Cross-cultural measurement equivalence of the EQ-5D-5L items for English-speaking Asians in Singapore.

PURPOSE: To investigate how the response labels of the 5-level EQ-5D (EQ-5D-5L) items are interpreted and used by English-speaking Chinese and non-Chinese Singaporeans, as a means to assessing whether those items are cross-culturally equivalent health-status measures in this Asian population. METHODS: In face-to-face interviews, Chinese, Malay and Indian visitors to a primary care institution in Singapore were asked to rate the relative severity conveyed by EQ-5D-5L response labels, each containing the keyword of 'no(t),' 'slight(ly),' 'moderate(ly),' 'severe(ly),' or 'unable'/'extreme(ly),' using a 0-100 numerical rating scale. Participants were also asked to describe 25 hypothetical health states using the EQ-5D-5L response labels. Differences between Chinese and Malay/Indian participants in label interpretation and selection were examined using multivariate regression analysis to adjust for participant characteristics. RESULTS: The differences in adjusted mean severity scores for individual EQ-5D-5L labels between Chinese (n = 148) and non-Chinese (Malay: n = 53; Indian: n = 56) participants ranged from 0.0 to 9.0. The relative severity of the labels to the participants supported the ordinality of the EQ-5D-5L response labels and was similar across ethnic groups. Chinese and non-Chinese participants selected similar response labels to describe each hypothetical health state, with the adjusted odds ratios of selecting any type of the five response labels for non-Chinese versus Chinese participants ranging from 0.92 to 1.15 (p > 0.05 for all). CONCLUSIONS: The EQ-5D-5L items are likely to generate equivalent health outcomes between English-speaking Chinese and non-Chinese Singaporeans.

Improving the uptake of human immunodeficiency virus (HIV) antenatal screening in a primary healthcare setting.

INTRODUCTION: It has been well established that proper treatment and management of human immunodeficiency virus (HIV)-infected mothers can decrease virus transmission to their fetuses. HIV screening of antenatal mothers attending government polyclinics was offered from 1998 at a subsidized cost of $5 and given on a voluntary basis. The polyclinics provide antenatal care to approximately 12% of pregnant mothers in Singapore who belong mainly to the lower socio-economic group. The uptake of the HIV screening by these mothers has been poor. MATERIALS AND METHODS: A one-month study was first undertaken in 1999 to determine the reasons for the poor uptake and to propose recommendations for improving the uptake. A second one-month study was undertaken in 2001 to evaluate the effect of the new strategies after implementation. FINDINGS: This first study showed that refusal for the test was mainly due to poor perception of risk among the mothers. The HIV screening test was incorporated into an antenatal screening package and consent was obtained for this package. This was implemented on an opt-out basis. The second study done after implementation showed that the uptake of the HIV screening improved from 45% to 99%. CONCLUSION: The incorporation of the antenatal HIV screening into an antenatal screening package, and implementing this on an opt-out basis, improves uptake to almost a universal level.

Ethnic differences in glycaemic control in adult Type 2 diabetic patients in primary care: a 3-year follow-up study.

OBJECTIVE: To evaluate ethnic differences and characteristics related to glycaemic control in patients with Type 2 diabetes in primary care. RESEARCH DESIGN AND METHODS: Prospective cohort study; 500 adult patients with Type 2 diabetes, who were not on insulin therapy, were followed up annually for 3 years. HbA(1c) at baseline and 3-year changes and subsequent insulin therapy were related to baseline characteristics. RESULTS: Malay patients had significantly higher HbA(1c) (mean 8.7% +/- sd 1.66) compared with Chinese (8.2 +/- sd 1.67) and Indian (8.2 +/- sd 1.55) (P = 0.032) at baseline, and consistently for all years of HbA(1c) assessment (P = 0.017). At baseline, Malay patients were significantly more obese than Chinese or Indians (P < 0.001); fewer of them received structured shared-care intervention (P = 0.001), but they had a significantly higher glucose control educational score (P < 0.05). Multivariable analyses showed that HbA(1c) at baseline was significantly related to age (P = 0.001), BMI (P = 0.031) and ethnicity (P = 0.002). HbA(1c) declined significantly over 3 years in the whole population and in all ethnic groups. Significantly greater HbA(1c) declines were associated with higher baseline HbA(1c), structured shared-care intervention and non-insulin therapy. Correcting for differences on these factors, the decline in HbA(1c) in Malays was significantly less than in the Chinese. Insulin therapy was associated with higher baseline HbA(1c) and higher BMI. CONCLUSIONS: Malay ethnicity was associated with persistently poor glycaemic control. Sociocultural and behavioural factors should be addressed in improving care for patients with poorly controlled diabetes.