A Randomised Equivalency Study of the EQ-5D-5L Shona Versions - Evaluation of Measurement Equivalency Between Digital and Paper Formats

Introduction: Comorbid anxiety and depression are common among people living with HIV (PLHIV), underscoring the necessity for concise diagnostic tools for routine mental health evaluations. Efficient screening can be supported by digital tools even in lower-income countries where HIV is a population health issue. The aims of this study were to: (1) examine the measurement equivalency between digital and paper versions of the Shona EQ-5D-5L, and (2), identify factors affecting the health-related quality of life (HRQoL) of PLHIV. Methods and materials: We conducted a parallel randomised study in Zimbabwe involving 700 participants equally divided into digital and paper groups. Results The study included 611 participants with a mean age of 37.5 years (SD 12.2). Most were female (70.7%), had secondary education (68.0%), and reported inadequate financial adequacy (68.7%). Both digital and paper-based versions of the EQ-5D-5L Shona displayed measurement equivalency. After adjusting for confounding and co-variation, only increased age (AOR = .60: 95% CI .41-.88, p = .008), food insecurity (AOR = 1.8: 95% CI 1.2: 2.8, p = .01), and elevated comorbid anxiety/depression symptoms (AOR = 0.45: 95% CI: 0.29–0.68, p < .001) were associated with lower HRQoL. Conclusion This study demonstrated the measurement equivalency of the digital and paper-based versions of the EQ-5D 5L Shona. These two versions can be used confidently for routine clinical care and research. The study emphasises the need for tailored interventions to improve the HRQoL of PLHIV.