{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:02:06Z","timestamp":1789646526161,"version":"4.0.0"},"reference-count":34,"publisher":"Springer Science and Business Media LLC","issue":"9","license":[{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T00:00:00Z","timestamp":1786060800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006419","name":"EuroQol Research Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100006419","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Qual Life Res"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Visual analog scales (VAS) serve as brief, informative patient reported outcome measures. The EQ VAS is an important component of EQ-5D instruments but is not currently included in the EQ-HWB-9. This study qualitatively assessed perceptions of alternative VAS constructs and recall periods for potential inclusion alongside the EQ-HWB-9 and quantitatively examined VAS ratings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>US adults who were: (1) diagnosed with chronic illness; (2) unpaid caregivers; (3) social care users (e.g., received caregiving, living with disability) completed an online survey and interview where they assessed VAS versions with health, health and wellbeing (HWB), and\/or quality of life (QoL), as the specified construct. Participants discussed construct interpretation, appropriateness of recall periods (none, today, past 7 days), and whether these influenced their responses. Interviews were analyzed qualitatively through thematic analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 34 participants, mean (SD) responses for health, HWB, and QoL were 61.9 (SD\u2009=\u200921.3), 60.9 (SD\u2009=\u200921.8) and 66.4 (SD\u2009=\u200921.5), respectively. All three VAS items were strongly correlated (\n                      <jats:italic>r<\/jats:italic>\n                      \u2009=\u20090.84\u20130.96). Interpretations of health focused on clinical, physical health more than mental\/emotional health, HWB indicated mental\/emotional health, and QoL evoked broader assessments encompassing finances or social-relationships. Most participants preferred having no specified recall period, allowing consideration of timeframes relevant to their experiences.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Although quantitative results suggested that the constructs of health, HWB, and QoL were similar, qualitative results found that they were perceived differently, highlighting the importance of a mixed-methods approach. Further research in larger samples and other countries could help to inform the extent to which constructs and recall periods affect VAS responses.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11136-026-04369-8","type":"journal-article","created":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T15:21:56Z","timestamp":1786116116000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploration of visual analogue scale versions with the EQ-HWB-9 to measure health, social care, and carer-related quality of life: a VASt landscape"],"prefix":"10.1007","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4758-7588","authenticated-orcid":false,"given":"Jonathan L.","family":"Nazari","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3696-9086","authenticated-orcid":false,"given":"Maja","family":"Kuharic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Yu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5645-7091","authenticated-orcid":false,"given":"A. Simon","family":"Pickard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,7]]},"reference":[{"key":"4369_CR1","doi-asserted-by":"publisher","first-page":"80","DOI":"10.1186\/1477-7525-10-80","volume":"10","author":"J Khadka","year":"2012","unstructured":"Khadka, J., Gothwal, V. K., McAlinden, C., Lamoureux, E. L., & Pesudovs, K. (2012). The importance of rating scales in measuring patient-reported outcomes. Health and Quality of Life Outcomes, 10, 80.","journal-title":"Health and Quality of Life Outcomes"},{"key":"4369_CR2","doi-asserted-by":"publisher","first-page":"67","DOI":"10.1016\/j.sjpain.2016.06.012","volume":"13","author":"GZ Heller","year":"2016","unstructured":"Heller, G. Z., Manuguerra, M., & Chow, R. (2016). How to analyze the visual analogue scale: Myths, truths and clinical relevance. Scandinavian Journal of Pain, 13, 67\u201375.","journal-title":"Scandinavian Journal of Pain"},{"key":"4369_CR3","doi-asserted-by":"publisher","first-page":"1223","DOI":"10.1016\/j.jval.2021.02.003","volume":"24","author":"LJ Cheng","year":"2021","unstructured":"Cheng, L. J., Tan, R. L. Y., & Luo, N. (2021). Measurement properties of the