Abstract

BackgroundWith an increasing awareness of people’s satisfaction and feeling, health-related quality of life (HRQoL) has become an essential aspect of measuring health. HRQoL is fundamentally a foreign concept introduced to China from the West. While a growing number of studies applied western HRQoL measures, few content validity tests examined the legitimacy of applying Western developed HRQoL measures in a Chinese cultural setting. If there are distinct differences in health conceptualisation between China and the West, it can be argued that those western measures may fail to ask the most appropriate and important questions among a Chinese population in assessing health. As a limited number of studies have investigated Chinese people’s understandings of health, this study aimed to explore how health is defined and described in China.MethodsA Q-methodological study was conducted to explore subjective constructions of health among Chinese participants. A scoping review of Chinese generic HRQoL measures, supplemented by a series of qualitative interviews conducted in China, produced a list of 42 statements representing aspects of health considered as being important in a Chinese cultural setting. Chinese participants in face-to-face interviews ranked and sorted these statements. Data were analysed to identify clusters of participants who shared a similar perspective, using a by-person factor analysis procedure.Results110 Chinese participants with various demographics characteristics completed sorting interviews. Five independent factors emerged: (I) “Physical independence and social interaction skills”; (II) “Physical health”; (III) “Sensations and feelings”; (IV) “Lifestyles”; (V) “Learning and working abilities”.ConclusionsThe Q-study showed that many health statements were rated highly as most important by a diverse range of Chinese participants but were not covered in the commonly used Western HRQoL measure EQ-5D. It then suggests that the EQ-5D descriptive system might need modification to improve its capacity to measure health status in China. The study thus raises a general question as to how appropriate the Western-developed HRQoL measures are when used to assess health in a significantly different cultural setting.

Highlights

  • With an increasing awareness of people’s satisfaction and feeling, health-related quality of life (HRQoL) has become an essential aspect of measuring health [1, 2]

  • Most of the commonly used HRQoL questionnaires have been developed in Europe or North America, with their descriptive systems being subsequently translated into other languages to be used worldwide

  • A growing number of studies use western HRQoL measures, few studies have considered cultural differences in conceptual equivalence [3,4,5], while those assessing crosscultural equivalence normally focus on statistical psychometric properties [5]

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Summary

Introduction

With an increasing awareness of people’s satisfaction and feeling, health-related quality of life (HRQoL) has become an essential aspect of measuring health [1, 2]. The proportion of people reporting a ceiling effect of EQ-5D in China (87% in the national population study in the year 2008) was much greater than European countries like UK, Sweden, and Germany where the proportions reporting no problem were 45, 42, and 66%, respectively. It may be because Chinese people are generally healthier than people living in the West, but this explanation is contradicted by data showing poorer life expectancy, mortality or morbidity in China. As a limited number of studies have investigated Chinese people’s understandings of health, this study aimed to explore how health is defined and described in China

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