WHOQOL-HIV for quality of life assessment among people living with HIV and AIDS: results from the field test

Abstract

Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial to research and evidence-based practice in this area. This paper describes the analysis of the WHOQOL HIV field test instrument, which was given to 1,334 PLWHA from seven culturally diverse centres (Australia, Brazil, Italy, Thailand, Ukraine and two centres in India: Bangalore and New Delhi). The instrument demonstrates good psychometric properties (α values for domains between 0.70 and 0.90) and good discriminant validity, with poorest QoL found for those who reported that they were least well. Men reported poorer physical well-being (F=13.1, p<0.001) and level of independence (F=16.1, p<0.001), while women reported poorer environment (F=25.8, p<0.001), social support (F=11.3, p<0.001) and spirituality (F=7.5, p<0.01). Older people (>34 years) demonstrated poorer QoL on physical (F=20.6, p<0.001) and levels of independence (F=18.3, p<0.001), while younger people showed poorer environmental (F=34.6, p<0.001) and spiritual (F=23.5, p<0.001) domains of well-being. The instrument provides a promising means for QoL assessment for HIV/AIDS in diverse cultural settings.

Notes

WHOQOL HIV Group details listed in Appendix.

The original field test version comprised an additional 35 items, covering 12 new HIV-specific facets, which were incorporated into the generic version. However, subsequent analyses on these items showed that the instrument benefited from slight refinement and modification to improve its properties. For example, it was found that the additional subfacets on body image and appearance, negative feelings, sexual activity and personal relations did not contribute to QoL above the other WHOQOL-100 facets. The addition of these facets decreased the discriminant validity of the domain, making an additional 12 items redundant in their meaning. In another case, social inclusion contained five items. In order to preserve the integrity of the WHOQOL, which is based on four items per facet, the item with the weakest contribution was removed, to create a four-item facet.

The seven participating field centres for the pilot study were as follows: Centre for the Study of Sexually Transmissible Disease, La Trobe University, Victoria, Australia; National Institute of Mental Health and Neurosciences, Bangalore, India; Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India; National Mental Health Project, National Institute of Health, Rome, Italy; Department of Psychiatry and Legal Medicine, University of the State of Rio Grande do Sul, Porto Alegre, Brazil; Branch of Preventive Mental Health, Department of Mental Health, Ministry of Public Health, Bangkok, Thailand; and Dniepropetrovsk Association Quality of Human Life, Dniepropetrovsk State Medical Academy, Ukraine.

Additional information

Notes on contributors

Whoqol Hiv Group

WHOQOL HIV Group details listed in Appendix.