Similarities and differences in health-related quality of life concepts between the East and the West: a qualitative analysis of the content of health-related quality of life measures

Objectives: Most of the commonly used health-related quality of life (HRQoL) measures were developed in the West and have been introduced into other countries for use worldwide. Arguably, this adaptation process assumes that health, as a concept, has universal cultural equivalence. This study identified those Chinese-developed HRQoL measures and summarized their contents, with which the Western-developed HRQoL measures were compared, aiming to explore cultural differences in defining and measuring health between the East and the West. Methods: A systematic literature search was conducted to identify Chinese-developed generic HRQoL measures. Two Western-developed HRQoL measures (EQ-5D, SF-36) and a cross-culturally developed measure (WHOQOL-100) were included for comparison. A qualitative content analysis was undertaken both deductively and inductively to categorize and summarize the content of the questionnaires in analyzing similarities and differences between Western and Chinese-developed HRQoL measures. Results: Eight HRQoL measures that were designed in a Chinese cultural context were identified and compared with the 3 non–Chinese-developed HRQoL measures. Although there is an agreement between the East and the West regarding the domains and subdomains of HRQoL, health concepts including "emotion control," "weather adaption," "social adaption," "spirit," and "complexion" were exclusively introduced by the Chinese measures. Conclusions: The results demonstrate that health is a culturally grounded concept, and because of cultural differences, it cannot be taken for granted that a well-recognized Western HRQoL measure is always appropriate for use in other cultural contexts. This study implies the necessity of further examining the legitimacy of applying Western-developed HRQoL measures in other cultural settings.