A randomised equivalence study of the EQ-5D-5L Shona versions: evaluation of measurement equivalence between digital and paper formats

Routine assessment of health-related quality of life (HRQoL) of people living with HIV (PLHIV) is essential. We evaluated measurement equivalence between the digital and paper versions of the Shona EQ-5D-5L and examined known-groups validity. We conducted a parallel randomised study in Zimbabwe with 700 participants allocated equally to the digital and paper groups. The study included 611 participants with a mean age of 37.5 years (SD 12.2). Most were female (70.7%), had secondary education (67.9%), and reported financial inadequacy (68.7%). The digital and paper versions of the EQ-5D-5L Shona demonstrated measurement equivalence. Older age (AOR = 0.60; 95% CI 0.41–0.88; p = 0.008), food insecurity (AOR = 1.80; 95% CI 1.20–2.80; p = 0.01), financial insecurity (AOR = 1.72; 95% CI 1.10–2.69; p = 0.017), and elevated CMD symptoms (AOR = 0.45; 95% CI 0.29–0.68; p < 0.001) were associated with lower HRQoL. This study demonstrated measurement equivalence between the digital and paper versions of the EQ-5D-5L Shona. Both versions can therefore be used confidently in routine clinical care and research. The findings also highlight the need for tailored interventions to improve HRQoL among PLHIV. Many people living with HIV experience anxiety and depression, which can harm their overall health. These mental health issues often go unnoticed, so it's important to have quick tools for regular checks. This study compares the digital and paper versions of the Shona EQ-5D-5L to see which one is more accurate for measuring the well-being of people living with HIV. Understanding these tools will help improve care for people with HIV. We studied 700 participants, split evenly between those using the digital version and those using the paper version of the Shona EQ-5D-5L. Our findings showed that both versions of the Shona EQ-5D-5L produced similar results. This means both can be reliably used to measure well-being in people living with HIV. We also found that older age, food insecurity, and higher anxiety or depression levels are linked to lower well-being. This shows a need for targeted programs to help improve the well-being of people living with HIV.