Comparison of the psychometric properties of the Afaan Oromo versions of the EQ-5D-Y-3L and EQ-5D-Y-5L in Ethiopia

The psychometric properties of the EQ-5D-Y-3L (Y-3L) and EQ-5D-Y-5L (Y-5L) have been compared across several countries; however, no evidence is available for the Afaan Oromo versions in Ethiopia. This study aimed to compare the psychometric properties of the Afaan Oromo versions of the Y-3L and Y-5L among Ethiopian children and adolescents with and without health conditions. The self-completed versions of the Y-3L and Y-5L were administered in a random order on two occasions (7 days apart) to assess test-retest reliability. Participants were children and adolescents aged 8–15 years with asthma, congestive heart failure, and acute lymphoblastic leukaemia, as well as school children and adolescents from the general population without known health conditions. Feasibility, ceiling effect, redistribution, and informativity were assessed using missing values, proportions reporting no problems, inconsistency between paired responses, and Shannon indices, respectively. Test-retest reliability was assessed using the intraclass correlation coefficient (ICC) and Cohen’s weighted kappa. Known-groups validity was evaluated using the Kruskal-Wallis test. A total of 473 participants completed both instruments. The proportion of missing values was low for both the Y-3 L (3.8%) and Y-5 L (4.2%). The ceiling effect was lower for Y-5 L (47.2%) compared to Y-3 L (53.6%). The proportion of inconsistent responses ranged from 4.4% for the ‘feeling worried, sad, or unhappy’ dimension to 7.0% for the ‘looking after myself’ and ‘having pain or discomfort’. The Y-5 L demonstrated higher discriminatory power, indicated by a higher Shannon diversity index across all dimensions. Test-retest reliability was moderate for the Y-3 L (ICC = 0.70) and good for the Y-5 L (ICC = 0.80) based on level sum scores. The EQ VAS also showed good reliability (ICC = 0.85). Known-group validity was supported, as both versions distinguished school children from those with chronic health conditions and between different clinical severities. The Y-3 L and Y-5 L demonstrated comparable feasibility and confirmed known-group validity among children and adolescents in Ethiopia. The Y-5 L showed slightly better measurement performance by reducing the ceiling effect, improving discriminatory power, and demonstrating higher test-retest reliability. Although both instruments are suitable for use in the Ethiopian pediatric population, these findings suggest that the Y-5 L may be preferable when assessing HRQoL due to its improved measurement performance.