EQ VAS around the globe: A systematic review and meta-regression analysis. Value in Health, 24, 1223\u20131233.","journal-title":"Value in Health"},{"key":"4369_CR4","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/j.jval.2022.01.009","volume":"25","author":"J Brazier","year":"2022","unstructured":"Brazier, J., Peasgood, T., Mukuria, C., et al. (2022). The EQ-HWB: Overview of the development of a measure of health and wellbeing and key results. Value in Health, 25, 482\u2013491.","journal-title":"Value in Health"},{"key":"4369_CR5","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1007\/s10198-021-01306-z","volume":"22","author":"T Peasgood","year":"2021","unstructured":"Peasgood, T., Mukuria, C., Carlton, J., et al. (2021). What is the best approach to adopt for identifying the domains for a new measure of health, social care and carer-related quality of life to measure quality-adjusted life years? Application to the development of the EQ-HWB? The European Journal of Health Economics, 22, 1067\u20131081.","journal-title":"The European Journal of Health Economics"},{"key":"4369_CR6","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1007\/s40271-023-00662-7","volume":"17","author":"C Shaw","year":"2023","unstructured":"Shaw, C., Longworth, L., Bennett, B., McEntee-Richardson, L., & Shaw, J. W. (2023). A review of the use of EQ-5D for clinical outcome assessment in health technology assessment, regulatory claims, and published literature. The Patient - Patient-Centered Outcomes Research, 17, 239\u2013249.","journal-title":"The Patient - Patient-Centered Outcomes Research"},{"key":"4369_CR7","doi-asserted-by":"publisher","first-page":"2163","DOI":"10.1007\/s11136-025-03947-6","volume":"34","author":"L-H Chuang","year":"2025","unstructured":"Chuang, L-H., Kind, P., Kohlmann, T., & Feng, Y-S. (2025). Exploring the origin and conceptual framework of the EQ VAS. Quality of Life Research, 34, 2163\u20132173.","journal-title":"Quality of Life Research"},{"key":"4369_CR8","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1007\/s11136-013-0537-z","volume":"23","author":"Y Feng","year":"2013","unstructured":"Feng, Y., Parkin, D., & Devlin, N. J. (2013). Assessing the performance of the EQ-VAS in the NHS PROMs programme. Quality of Life Research, 23, 977\u2013989.","journal-title":"Quality of Life Research"},{"key":"4369_CR9","doi-asserted-by":"publisher","first-page":"489","DOI":"10.1007\/s10198-013-0489-9","volume":"15","author":"F-J Lin","year":"2013","unstructured":"Lin, F-J., Samp, J., Munoz, A., Wong, P. S., & Pickard, A. S. (2013). Evaluating change using patient-reported outcome measures in knee replacement: The complementary nature of the EQ-5D index and VAS scores. The European Journal of Health Economics, 15, 489\u2013496.","journal-title":"The European Journal of Health Economics"},{"key":"4369_CR10","doi-asserted-by":"crossref","unstructured":"Teni, F. S., Burstr\u00f6m, K., Devlin, N. (2023). Experience-based health state valuation using the EQ VAS: A register-based study of the EQ-5D-3L among nine patient groups in Sweden. Health and Quality of Life Outcomes. ;21.","DOI":"10.1186\/s12955-023-02115-z"},{"key":"4369_CR11","doi-asserted-by":"publisher","first-page":"283","DOI":"10.1007\/s40271-020-00452-5","volume":"14","author":"RLY Tan","year":"2020","unstructured":"Tan, R. L. Y., Yang, Z., Igarashi, A., Herdman, M., & Luo, N. (2020). How do respondents interpret and view the EQ-VAS? A qualitative study of three asian populations. The Patient - Patient-Centered Outcomes Research, 14, 283\u2013293.","journal-title":"The Patient - Patient-Centered Outcomes Research"},{"key":"4369_CR12","unstructured":"Congress, U. S. (2022). Protecting health care for all patients act of 2022 (H.R. 7634) \u2014 Bill Text and Summary."},{"key":"4369_CR13","doi-asserted-by":"publisher","first-page":"931","DOI":"10.1016\/j.jval.2019.02.009","volume":"22","author":"AS Pickard","year":"2019","unstructured":"Pickard, A. S., Law, E. H., Jiang, R., et al. (2019). United States valuation of EQ-5D-5L health states using an international protocol. Value in Health, 22, 931\u2013941.","journal-title":"Value in Health"},{"key":"4369_CR14","doi-asserted-by":"publisher","first-page":"1159","DOI":"10.1007\/s11136-018-1829-0","volume":"27","author":"CB Terwee","year":"2018","unstructured":"Terwee, C. B., Prinsen, C. A. C., Chiarotto, A., et al. (2018). COSMIN methodology for evaluating the content validity of patient-reported outcome measures: A Delphi study. Quality of Life Research, 27, 1159\u20131170.","journal-title":"Quality of Life Research"},{"key":"4369_CR15","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","volume":"52","author":"B