility among older adults living in the community. In contrast, correctable VI due to URE did not significantly affect utility values, suggesting that generic instruments like EQ-5D-5 L and TTO may lack sensitivity to detect the burden of milder, reversible vision loss. These findings provide essential data for evaluating the cost-effectiveness of community eye care programs and highlight the need for more targeted quality-of-life measures in vision research.
Structural equation modeling of multidimensional determinants of postoperative quality of life in patients with oral cancer.
Xiong Z, Zhou J, Wang X … +3 more , Huang J, Lin C, Cong L
Health Qual Life Outcomes · 2026 Jan · PMID 41572282 · Full text
BACKGROUND: Postoperative quality of life (QoL) in oral cancer patients is not only influenced by physical impairments but also by interrelated psychosocial factors. However, few studies have investigated these multidime...
BACKGROUND: Postoperative quality of life (QoL) in oral cancer patients is not only influenced by physical impairments but also by interrelated psychosocial factors. However, few studies have investigated these multidimensional pathways during the acute recovery phase. This study aimed to examine how speech disorder, self-esteem, social alienation, and body image interact in relation to QoL in the first week following oral cancer surgery. METHODS: A cross-sectional study was conducted among 401 patients within 7 days post-surgery. Validated Chinese versions of standardized scales were administered to assess functional and psychosocial domains relevant to QoL. Structural equation modeling was used to test hypothesized pathways among speech disorder, self-esteem, social alienation, body image, and quality of life. Model fit was assessed with χ²/df, CFI, TLI, RMSEA, and SRMR, using established thresholds. RESULTS: Speech disorder was negatively associated with QoL both directly (β = −0.446) and indirectly through sequential pathways involving self-esteem, social alienation, and body image. Among these variables, speech disorder showed the strongest overall association with QoL when both direct and indirect pathways were considered (β = −0.824), whereas body image demonstrated the strongest direct association with QoL (β = −0.609). The structural equation modeling demonstrated acceptable model fit (χ² = 187.818, df = 78, χ²/df = 2.408, CFI = 0.969, TLI = 0.959, RMSEA = 0.059, SRMR = 0.039). CONCLUSIONS: Postoperative QoL in oral cancer patients is shaped by complex mediation pathways linking speech dysfunction, psychosocial vulnerabilities, and body image. These findings highlight the need for early multidisciplinary interventions that integrate functional rehabilitation with psychosocial support to improve recovery. Future research is warranted to validate these associations through longitudinal and interventional studies.
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