Developing the EuroQol toddler and infant populations (EQ-TIPS) instrument: qualitative analysis of expert views on content validity and conceptual challenges

Abstract

Purpose: The EuroQol Toddler and Infant Populations (EQ-TIPS) is an experimental generic measure of Health-Related Quality of Life (HRQoL), for which preference weights are planned. Expert consultation aimed to (a) review EQ-TIPS V2.0 wording and content, (b) discuss possible uses for the new measure and challenges with instrument development. Methods: Semi-structured online focus group consultations were conducted with three expert groups: (1) EuroQol member experts in preference-weighted questionnaire development and use, (2) paediatric health and development practitioners, and (3) paediatric HRQoL instrument developers. Discussions were audio-recorded, transcribed verbatim and thematically analysed. Results: Experts thought EQ-TIPS would be useful in informing health research and clinical/economic decision-making, due to limited availability of preference-weighted measures for this age group. EQ-TIPS wording was generally considered appropriate, easy to follow and understand. Overall, the six EQ-TIPS dimensions included in version 2.0 were considered to provide an adequate representation of HRQoL in this age group. However, there was substantial agreement that sleep and emotions, not included in the version discussed, could be relevant. All groups further suggested that including dimension examples, rather than referring to ‘age-appropriate behaviour’, could enhance proxy comprehension. Experts emphasised that future iterations of the descriptive system should ensure dimensions remain relevant to children’s HRQoL, rather than measuring the impact on the proxy respondent. Conclusion: Overall, content in EQ-TIPS version 2.0 was considered appropriate for the target age group, but some rewording was suggested, as well as testing of additional content to ensure adequate coverage of the construct measured. Future work should include caregivers from diverse geographical, socio-economic and cultural settings.