There are nearly three million Chinese speakers in the U.S. (the third most common language in this country after English and Spanish). Many evidence-based tools and health interventions have not been validated or culturally adapted for Chinese Americans.  Our goal is to contribute to the knowledge base to improve access to care and quality of care for this population.

There is increasing interest in integrating patient-reported outcome measures (PROMs) into routine clinical care. PROMs are questionnaires that translate symptoms and their impact on mental and physical functioning into a numerical score that can be used by providers to better understand and track patients’ perspectives on their overall mental or physical well-being.  The EQ-5D-5L1 is a health-related quality of life PROM developed by the EuroQol Group that has two main components – (1) 5 questions that measure problems related to mobility, self-care, usual activities, pain, and anxiety, and (2) a visual analogue scale, measuring self-reported overall health. Although the EQ-5D-5L has been validated with Chinese-speaking populations outside of the US, limited research exists regarding its application to Chinese American populations.

EQ-5D-5L quality of life items

One of five health-related quality of life items that comprise the EQ-5D-5L. Source: Herdman, M., Gudex, C., Lloyd, A., et al. (2011). Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res, 20, 1727-1736.

In order to assess the feasibility of PROM use during routine clinical care, the Charles B. Wang Community Health Center performed an evaluation of patient attitudes toward the EQ-5D-5L. In this evaluation, English-, Mandarin- and Cantonese-speaking patients were asked to complete the EQ-5D-5L followed by a brief survey assessing their attitudes towards its ease of use.

Chart of Visual Analogue Scale

Despite some differences across patients’ spoken languages, most patients found the EQ-5D-5L visual analogue scale easy to answer.

Survey results showed overall positive attitudes toward both the five-item questionnaire and visual analogue scale with the majority of patients reporting both components being easy to answer. Findings suggest feasibility for routine clinical use.

PROMs can be a powerful tool for measuring patient health outcomes and may be able to capture health-related quality of life issues in ways that traditional clinical indicators cannot.  However, physician perspectives on the routine use of PROMs should also be considered before further steps toward implementation can be considered.

This research project was conducted by Naumi Feldman and Jane Wong. Their study, “Incorporating a Patient Reported Outcome Measure into Clinical Care: Patient Perspectives on the EQ-5D-5L” was presented at the 2017 Chinese American Medical Society’s Annual Scientific Conference as an oral presentation.

1EQ-5DTM is a trademark of the EuroQol Group. All EQ-5D products, including the EQ-5D-5L, are distributed exclusively from the EuroQol Executive Office (


Posted by Charles B. Wang Community Health Center

The Charles B. Wang Community Health Center is a nonprofit and federally qualified health center, established in 1971. Our mission is to provide high quality and affordable health care to the undeserved, with a focus on Asian Americans. Our vision is to ensure that everyone has full and equal access to the highest level of health care. Learn more at

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