Evaluating Performance of the Experimental EQ-TIPS (V3) for Assessing Infants and Toddlers with Acute Infections: A Mixed-Methods Approach of Cognitive Debriefing and Psychometric Testing
1
Saw Swee Hock School of Public Health, National university of Singapore, Singapore, Singapore
2
Children's Emergency, Department of Paediatrics, Khoo Teck Puat, National University Children's Medical Institute, National University Hospital, Singapore, Singapore
3
EuroQol Research Foundation, Rotterdam, Netherlands
4
Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
5
National Perinatal Epidemiology Unit, Nuffield Department of Women’s and Reproductive Health, University of Oxford, Singapore, Singapore
6
Alice Lee Centre for Nursing Studies, Young Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
The EuroQol Toddler and Infant Populations (EQ-TIPS) was developed to assess health-related quality of life (HRQoL) in children aged 0–3 years. While the earlier 6-item, 3-level EQ-TIPS (V2) has been tested, the experimental 7-item version (V3) with 3- or 5-level response scales (EQ-TIPS-3L and EQ-TIPS-5L) has not yet been evaluated. This study assessed the updated experimental EQ-TIPS among caregivers of infants and toddlers with acute infections in Singapore.
METHODS:
We used a mixed-methods design, comprising cognitive interviews and psychometric testing. Primary caregivers of children participated in interviews exploring clarity, comprehensiveness, and interpretation of EQ-TIPS items and the visual analogue scale (VAS), which were then analysed thematically. For psychometric testing, caregivers of children with acute infections such as rhinorrhoea or tachypnoea were recruited from a tertiary hospital’s emergency department. At baseline, caregivers completed EQ-TIPS-3L, EQ-TIPS-5L, and PedsQL to assess ceiling and floor effects, as well as convergent validity. Two weeks later, follow-up assessments were conducted via Zoom to evaluate responsiveness to clinical change using standardized response means (SRM) of EQ-TIPS-3L and EQ-TIPS-5L level sum scores (LSS).
RESULTS:
Caregivers (n=10) found EQ-TIPS acceptable, relevant, and easy to complete, although some ambiguity was noted in emotion and sleep items, with suggestions to extend the recall period and simplify the VAS. For the data from 77 caregivers of children (40 reassessed), ceiling effects (1111111) were 28.6% (3L) and 16.9% (5L), while floor effects were 0%. Both versions demonstrated strong convergent validity (ρ = 0.71). At follow-up, large SRMs among caregivers reporting HRQoL improvements indicated good responsiveness: –0.82 (EQ-TIPS-3L LSS), –0.81 (EQ-TIPS-5L LSS), and 1.47 (VAS).
CONCLUSIONS:
Both EQ-TIPS-3L and EQ-TIPS-5L demonstrated good content and construct validity, as well as responsiveness to recovery, for assessing acutely ill young children. Despite some item ambiguity, findings support their use in evaluating HRQoL in this population.
The EuroQol Toddler and Infant Populations (EQ-TIPS) was developed to assess health-related quality of life (HRQoL) in children aged 0–3 years. While the earlier 6-item, 3-level EQ-TIPS (V2) has been tested, the experimental 7-item version (V3) with 3- or 5-level response scales (EQ-TIPS-3L and EQ-TIPS-5L) has not yet been evaluated. This study assessed the updated experimental EQ-TIPS among caregivers of infants and toddlers with acute infections in Singapore.
METHODS:
We used a mixed-methods design, comprising cognitive interviews and psychometric testing. Primary caregivers of children participated in interviews exploring clarity, comprehensiveness, and interpretation of EQ-TIPS items and the visual analogue scale (VAS), which were then analysed thematically. For psychometric testing, caregivers of children with acute infections such as rhinorrhoea or tachypnoea were recruited from a tertiary hospital’s emergency department. At baseline, caregivers completed EQ-TIPS-3L, EQ-TIPS-5L, and PedsQL to assess ceiling and floor effects, as well as convergent validity. Two weeks later, follow-up assessments were conducted via Zoom to evaluate responsiveness to clinical change using standardized response means (SRM) of EQ-TIPS-3L and EQ-TIPS-5L level sum scores (LSS).
RESULTS:
Caregivers (n=10) found EQ-TIPS acceptable, relevant, and easy to complete, although some ambiguity was noted in emotion and sleep items, with suggestions to extend the recall period and simplify the VAS. For the data from 77 caregivers of children (40 reassessed), ceiling effects (1111111) were 28.6% (3L) and 16.9% (5L), while floor effects were 0%. Both versions demonstrated strong convergent validity (ρ = 0.71). At follow-up, large SRMs among caregivers reporting HRQoL improvements indicated good responsiveness: –0.82 (EQ-TIPS-3L LSS), –0.81 (EQ-TIPS-5L LSS), and 1.47 (VAS).
CONCLUSIONS:
Both EQ-TIPS-3L and EQ-TIPS-5L demonstrated good content and construct validity, as well as responsiveness to recovery, for assessing acutely ill young children. Despite some item ambiguity, findings support their use in evaluating HRQoL in this population.
| eISSN: | 2654-1459 |
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