Validation and Longitudinal Application of the Whoqol-hiv Questionnaire Among People Living With Hiv and Aids in Limpopo Province, South Africa
Year: 2012
Type: dissertation
Study design: Observational Study
Abstract: The rate of HIV infection in South Africa remains high despite the continued efforts to prevent \nits transmission. Conversely, the rate of AIDS related mortality has been on the decline since \nthe country introduced its comprehensive care and treatment plan. Among other things, the \ncomprehensive plan seeks to coordinate activities to prevent further infection and facilitate \nhealth and social support services for the infected and affected. Despite this, South Africa has \nan increasing number of people living with HIV (PLWH) and is home to the largest population of \nHIV infected people in the world. Consequently, there is a growing shift of focus of HIV/AIDS \nresponse programmes from issues of survival and death prevention to the quality of survival of \nPLWH. This point accentuates the need for patient evaluation of their wellbeing and quality of \nlife in the context of the country’s HIV/AIDS response services. There are HIV-specific quality of \nlife assessment tools like the WHOQOL-HIV, but these tools are subject to cultural variations \nand have not been validated across South Africa’s multicultural society. The available tools are \noften too long and cannot be used in routine care and support of PLWH. In the absence of \nvalidated and efficient quality of life assessment tools, there is over reliance on biomedical \nmarkers of HIV/AIDS like the CD4 cell count and viral load. These biomedical indicators do not \nprovide a complete view of the impact of the disease given the multidimensional consequences \nof HIV and AIDS. \nWith the above background, this study sought to firstly explore the health related quality of life \n(HRQOL) and the experiences of PLWH in seeking care and support services, and secondly, to \nvalidate the ability of the WHOQOL-HIV instrument to measure the health related quality of life \nof PLWH among the three cultural groups in Limpopo Province over a specified time period. \nThe study was divided into two, with the first and second studies using qualitative and \nquantitative research approaches respectively. Both studies divided their participants into three \ngroups, with each group representing each of the three main ethnic groups in Limpopo \nProvince (Pedi, Tsonga and Venda). The qualitative study used focus group discussions (FGDs) \niii \nto solicit information and grounded theory to guide its participant selection, number of FGDs \nconducted and the interpretation of its findings. \nThe second study was a longitudinal follow up of participants in the three groups from the point \nof treatment initiation over 12 months. In the second study, there were three points of data \ncollection (baseline, six and twelve months). The participants were conveniently selected and \ninterviewed repeatedly with the WHOQOL-HIV and MOS-HIV instruments. The study findings \nwere mostly presented in tables and t-tests and ANOVA were used to compare quality of life \nscores in different groupings while correlation and limits of agreements were used to establish \ninstrument validity. Item-total correlation coefficient and alpha if item deleted, was used to \nexplore the possibility of shortening the WHOQOL-HIV instrument in an attempt to suggest a \nshorter and more user friendly version of the instrument. \nThe key findings of the qualitative study are that the quality of life of PLWH in Limpopo is \ndetermined by three groups of factors (physical, mental and external). The frequency and \nseverity of these factors are determined by the participants’ duration on treatment, disclosure \nof their HIV status and socioeconomic status. The physical factors were mostly constituted by \nbiological symptoms of the disease. The most commonly cited symptoms were diarrhoea, pain \nand fatigue. The study also noted marked differences in the occurrence of the symptoms \nthrough the trajectory of the disease revealing four main stages: pre-treatment; treatment \ninitiation; early treatment; and treatment maintenance stages. The study also noted that the \nimpact of the determinants of the quality of life on an individual is influenced by intervening \nfactors which can be altered by a set of modifying factors. In all, the quality of life determinants \nidentified by this study replicates those that constitute the WHOQOL-HIV instrument. This \nfinding hence obviates the need for the modification of existing quality of life instruments to \nsuit the three South African ethnic groups investigated by this study. \nThe quantitative study showed high reliability of the WHOQOL-HIV among the three ethnic \ngroups with alpha ranging from 0.79 to 0.94 in the six domains of the instrument. The study \niv \nalso showed that the quality of life varied by socio-demographic characteristics such as ethnic \ngroup, sex, marital status, number of children, employment status and membership of \nHIV/AIDS support groups. The observed difference reflects poor financial capacity and activity \ntolerance across the various categories of the participants and at different times. While \nsignificant changes in the quality of life was noted between the baseline data and the six and \ntwelve months data respectively, little or no improvements were seen between the six and \ntwelve months data. The participants were actually more likely to have a better quality of life at \nsix months when compared to their quality of life at twelve months. In the same manner, the \nmedian CD4 cell count and viral load were very similar at six and twelve months but differed \nsignificantly with the baseline reports. Over time and across cultural groups, the participants \nreported lower quality of life in the level of dependence domain and financial support subscale. \nThere were little or no associations between the biomedical markers and HRQOL indicators. In \naddition, the quality of life tended to increase with increase in CD4 cell count. The validation of \nthe WHOQOL-HIV using the MOS-HIV through a correlation of similar domains and their limits \nof agreement largely suggests that the WHOQOL-HIV is valid but both instruments are not exact \nreplicas in their measurements. The multidimensional nature hypothesized by the original \nWHOQOL-HIV instrument study was also demonstrated by the factor analysis component \nmatrix. Attempts to shorten the WHOQOL-HIV proved to be impossible as the items with \nhighest item-total correlation varied with the participants’ duration on treatment. \nIn conclusion, this study suggested the needs and factors that contribute to the quality of life of \nPLWH in Limpopo and how those factors can be harnessed through a set of modifying factors. \nWith this, an individual’s quality of life is determined by the delicate balance between \nintervening and modifying factors. The linkages between the observed determinants of quality \nof life suggest a vicious circle where one determinant may exacerbate the effect of another \ndeterminant. The study also showed that the WHOQOL-HIV instrument is valid and reliable in \nmeasuring the quality of life of PLWH in the province. The observed poor to no associations \nbetween the health related quality of life indicators and the biomedical makers show that they \ncannot be direct proxies of each other. Finally, the study discourages any further shortening of \nv \nthe WHOQOL-HIV instrument on the basis that HIV-infected people are not a homogenous \ngroup as their bio-psychosocial needs vary with time and their position along the trajectory of \nthe disease.
Author: Jude Igumbor
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2151568860