Experiences administering the EuroQol five-dimension five-level (EQ-5D-5L) for valuation of health-related quality of life estimates in Kenya: An embedded qualitative study

The EuroQol five-dimension five-level (EQ-5D-5L) instrument is increasingly used to develop health-state utility value sets for computing quality-adjusted life years (QALYs) in economic evaluations. However, little attention has been given to the practical realities of administering EQ-5D-5L valuation interviews in African settings. This study examined experiences of administering EQ-5D-5L valuation interviews in Kenya. We conducted an embedded qualitative study alongside the Kenyan EQ-5D-5L national valuation study. Data were collected through 23 post-valuation in-depth interviews with community participants and 16 debrief sessions with valuation interviewers and field supervisors. Post-valuation interviews were conducted in English or Kiswahili, audio-recorded, transcribed verbatim, translated where necessary, and analysed thematically. Health-state preferences were shaped by personal and contextual factors, including illness experience, household financial implications of ill health, beliefs about death, norms concerning independence and social worth, and local environmental conditions. Participants identified aspects of health they felt were not fully captured by the EQ-5D-5L descriptive system, namely vision, speech, broader aspects of mental health and social relationships. Pain/discomfort, mobility, and usual activities were often the most influential dimensions, while anxiety/ depression was generally given less weight. Tool-related linguistic and semantic challenges affected comprehension of some terms, while participant-related factors such as limited literacy, sensory difficulties and caregiving responsibilities also shaped administration. Valuation interviewers and field supervisors used strategies to preserve the intended logic of the valuation tasks, support participant comprehension, manage interruptions and protect data quality. Embedding qualitative methods within EQ-5D-5L valuation studies can complement standard quality-control procedures and quantitative valuation outputs by explaining how participants understood health states, what factors shaped their preferences, and whether administration challenges may have influenced responses. These insights can help researchers and decision-makers interpret final utility values by showing whether observed valuation patterns reflect locally meaningful preferences or challenges in understanding and completing valuation tasks.