PNS324 A NOVEL APPROACH OF USING GRAPHICAL REPRESENTATION OF EQ-5D-3L DIMENSIONS, LEVELS, AND HEALTH STATES FOR ILLITERATE RESPONDENTS IN VALUATION STUDIES - AN EXAMPLE FROM MOROCCO

Abstract

Valuation studies of EQ-5D involve the use of time-trade off (TTO) and discrete-choice experiment (DCE) which require the respondent to be literate (i.e., able to read/write) to complete the tasks. In Morocco, the prevalence of illiteracy is reported to be 33% in 2014. Illiterate individuals represent a major segment of the Moroccan population that cannot be ignored in valuation studies; however, these individuals cannot complete text-based TTO/DCE tasks which is why we created graphical representations of the EQ-5D health states (HS) used in TTO/DCE tasks for illiterate respondents in the EQ-5D-3L valuation study in Morocco Graphical representation of the EQ-5D-3L instrument were created. Graphics depicting each dimension for the dimensions.Traffic light analogy for the levels: green=level 1, yellow=level 2, red=level 3. Illiterate respondents were instructed to look at the dimensions and levels graphics while completing the instrument. Using the same graphics and colours, we created representations for the 28 HS used in TTO and 60 in DCE, and printed them in a booklet. Out of 343 participants, 111 (32.4%) were illiterate; these participants were older, more likely to be female, live in rural settings, be married, have lower income, be unemployed, have more chronic conditions, and report more problems on all EQ-5D dimensions than literates. The mean±SD TTO score of HS valued by illiterate respondents (0.38±0.70) was slightly higher than that of literates (0.35±0.66); however, the difference was not statistically significant, and the distribution of scores was very similar. Interviewers indicated that using graphics was useful for illiterate respondents, especially the colour analogy for levels. All interviewers emphasized the importance of integrating the graphics into EQ-PVT to facilitate conducting interviews with illiterates. This novel development of graphical representation of EQ-5D dimensions, levels, and HS presents a promising approach for administering TTO and DCE tasks to illiterate respondents.