Validation and reliability of the Chichewa translation of the EQ-5D quality of life questionnaire in adults with orthopaedic injuries in Malawi

Abstract

Background: The EQ-5D is a standardised instrument that measures health-related quality-of-life and explores cost-effectiveness of treatments. Malawi is a low-resource country that would benefit from assessment of quality-of-life. Chichewa is the native language of Malawi. The Chichewa version of the EQ-5D-3L developed by EuroQoL group has not been validated with Chichewa speakers. The purpose of this study was to evaluate the clinimetric properties of the Chichewa EQ-5D-3L. Methods: Patients with orthopaedic conditions were recruited in the outpatient orthopaedic clinics and wards at Queen Elizabeth Central Hospital, Blantyre Malawi. Fifty-three patients with various musculoskeletal problems were administered the Chichewa EQ-5D-3L and World Health Organisation quality of life (WHO-QOL) questionnaires. To assess repeatability, an separate test-retest population of 20 patients were also selected from orthopaedic clinics and wards to fill out the questionnaire twice. Results: Convergence validity was determined with each of the WHO-QOL domains and the EQ5D Descriptive index and VAS with good to moderate correlation (r = 0.3-0.7). Internal consistency was measured for the Descriptive index and the Cronbach’s alpha was 0.7. The ceiling effect for the Descriptive Index and the VAS were 9.4% and 0% respectively. No respondents reached floor effect for the descriptive index or the VAS. The test-retest intraclass correlation coefficient reliability at 14 days was 0.984 for the VAS and 1 for the Descriptive Index with all twenty respondents providing the same responses. Conclusions: The EuroQoL translated version of the Chichewa EQ-5D-3L was found to demonstrate adequate validity, internal consistency, floor/ceiling effects, and reliability.