Experiences administering the EuroQol five-dimension five-level (EQ-5D-5L) for valuation of health-related quality of life estimates in Kenya: An embedded qualitative study
4 affiliations
- 1Health Economics Research Unit, KEMRI Wellcome Trust Research Programme, Nairobi, Kenya
- 2Department of Economics, School of Humanities and Social Sciences, University of Zambia, Lusaka, Zambia
- 3Health Policy Research Group, Departments of Health Administration & Management and Pharmacology & Therapeutics, College of Medicine, University of Nigeria, Nsukka, Nigeria
- 4Centre for Global Health and Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
Abstract
The EuroQol five-dimension five-level (EQ-5D-5L) instrument is increasingly used to develop health-state utility value sets for computing quality-adjusted life years (QALYs) in economic evaluations. However, little attention has been given to the practical realities of administering EQ-5D-5L valuation interviews in African settings. This study examined experiences of administering EQ-5D-5L valuation interviews in Kenya. We conducted an embedded qualitative study alongside the Kenyan EQ-5D-5L national valuation study. Data were collected through 23 post-valuation in-depth interviews with community participants and 16 debrief sessions with valuation interviewers and field supervisors. Post-valuation interviews were conducted in English or Kiswahili, audio-recorded, transcribed verbatim, translated where necessary, and analysed thematically. Health-state preferences were shaped by personal and contextual factors, including illness experience, household financial implications of ill health, beliefs about death, norms concerning independence and social worth, and local environmental conditions. Participants identified aspects of health they felt were not fully captured by the EQ-5D-5L descriptive system, namely vision, speech, broader aspects of mental health and social relationships. Pain/discomfort, mobility, and usual activities were often the most influential dimensions, while anxiety/ depression was generally given less weight. Tool-related linguistic and semantic challenges affected comprehension of some terms, while participant-related factors such as limited literacy, sensory difficulties and caregiving responsibilities also shaped administration. Valuation interviewers and field supervisors used strategies to preserve the intended logic of the valuation tasks, support participant comprehension, manage interruptions and protect data quality. Embedding qualitative methods within EQ-5D-5L valuation studies can complement standard quality-control procedures and quantitative valuation outputs by explaining how participants understood health states, what factors shaped their preferences, and whether administration challenges may have influenced responses. These insights can help researchers and decision-makers interpret final utility values by showing whether observed valuation patterns reflect locally meaningful preferences or challenges in understanding and completing valuation tasks.
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BibTeX
@article{waithaka2026experiences,
title = {{Experiences administering the EuroQol five-dimension five-level (EQ-5D-5L) for valuation of health-related quality of life estimates in Kenya: An embedded qualitative study}},
author = {Dennis Wambiri Waithaka and Angela Kairu and Jacob Kazungu and Stacey Orangi and Felix Masiye and Obinna Onwujekwe and Edwine Barasa},
journal = {PLOS Global Public Health},
year = {2026},
month = nov,
doi = {10.1371/journal.pgph.0007568},
url = {https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007568},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Experiences administering the EuroQol five-dimension five-level (EQ-5D-5L) for valuation of health-related quality of life estimates in Kenya: An embedded qualitative study
AU - Dennis Wambiri Waithaka
AU - Angela Kairu
AU - Jacob Kazungu
AU - Stacey Orangi
AU - Felix Masiye
AU - Obinna Onwujekwe
AU - Edwine Barasa
PY - 2026
DA - 2026/11/04
JO - PLOS Global Public Health
DO - 10.1371/journal.pgph.0007568
UR - https://journals.plos.org/globalpublichealth/article?id=10.1371/journal.pgph.0007568
AB - The EuroQol five-dimension five-level (EQ-5D-5L) instrument is increasingly used to develop health-state utility value sets for computing quality-adjusted life years (QALYs) in economic evaluations. However, little attention has been given to the practical realities of administering EQ-5D-5L valuation interviews in African settings. This study examined experiences of administering EQ-5D-5L valuation interviews in Kenya. We conducted an embedded qualitative study alongside the Kenyan EQ-5D-5L national valuation study. Data were collected through 23 post-valuation in-depth interviews with community participants and 16 debrief sessions with valuation interviewers and field supervisors. Post-valuation interviews were conducted in English or Kiswahili, audio-recorded, transcribed verbatim, translated where necessary, and analysed thematically. Health-state preferences were shaped by personal and contextual factors, including illness experience, household financial implications of ill health, beliefs about death, norms concerning independence and social worth, and local environmental conditions. Participants identified aspects of health they felt were not fully captured by the EQ-5D-5L descriptive system, namely vision, speech, broader aspects of mental health and social relationships. Pain/discomfort, mobility, and usual activities were often the most influential dimensions, while anxiety/ depression was generally given less weight. Tool-related linguistic and semantic challenges affected comprehension of some terms, while participant-related factors such as limited literacy, sensory difficulties and caregiving responsibilities also shaped administration. Valuation interviewers and field supervisors used strategies to preserve the intended logic of the valuation tasks, support participant comprehension, manage interruptions and protect data quality. Embedding qualitative methods within EQ-5D-5L valuation studies can complement standard quality-control procedures and quantitative valuation outputs by explaining how participants understood health states, what factors shaped their preferences, and whether administration challenges may have influenced responses. These insights can help researchers and decision-makers interpret final utility values by showing whether observed valuation patterns reflect locally meaningful preferences or challenges in understanding and completing valuation tasks.
SN - 2767-3375
ER -