Key result
Modified EQ-HWB scales show mixed psychometric performance with weaker item-level correlations than the original version.
Why the study?
Following proposed revisions to item order, response levels, and wording since the 2022 version, the psychometric properties of the modified Simplified Chinese EQ-HWB and EQ-HWB-S needed assessment.
Cross-Sectional (n=1,053)
The modified Simplified Chinese EQ-HWB and EQ-HWB-S demonstrate mixed psychometric performance with improved distributional characteristics but weaker item-level correlations compared to earlier versions.
Answers are grounded in this paper and cite their sources.
May warrant caution before clinical adoption of modified EQ-HWB; leaves open need for item-level optimization and further validation.
OBJECTIVES: The Modified EQ Health and Wellbeing (EQ-HWB) and its shorter version (EQ-HWB-S) are new health and well-being measures nearing finalization. Since the 2022 version, the development group has proposed revisions to the item order, response levels, and wording. This study aimed to assess the psychometric properties of the modified Simplified Chinese EQ-HWB and EQ-HWB-S and compare their performance with other measures. METHODS: The data were collected through a web-based survey of the Chinese general population (n = 1053). Outcome measures included the modified EQ-HWB, EQ-5D-5L, SF-6Dv2, ICEpop CAPability measure for Adults, short version of Warwick-Edinburgh Mental Wellbeing Scale (SWEMWBS), and World Health Organization Well-Being Index 5-Item. We examined psychometric properties, such as distributional characteristics (ceiling and floor), convergent (correlations), known-group (effect sizes), and structural validity (principal component analysis). RESULTS: At the instrument level, neither the modified EQ-HWB nor EQ-HWB-S showed ceiling effect. The response distribution of the 3 items (enjoyable activities, excluded by others, and negative feelings about oneself) modified from positively to negatively framed was in the range of the other items. The EQ-HWB "getting around inside or outside," "day-to-day activities," and "enjoyable activities" items showed only moderate correlations with the corresponding EQ-5D-5L and SF-6Dv2 dimensions (rho = 0.31-0.36). The EQ-HWB items mainly loaded on separate factors from the ICEpop CAPability measure for Adults, short version of Warwick-Edinburgh Mental Wellbeing Scale, and World Health Organization Well-Being Index 5-Item items. The EQ-HWB effectively differentiated between sociodemographic and health-related known groups with larger effect sizes than the EQ-HWB-S. CONCLUSIONS: The modified EQ-HWB and EQ-HWB-S demonstrated mixed psychometric performance. Several modified items showed improved distributional characteristics compared with earlier findings with the original EQ-HWB. However, item-level correlations were somewhat weaker than those reported in previous studies using the original version.
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Xu et al. (2025) conducted a cross-sectional in General population (n=1,053). Modified EQ Health and Wellbeing (EQ-HWB) questionnaire vs. Other well-being measures (EQ-5D-5L, SF-6Dv2, ICECAP-A, SWEMWBS, WHO-5) was evaluated on Psychometric properties (ceiling/floor effects, convergent validity, known-group validity, structural validity). The modified EQ-HWB and EQ-HWB-S demonstrated mixed psychometric performance, showing no instrument-level ceiling effects but weaker item-level correlations than the original version.
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