How Do Respondents Interpret and View the EQ-VAS? A Qualitative Study of Three Asian Populations

Background: This study aimed to understand how respondents from three Asian countries interpret and perceive the EuroQol Visual Analogue Scale (EQ-VAS). Method: Data were from a project that aimed to examine the cultural appropriateness of EQ-5D in Asia. Members of the general public from China, Japan, and Singapore were interviewed one-to-one in their preferred languages. Open-ended questions (e.g. What does “best imaginable health” mean to you?) were used to elicit participants’ interpretation of the labels of EQ-VAS. How the scale could be improved was also probed. Thematic and content analyses were performed separately for each country before pooling for comparison. Results: Sixty Chinese, 24 Japanese, and 60 Singaporeans were interviewed. Interpretations of the label “Best Imaginable Health” varied among the participants. Interestingly, some participants indicated that “Best Imaginable Health” is unachievable. Interpretations for “Worst Imaginable Health” also varied, with participants referring primarily to one of three themes, namely, “death,” “disease,” and “disability.” There were different opinions as to what changes in health would correspond to a 5- to 10-point change on the EQ-VAS. While participants opined that EQ-VAS is easy to understand, some criticized it for being too granular and that scale labels are open to interpretation. Findings from the three countries were similar. Conclusion: It appears that interpretations of the EQ-VAS vary across Asian respondents. Future studies should investigate whether the variations are associated with any respondent characteristics and whether the EQ-VAS could be modified to achieve better respondent acceptance.