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Large-scale population surveys in China that collect EQ-5D data via face-to-face interviews typically show high ceiling effects. We aimed to identify non-standard interviewing approaches in the collection of EQ-5D data in a large-scale population health survey in China and to explore reasons for these non-standard approaches and plausible mechanisms through which these deviations may influence EQ-5D response patterns.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A random sample of routinely recorded interviews from population health surveys in Nanjing, China were thematically analysed to identify interviewing approaches to collecting EQ-5D-3L. Focus group discussions with ten interviewers were used to explore the reasons for those approaches.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Six non-standard interviewing approaches were identified: skipping questions; altering question wording; combining multiple dimensions into one question; altering response options; selecting responses based on interviewer interpretation of respondent\u2019s narrative; and not asking the interviewee any questions. Three main reasons motivated these non-standard approaches: (a) comprehension and response challenges among low-literacy respondents; (b) survey structure, including overall length, positioning of EQ-5D questions and respondent burden leading to time-saving interview strategies; (c) limited interviewer knowledge of self-reported health measures, including a tendency to view EQ-5D as an observer-assessed instrument.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings highlight challenges in interviewer administration of the EQ-5D in large-scale population surveys. The non-standard approaches observed may affect data quality, potentially contribute to ceiling effects, and complicate the interpretation of these data being \u2018self-reported\u2019. Providing training on EQ-5D data collection to interviewers may be a first step to strengthening data collection processes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11136-026-04351-4","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T11:04:04Z","timestamp":1785409444000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges with interviewer administration of EQ-5D questionnaires in a large-scale population survey in China: a qualitative analysis"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2243-8818","authenticated-orcid":false,"given":"Tianxin","family":"Pan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nan","family":"Luo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhuxin","family":"Mao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xin","family":"Hong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chao","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Devlin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"4351_CR1","doi-asserted-by":"publisher","DOI":"10.1007\/s11136-025-03983-2","author":"JA Johnson","year":"2025","unstructured":"Johnson, J. 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All authors have received previous or current funding from the EuroQol Research Foundation, who is the developer and copyright holder of the instruments included in this study.","order":1,"name":"Ethics","label":"Conflict of interest","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and\/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical approval was granted by Nanjing Centre of Disease Control and Prevention Ethics Committee (PJ2020-B001-01 on 17th of August 2020, PJ2022-A001-04 on 10th of February 2022).","order":2,"name":"Ethics","label":"Ethical approval","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"252"}}