Saunders","year":"2017","unstructured":"Saunders, B., Sim, J., Kingstone, T., et al. (2017). Saturation in qualitative research: Exploring its conceptualization and operationalization. Quality & Quantity, 52, 1893\u20131907.","journal-title":"Quality & Quantity"},{"key":"4369_CR16","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1016\/j.jval.2021.12.007","volume":"25","author":"J Carlton","year":"2022","unstructured":"Carlton, J., Peasgood, T., Mukuria, C., et al. (2022). Generation, selection, and face validation of items for a new generic measure of quality of life: The EQ-HWB. Value in Health, 25, 512\u2013524.","journal-title":"Value in Health"},{"key":"4369_CR17","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1016\/j.jval.2021.11.1361","volume":"25","author":"T Peasgood","year":"2022","unstructured":"Peasgood, T., Mukuria, C., Brazier, J., et al. (2022). Developing a new generic health and wellbeing measure: Psychometric survey results for the EQ-HWB. Value in Health, 25, 525\u2013533.","journal-title":"Value in Health"},{"key":"4369_CR18","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1007\/s11136-019-02344-0","volume":"29","author":"DM Condon","year":"2020","unstructured":"Condon, D. M., Chapman, R., Shaunfield, S., et al. (2020). Does recall period matter? Comparing PROMIS(\u00ae) physical function with no recall, 24-hr recall, and 7-day recall. Quality Of Life Research, 29, 745\u2013753.","journal-title":"Quality Of Life Research"},{"key":"4369_CR19","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1016\/j.jval.2023.10.006","volume":"27","author":"AEJ Gibson","year":"2024","unstructured":"Gibson, A. E. J., Longworth, L., Bennett, B., Pickard, A. S., & Shaw, J. W. (2024). Assessing the content validity of preference-based measures in cancer. Value in Health, 27, 70\u201378.","journal-title":"Value in Health"},{"key":"4369_CR20","doi-asserted-by":"crossref","unstructured":"Masutti, S., Falivena, C., Purba, F. D. (2024). Content validity of the EQ-HWB and EQ-HWB-S in a sample of Italian patients, informal caregivers and members of the general public. Journal of Patient-Reported Outcomes. ;8.","DOI":"10.1186\/s41687-024-00706-y"},{"key":"4369_CR21","doi-asserted-by":"publisher","first-page":"574","DOI":"10.1177\/0022167820962626","volume":"65","author":"G Di Malta","year":"2020","unstructured":"Di Malta, G., Cooper, M., Vos, J., & van der Veer, K. (2020). An application of the three-step test-interview (TSTI) in the validation of the relational depth frequency scale. Journal of Humanistic Psychology, 65, 574\u2013592.","journal-title":"Journal of Humanistic Psychology"},{"key":"4369_CR22","doi-asserted-by":"crossref","unstructured":"Nazari, J. L., Pickard, A. S., Yu, J., & Kuharic, M. (2026). Qualitative assessment of content validity of the modified EQ-HWB-9 by patients, caregivers, and social care users in the United States. Health Qual Life Outcomes.","DOI":"10.1186\/s12955-026-02561-5"},{"key":"4369_CR23","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","volume":"3","author":"V Braun","year":"2006","unstructured":"Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77\u2013101.","journal-title":"Qualitative Research in Psychology"},{"key":"4369_CR24","doi-asserted-by":"crossref","unstructured":"Gale, N. K., Heath, G., Cameron, E., Rashid, S., & Redwood, S. (2013). Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Medical Research Methodology. ;13.","DOI":"10.1186\/1471-2288-13-117"},{"key":"4369_CR25","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","volume":"19","author":"A Tong","year":"2007","unstructured":"Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care, 19, 349\u2013357.","journal-title":"International Journal for Quality in Health Care"},{"key":"4369_CR26","doi-asserted-by":"crossref","unstructured":"Xu, R. H., Yang, C., & Rencz, F. (2026). A quantitative exploration of the performance of a potential \u2018health and wellbeing\u2019 visual analogue scale (EQ-HWB VAS) for the EQ-HWB-9. Value Health.","DOI":"10.1016\/j.jval.2026.02.013"},{"key":"4369_CR27","doi-asserted-by":"publisher","first-page":"213","DOI":"10.3961\/jpmph.22.151","volume":"55","author":"M Ock","year":"2022","unstructured":"Ock, M., Pyo, J., Jo, M-W., Herdman, M., & Luo, N. (2022). Perceptions of the general public about health-related quality of life and the EQ-5D questionnaire: A qualitative study in Korea. Journal of Preventive Medicine and Public Health, 55, 213\u2013225.","journal-title":"Journal of Preventive Medicine and Public Health"},{"key":"4369_CR28","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1177\/237946152000600102","volume":"6","author":"C