ArticleQuality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation2026
Challenges with interviewer administration of EQ-5D questionnaires in a large-scale population survey in China: a qualitative analysis.
Article in Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionWhile most adult measures of health-related quality of life (HRQoL) are designed for self-completion, their use in low- and middle-income countries involves interviewer administration. Large-scale population surveys in China that collect EQ-5D data via face-to-face interviews typically show high ceiling effects. We aimed to identify non-standard interviewing approaches in the collection of EQ-5D data in a large-scale population health survey in China and to explore reasons for these non-standard approaches and plausible mechanisms through which these deviations may influence EQ-5D response patterns.
methodsA random sample of routinely recorded interviews from population health surveys in Nanjing, China were thematically analysed to identify interviewing approaches to collecting EQ-5D-3L. Focus group discussions with ten interviewers were used to explore the reasons for those approaches.
resultsSix non-standard interviewing approaches were identified: skipping questions; altering question wording; combining multiple dimensions into one question; altering response options; selecting responses based on interviewer interpretation of respondent's narrative; and not asking the interviewee any questions. Three main reasons motivated these non-standard approaches: (a) comprehension and response challenges among low-literacy respondents; (b) survey structure, including overall length, positioning of EQ-5D questions and respondent burden leading to time-saving interview strategies; (c) limited interviewer knowledge of self-reported health measures, including a tendency to view EQ-5D as an observer-assessed instrument.
conclusionOur findings highlight challenges in interviewer administration of the EQ-5D in large-scale population surveys. The non-standard approaches observed may affect data quality, potentially contribute to ceiling effects, and complicate the interpretation of these data being 'self-reported'. Providing training on EQ-5D data collection to interviewers may be a first step to strengthening data collection processes.
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