Qualitative testing of EQ-HWB-9 self-complete and proxy versions in older adult-carer dyads in Hungary

Background The EuroQol Health and Wellbeing 9 (EQ-HWB-9) is an experimental generic instrument designed for use in settings, populations and contexts where measuring wellbeing alongside health is relevant to decision making, such as in social care or in assessing impacts on carers. This study aims to assess the content validity of the EQ-HWB-9 self-complete and proxy versions in dyads of older adult social care users and their carers in Hungary, and to qualitatively compare the ‘experimental modified’ (2024) version with the ‘experimental’ (2022) version. Methods In 2025, one-on-one, semi-structured interviews incorporating item-level probing and a card-sorting exercise were conducted with 15 dyads of older adult social care users and their carers in Hungary, using a convenience recruitment strategy. The self-complete version of EQ-HWB-9 was used for care recipients, while the proxy version (proxy-proxy perspective) was used for carers. We followed a standardised topic guide, focusing on three elements of content validity: comprehensibility, relevance and comprehensiveness. The interviews were analysed using framework analysis. Results EQ-HWB-9 was positively viewed by both older adult care recipients and carers, with all items considered comprehensible and relevant by most respondents in the social care context. Carers’ interpretations of the proxy version aligned with those of care recipients. Three respondents considered the examples ‘working, shopping, housework’ in the day-to-day activities item not relevant. Ten respondents mentioned seven missing concepts, most commonly social relationships, community life and intellectual life. In terms of preferences for modifications, there was support for starting with day-to-day activities, using ‘difficulty’ rather than ‘trouble’ for the ‘concentrating/thinking clearly’ item, and ‘moderate’ over ‘some’ for the difficulty response scale. However, the experimental version’s wording was preferred for the mobility and control items. Overall, 28 of 30 respondents correctly ranked the cards in the card-sorting exercise for the modified frequency scale. Conclusions This study confirmed the content validity of the experimental modified EQ-HWB-9 self-complete and proxy versions in Hungarian social care user older adult-carer dyads and provided systematic evidence on the proposed modifications to inform the finalisation of the instrument.