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EQ-5D-Y-5L health questionnaire (age 4-12)

Thank you for taking the time to complete this survey. It is part of the evaluation for the South East London Enhanced Sickle Cell Community Service and should take no more than five minutes to complete. You will be asked questions about the child’s health today.

This survey covers five dimensions of health: mobility, looking after myself, doing usual activities, having pain or discomfort, and feeling worried, sad, or unhappy. It is important that the child’s own perspective is reflected in the responses. Please involve the child in answering each question and encourage them to share their honest feelings.

We would like to follow up with the child in 4–6 months to repeat the survey. Completing both surveys will help us assess whether the Enhanced Sickle Cell Community Service is having a positive impact on the quality of life within the sickle cell community. To allow us to contact you for the follow-up survey, please provide your email address in the survey.

Confidentiality: All responses will be kept confidential and used solely for the stated purposes. All recorded responses and published data will be anonymised, and no personally identifiable information will be shared.

To learn more about this survey, visit the EQ-5D-Y-5L website. If you have any questions, please contact gst-tr.selsicklecommunity@nhs.net

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Parent/carer/guardian contact details

By providing your name and email address below, you are giving consent for us to contact you in 4-6 months to ask you to complete this survey again with the child. This will allow us to evaluate the community service that you have accessed so that we can continue providing enhanced community services to the sickle cell community in south east London. 

Your email address will not be used for any other communications.

Maximum 255 characters

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