Content validity of the EQ-HWB in caregivers of children with health conditions

Introduction

The EQ Health and Wellbeing instrument (EQ-HWB) is a new generic instrument designed for evaluation across health, social care, community, and caregiver populations. It has 25-item (EQ-HWB) and 9-item (EQ-HWB-S) versions. Validation across target populations is needed. As the instrument remains in an ‘experimental’ phase, modifications are being considered, including to item wording, item order, and positive versus negative framing of three items. We aimed to investigate the content validity of the EQ-HWB for caregivers of children with chronic health conditions and explore the potential modifications.

Methods

In total, 21 caregivers from an Australian children’s hospital sample completed semi-structured interviews, answering the 25 EQ-HWB items while ‘thinking aloud’, followed by interviewer probing. Interviews and coding focused on the COSMIN components of relevance, comprehension (understanding), and comprehensiveness.

Results

Most EQ-HWB items were relevant and well understood by participants, especially the psychosocial items (e.g., loneliness, anxiety). Some participants were confused by the wording in the seeing and hearing items, which were also less relevant in this population. The item ‘feeling unsafe’ was only relevant for a few participants, but most considered it important. Responses to potential modifications to items were mixed. Many participants were keen to keep the three positively worded items. Some participants suggested that finishing with positive items may mitigate negative feelings on completion.

Conclusions

EQ-HWB items have high relevance and are generally well understood by caregivers of children with health conditions. We recommend endorsing the modifications we tested for the EQ-HWB-S.