Comparing the measurement equivalence of paper and text message versions of the EQ-5D-3L in a rural South African setting.

Henry Burnand, Samuel McMahon, Adrian Sayers, Tembisa Tshengu, Norrie Gibson, Ashley Blom, Michael Whitehouse, Vikki Wylde

Research output: Contribution to journalArticle (Academic Journal)peer-review


Administering patient-reported outcome measures (PROMs) by text message may improve response rate in hard-to-reach populations. This study explored cultural acceptability of PROMs and compared measurement equivalence of the EQ-5D-3L administered on paper and by text message in a rural South African setting.

Participants with upper or lower limb orthopaedic pathology were recruited. The EQ-5D was administered first on paper and then by text message after 24 hours and seven days. Differences in mean scores for paper and text message versions of the EQ-5D were evaluated. Test-retest reliability between text message versions was evaluated using Intraclass Correlation Coefficients (ICCs).

147 participants completed a paper EQ-5D. Response rates were 67% at 24 hours and 53% at seven days. There were no differences in means between paper and text message responses for the EQ-5D Index (p=0.95) or EQ-5D VAS (p=0.26). There was acceptable agreement between the paper and 24-hour text message EQ-5D Index (0.84; 95% Confidence Interval (CI) 0.78 – 0.89) and EQ-5D VAS (0.73; 95% CI 0.64 - 0.82) and acceptable agreement between the 24-hour and seven-day text message EQ-Index (0.72; CI 0.62 – 0.82) and EQ-VAS (0.72; CI 0.62 – 0.82). Non-responder traits were increasing age, Xhosa as first-language and lower educational levels.

Text messaging is equivalent to paper-based measurement of EQ-5D in this setting and is thus a viable tool for responders. Non-responders had similar socioeconomic characteristics and dropout rates to traditional modes of administration. The EQ-5D by text message offers potential clinical and research uses in hard-to-reach populations.
Original languageEnglish
JournalQuality of Life Research
Publication statusUnpublished - 2019

Structured keywords

  • Centre for Surgical Research


  • Text messaging
  • Rural health services
  • Patient reported outcome measures
  • Measurement equivalence
  • EQ-5D


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