Graham","year":"2020","unstructured":"Graham, C., & MacLennan, S. (2020). Policy insights from the new science of well-being. Behavioral Science & Policy, 6, 1\u201320.","journal-title":"Behavioral Science & Policy"},{"key":"4369_CR29","doi-asserted-by":"publisher","first-page":"14","DOI":"10.3390\/economies7010014","volume":"7","author":"T Peasgood","year":"2019","unstructured":"Peasgood, T., Carlton, J., & Brazier, J. (2019). A qualitative study of the views of health and social care decision-makers on the role of wellbeing in resource allocation decisions in the UK. Economies, 7, 14.","journal-title":"Economies"},{"key":"4369_CR30","doi-asserted-by":"publisher","first-page":"24","DOI":"10.4236\/health.2013.512A004","volume":"05","author":"M Picard","year":"2013","unstructured":"Picard, M., Juster, R-P., & Sabiston, C. M. (2013). Is the whole greater than the sum of the parts? Self-rated health and transdisciplinarity. Health, 05, 24\u201330.","journal-title":"Health"},{"key":"4369_CR31","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1016\/j.jval.2025.03.006","volume":"28","author":"NJ Devlin","year":"2025","unstructured":"Devlin, N. J., Mullins, C. D., & van Baal, P. (2025). What Does \u2018Whole Health\u2019 Really Mean for Health Economics and Outcomes Research? Value in Health, 28, 699\u2013701.","journal-title":"Value in Health"},{"key":"4369_CR32","doi-asserted-by":"publisher","first-page":"702","DOI":"10.1016\/j.jval.2025.03.003","volume":"28","author":"LT Pizzi","year":"2025","unstructured":"Pizzi, L. T., Abbott, R. M., & Onukwugha, E. (2025). Taking health economics and outcomes research forward: Expanding the definition of value to include whole health. Value in Health, 28, 702\u2013704.","journal-title":"Value in Health"},{"key":"4369_CR33","doi-asserted-by":"publisher","first-page":"705","DOI":"10.1016\/j.jval.2025.03.005","volume":"28","author":"J Nabyonga-Orem","year":"2025","unstructured":"Nabyonga-Orem, J., Aidam, K., & Banda, R. (2025). Whole health: A global perspective. Value in Health, 28, 705\u2013708.","journal-title":"Value in Health"},{"key":"4369_CR34","doi-asserted-by":"publisher","first-page":"S400","DOI":"10.1016\/j.jval.2026.03.1976","volume":"29","author":"JL Nazari","year":"2026","unstructured":"Nazari, J. L., Kuharic, M., Winn, A. N., et al. (2026). PCR203 Comparing health, Health and wellbeing (HWB), and Quality of life (QOL) Visual analogue scale (VAS) Constructs with the EQ-HWB-9 in the United States (US), United Kingdom (UK), and Germany. Value in Health, 29, S400.","journal-title":"Value in Health"}],"container-title":["Quality of Life Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11136-026-04369-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s11136-026-04369-8","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s11136-026-04369-8.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:05:53Z","timestamp":1789643153000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s11136-026-04369-8"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,7]]},"references-count":34,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2026,9]]}},"alternative-id":["4369"],"URL":"https:\/\/doi.org\/10.1007\/s11136-026-04369-8","relation":{},"ISSN":["0962-9343","1573-2649"],"issn-type":[{"value":"0962-9343","type":"print"},{"value":"1573-2649","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,7]]},"assertion":[{"value":"1 May 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 August 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 August 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"This study was performed in line with the principles of the Declaration of Helsinki. Ethics approval was granted by the Institutional Review Board of the University of Illinois Chicago (IRB# 2025\u2009\u2212\u20090169).","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors affirm that human research participants provided informed consent for publications of study findings.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Informed consent was obtained electronically via the pre-interview survey, and verbal consent was re-confirmed prior to the interview. Participants provided explicit permission for audio recording.","order":3,"name":"Ethics","label":"Informed consent","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"JLN received travel support from the EuroQol group to present this work. MK and ASP are members of the EuroQol Group. JY is supported by the 2024-2026 HEOR fellowship from UIC and Pfizer Inc.","order":4,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"258"}}