title: Interpretation and use of the 5-level EQ-5D response labels varied with survey language among Asians in Singapore.
abstract: OBJECTIVE
  This study aimed to investigate the comparability of the English, Chinese, and Malay versions of the 5-level EQ-5D (EQ-5D-5L) response labels in Singapore.
  
  
  METHODS
  Visitors to a primary care institution in Singapore (n = 743) were asked to complete two exercises: (1) rating the severity of the EQ-5D-5L response labels presented in English, Chinese, or Malay using a 0-100 numeric rating scale and (2) using the labels to describe various hypothetical health problems. Label ratings and choices between language versions were compared using regression analysis.
  
  
  RESULTS
  Perceived severity of the English and Chinese labels was similar. Compared with their English counterparts, the Malay label "slight(ly)" was rated as more severe (adjusted mean difference: 10.5 to 14.5) and "unable"/"extreme(ly)" as less severe (adjusted mean difference: -13.3 to -11.0) (P < 0.001 for all). The Malay labels "no(t)" and "unable"/"extreme(ly)" and the less severe Chinese labels were more frequently used to describe hypothetical health problems than their English counterparts.
  
  
  CONCLUSIONS
  Interpretation and use of the EQ-5D-5L response labels vary among Singaporeans using different language versions of the instrument. Future studies need to investigate ways to reduce the variations and increase the cross-cultural measurement equivalence of the instrument.
authors.affiliation: Health Systems & Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Block MD1, 12 Science Drive 2, Singapore 117549. Electronic address: nan_luo@nuhs.edu.sg.
authors.forename: Nan
authors.initials: N
authors.lastname: Luo
authors.affiliation: Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA.
authors.forename: Ye
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Care and Health Integration, Changi General Hospital, 2 Simei Street 3, Singapore 529889.
authors.forename: Choon How
authors.initials: CH
authors.lastname: How
authors.affiliation: SingHealth Polyclinics, 167 Jalan Bukit Merah, Singapore 150167.
authors.forename: Ee Guan
authors.initials: EG
authors.lastname: Tay
authors.affiliation: Department of Rheumatology & Immunology, Singapore General Hospital, Outram Road, Singapore 169608; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228.
authors.forename: Julian
authors.initials: J
authors.lastname: Thumboo
authors.affiliation: Office of Health Economics, 105 Victoria Street, London SW1E 6QT, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Herdman
mesh_terms: D000328:Adult; D000368:Aged; D044466:Asian People / Q000523:psychology*; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008875:Middle Aged; D011594:Psychometrics / Q000295:instrumentation* / Q000379:methods; D011788:Quality of Life / Q000523:psychology*; D012044:Regression Analysis; D015203:Reproducibility of Results; D018434:Sickness Impact Profile; D012846:Singapore; D011795:Surveys and Questionnaires / Q000592:standards*; D055815:Young Adult
keywords: Cross-cultural; EQ-5D; Language; Measurement equivalence; Response label; Singapore