Are symbols useful and culturally acceptable in health-state valuation studies? An exploratory study in a multi-ethnic Asian population

Original Research

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Authors: Hwee-Lin, Wee, Shu-Chuen Li, Xu-Hao Zhang, Feng Xie, David Feeny, et al

Published Date October 2008 Volume 2008:2 Pages 271 - 276

DOI: http://dx.doi.org/10.2147/PPA.S4142

Hwee-Lin, Wee¹, Shu-Chuen Li², Xu-Hao Zhang¹, Feng Xie³, David Feeny⁴, Nan Luo⁵, Yin-Bun Cheung⁶, David Machin⁷, Kok-Yong Fong⁸, Julian Thumboo⁸

¹Department of Pharmacy, National University of Singapore (NUS), Singapore; ²Discipline of Pharmacy and Experimental Pharmacology, School of Biomedical Sciences, Faculty of Health, University of Newcastle, Newcastle, NSW, Australia; ³McMaster University, Hamilton, Ontario, Canada; ⁴Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA; ⁵Department of Community, Occupational and Family Medicine, Yong Loo Lin School of Medicine, NUS, Singapore; ⁶Clinical Trials and Epidemiology Research Unit, Singapore; ⁷School of Health and Related Research, University of Sheffield, Sheffield, UK; ⁸Department of Rheumatology and Immunology, Singapore General Hospital, Singapore

Background: Symbols have been used in health state valuation studies to help subjects distinguish the severity of various characteristics of a given health state. Symbols used in such studies need to be evaluated for their cross-cultural appropriateness because a given symbol may have different meanings or acceptability in different cultures, which may affect results of such studies.

Objectives: To evaluate if using symbols to differentiate health states of different severity is useful and culturally acceptable in a multi-ethnic, urban Asian population.

Methods: Using in-depth interviews with adult Chinese, Malay, and Indian Singaporeans conducted in English/mother-tongue, subjects were shown a health state with 6 levels (Health Utilities Index 3 vision), each displayed with a symbol, and asked (1a) if symbols were useful in differentiating severity of each level (measured using dichotomous and 0–10 visual analog scale [VAS] scales) or (1b) offensive and (2) to assess 7 alternative sets of symbols.

Results: Of 63 subjects (91% response rate), 18 (29%) felt symbols were useful in differentiating severity of each level. Reported usefulness of symbols was fair (median VAS score: 3.0, score exceeding 5.0 for 33% of subjects). One Malay subject felt symbols were offensive.

Conclusions: Use of symbols for health state valuation was culturally acceptable and useful for some subjects.

Keywords: Asian, Southeastern, culture, health status, questionnaires, Singapore