Psychometric properties of the health-related quality of life instrument with 8 items: a systematic review and meta-analysis

The Health-Related Quality of Life Instrument with 8 items (HINT-8) is a preference-based generic measure developed in 2014 for the Korean population. HINT-8 encompasses eight domains: climbing stairs, pain, vitality, working, depression, memory, sleep, and happiness. With the increasing use of HINT-8 in diverse research settings, a comprehensive synthesis is needed to clarify its psychometric performance and clinical utility. This study evaluated the properties of HINT-8 through a systematic review and meta-analysis. We systematically searched PubMed, KoreaMed, KMbase, KISS, and Google Scholar for studies published from January 2019 to December 2024 reporting HINT-8 outcomes. Data on HINT-8 index scores and domain-level outcomes were extracted for quantitative synthesis. Four pooled analyses were conducted: (1) construct validity using correlation with EQ-5D and SF-36, (2) reliability using Cohen’s kappa and intraclass correlation coefficients, (3) overall and domain-specific ceiling effects based on response distributions, and (4) subgroup specific HINT-8 index scores across demographic and clinical characteristics. Random-effects meta-analyses were performed, and statistical heterogeneity was assessed using I² and τ² statistics. Among the 70 studies reporting HINT-8 outcomes, 23 contributed to the quantitative synthesis. Lower HINT-8 index scores were observed among female, older adults, and individuals with lower socioeconomic status compared with their respective reference groups. Correlation coefficients demonstrated expected construct validity with higher correlations for similar domains. Distinct HINT-8 domains such as vitality, working, memory and sleep showed low correlations with EQ-5D or SF-36, reflecting its unique construct coverage. Reliability assessed by Cohen’s kappa ranged from 0.237 to 0.521 across domains, while intraclass correlation coefficients indicated substantial agreement. HINT-8 showed lower ceiling effects (5.4% [95%CI: 2.3–8.6]) than EQ-5D (41.0% [25.4–56.6]), indicating better discriminatory ability. HINT-8 index values showed clear differences across various health conditions and demographic factors. With enriched domains, HINT-8 demonstrated sensitivity and utility as a generic measure for capturing diverse health statuses when applied with established tariff-derived index scores. As all included studies were conducted in Korea, further validation in diverse settings is warranted.