Using best-worst scaling choice experiments to elicit the most important domains of health for health-related quality of life in Singapore

Health-related quality of life (HRQOL) instruments are sometimes used without explicit understanding of which HRQOL domains are important to a given population. In this study, we sought to elicit an importance hierarchy among 27 HRQOL domains (derived from the general population) via a best-worst scaling survey of the population in Singapore, and to determine whether these domains were consistently valued across gender, age, ethnicity, and presence of chronic illnesses. We conducted a community-based study that sampled participants with quotas for gender, ethnicity, age, presence of chronic illness, and interview language. For the best-worst scaling exercise, we constructed comparison sets according to a balanced incomplete block design resulting in 13 sets of questions, each with nine choice tasks. Each task involved three HRQOL domains from which participants identified the most and least important domain. We performed a standard analysis of best-worst object scaling design (Case 1) using simple summary statistics; 603 residents participated in the survey. The three most important domains of health were: "the ability to take care of self without help from others" (best-worst score (BWS): 636), "healing and resistance to illness" (BWS: 461), and "having good relationships with family, friends, and others" (BWS: 373). The 10 top-ranked domains included physical, mental, and social health. The three least important domains were: "having a satisfying sex life" (BWS: -803), "having normal physical appearance" (BWS: -461), and "interacting with others (talking, shared activities, etc.)" (BWS: -444). Generally, top-ranked domains were consistently valued across gender, age, ethnicity, and presence of chronic illness. We conclude that the 10 top-ranked domains reflect physical, mental, and social dimensions of well-being suggesting that the sampled population's views on health are consistent with the World Health Organization's definition of health, "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity".