Psychometric properties of the Chinese version of the WHOQOL-HIV BREF to assess quality of life among people living with HIV/AIDS: a cross-sectional study

Validation and Refinement of the Self-Regulatory HIV/AIDS Symptom Management Model Among People With HIV in China Using Path Analysis: A Secondary Data Analysis

ABSTRACT

This study explored the path affecting the quality of life (QOL) of people with HIV in China and clarified the applicability and interpretability of the Self-Regulatory HIV/AIDS Symptom Management Model. We conducted a cross-sectional survey in nine regions of China and collected information about demographics, symptom experience, social support, perceived symptom manageability, self-efficacy, and QOL. A total of 711 patients participated in this survey. After four rounds of path analysis were conducted, the most fit indices met the standards (χ 2 /df = 2.633, Root Mean Square Error of Approximation = 0.081, Goodness-of-Fit Index/Adjusted Goodness-of-Fit Index/Comparative Fit Index/Incremental Fit Index/Tucker-Lewis Coefficient > 0.9), and the relationships between variables were statistically significant ( p < .05). Among all the pathways, social support had the most significant impact on the QOL, with a total path coefficient of 0.665. Symptom experience, as a negative factor, had a total effect value of -0.361. This study showed how all the factors influencing QOL were interconnected, serving as a crucial theoretical foundation for intervention strategies in future clinical practice.

Validation of PozQoL scale in Turkish population living with HIV: a cross-cultural adaptation study

Background

The increasing number of people living with HIV requires a simple and easy-to-use quality of life (QoL) scale for people living with HIV (PLWH). This study aims to adapt the PozQoL scale into Turkish and assess its reliability and validity for the PLWH population in Turkey.

Methods

Translation-back-translation methodology was employed, and face-to-face interviews were conducted with 130 patients using the PozQoL, socio-demographic, and clinical data questionnaire. Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA) were utilized to identify the underlying factor structure and examine the validity of the measurement model, respectively. Cronbach's alpha and intraclass correlation coefficients (ICCs) were used to assess internal consistency and test-retest reliability, respectively.

Results

EFA revealed four factors with an eigenvalue of 0.88, explaining 62.1% of the cumulative variance. CFA indicated that the four-factor solution achieved good levels of fit. The total Cronbach's alpha was 0.81, indicating high internal consistency. The ICC for the total score was 0.92 (95% confidence interval (CI) [0.90-0.94]; p < 0.05), demonstrating high test-retest reliability.

Conclusion

The Turkish version of the PozQoL was found to be a valid and reliable tool for assessing the health-related QoL of PLWH in Turkey.

Health-related quality of life in reproductive-age women on antiretroviral therapy: a cross sectional study in Ethiopia

OBJECTIVES

While numerous studies have explored the impact of gender on Health-Related Quality of Life (HRQOL), there is a lack of evidence specifically among reproductive-age women undergoing Antiretroviral Therapy (ART). Therefore, this study aims to investigate HRQOL and its associated factors among reproductive-age women receiving ART at Hiwot Fana Comprehensive Specialized Hospital in Eastern Ethiopia.

METHODS

A cross-sectional study included 418 women of ART. The World Health Organization quality of Life Questionnaire (WHOQOL-HIV BREF) was used to assess HRQOL. Binary logistic regression was used to determine the factors that could predict HRQOL.

RESULTS

The study found that the median age of the participants was 37 years, and the overall percentage of women with good HRQOL was 40.7%. Women who stayed on ART for more than 6 years had higher odds of overall good HRQOL (AOR 6.73, 95% CI 3.31-13.71) compared to those with a duration of 6 years or less. Besides, women having no child (AOR 25.03, 95% CI 4.93-127.06), one child (AOR 18.60, 95% CI 3.95-87.65), two children (AOR 12.89, 95% CI 3.66-45.37) and three children (AOR 3.77, 95% CI 1.06-13.34) had higher odds of overall good HRQOL compared to those with four/more children.

CONCLUSIONS

The study found that the majority of women on ART had poor HRQOL. Factors such as longer duration of taking ART, higher CD4+ cell count, disclosure of HIV status, and receiving care from adherence support teams were associated with better quality of life. Thus, strengthening adherence support teams, promoting safe disclosure of HIV status, and providing comprehensive support for HIV-positive women are required to improve their overall HRQOL.

Dyadic typology of illness perceptions in human immunodeficiency virus (HIV) Serodiscordant couples

OBJECTIVE

Illness perceptions direct coping resources in the illness adaptation process. Previous studies regarding illness perception profiles have been conducted at the individual level, without considering the couple as a unit. This study aimed to investigate the dyadic topologies of illness perceptions in HIV-serodiscordant couples and the association between the identified profiles and individual- and couple-level outcomes.

METHODS

A comprehensive examination was undertaken, encompassing 231 Chinese HIV-serodiscordant couples, who voluntarily participated in this cross-sectional study during the period spanning June to October 2022. To discern various patterns of illness perception, dyadic latent profile analyses were performed, followed by the implementation of one-way analyses of variance to investigate outcome differences at both the individual and couple levels across the identified profiles.

RESULTS

We identified three distinct profiles of illness perception, namely the incongruent-but-low, congruent-but-high, and incongruent-and-high profiles. Except for the partner's sex (p < .01, Cramer' v = 0.214) and the education levels of persons living with HIV and their partners (both p < .01, Cramer' v = 0.236 for persons living with HIV and 0.198 for partners), no significant demographic differences across the various profiles were found. Furthermore, we observed significant differences in all outcomes among the different couple profiles (all p < .001). These differences were of medium-to-large magnitudes (partial η2 values ranging from 0.07 to 0.22).

CONCLUSION

A couple-centered typological approach provides a useful way of identifying the couple's configuration of illness perceptions, which will inform the provision of tailor-made treatment for couples with different profiles.

Turkish Translation and Cross-Cultural Validity of WHOQOL-HIV Bref Tool

BACKGROUND

The assessment of health-related quality of life among people living with HIV (PLWH) has gained increasing importance as it assesses their overall well-being, guides treatment decisions, and addresses psychosocial challenges, improving their quality of life. This study focuses on adapting and validating the Turkish version of the WHOQOL-HIV Bref, a tool developed by the World Health Organization (WHO) to measure health-related quality of life in PLWH. This adaptation is based on the generic WHOQOL-Bref Turkish and WHOQOL-HIV Bref inventory.

METHODS

In line with WHO guidelines, the tool was translated and tested on 189 PLWH from İstanbul Şişli Hamidiye Etfal Training and Research Hospital's HIV outpatient clinic. A variety of statistical methods were employed to assess content, construct, concurrent, and known-group validity, as well as internal consistency and reliability.

RESULTS

Participants' median age was 35 years (IQR: 14), with 178(94%) being male. The Turkish WHOQOL-HIV Bref showed overall satisfactory psychometric properties. Despite limitations in the spirituality domain, it demonstrated good internal consistency (alpha coefficient: 0.93) and strong validity across several metrics, including test-retest reliability (ICC: 0.79).

CONCLUSION

The WHOQOL-HIV BREF in Turkish is a reliable and valid instrument for assessing the quality of life in Turkish PLWH.

HIV infection disclosure, treatment self-efficacy and quality of life in HIV-infected MSM receiving antiretroviral therapy

BACKGROUND

Research on the relationship between disclosure of HIV status to male sexual partners (HIV disclosure) and quality of life (QOL) revealed complex and even contradictory results. The impact of HIV disclosure on various domains of QOL and the mediation effect between them are unclear. The purposes of this study were to explore the impact of HIV disclosure on QOL among men who have sex with men (MSM), and whether HIV treatment self-efficacy mediated these relationships.

METHODS

The data came from a baseline survey on the design of a randomized control trial conducted in Shandong, China. A total of 579 MSM patients were included. SPSS 24.0 was used to conduct independent samples t test, one-way analysis of variance and nonparametric tests and the PROCESS macro was used to conduct mediation analysis.

RESULTS

Among 579 participants, 16.06% disclosed their HIV infection status to their male sexual partners. The effect of HIV disclosure on QOL was mediated by treatment self-efficacy. Self-efficacy played partial mediating role in social relationships, meaning that HIV disclosure had both direct and indirect effects on this factor. In the overall QOL and domains of physical, psychological, independence, and environment, HIV disclosure had an indirect effect only through self-efficacy and no significant effect on the spirituality domain.

CONCLUSIONS

The results emphasize the importance of HIV disclosure and self-efficacy on the QOL of MSM patients and suggest that health care providers should assist MSM patients in deciding whether to disclose their HIV status during daily medical services.

HIV-Specific Reported Outcome Measures: Systematic Review of Psychometric Properties

BACKGROUND

The management of people living with HIV and AIDS is multidimensional and complex. Using patient-reported outcome measures (PROMs) has been increasingly recognized to be the key factor for providing patient-centered health care to meet the lifelong needs of people living with HIV and AIDS from diagnosis to death. However, there is currently no consensus on a PROM recommended for health care providers and researchers to assess health outcomes in people living with HIV and AIDS.

OBJECTIVE

The purpose of this systematic review was to summarize and categorize the available validated HIV-specific PROMs in adults living with HIV and AIDS and to assess these PROMs using the Consensus-Based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology.

METHODS

This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A literature search of 3 recommended databases (PubMed, Embase, and PsychINFO) was conducted on January 15, 2021. Studies were included if they assessed any psychometric property of HIV-specific PROMs in adults living with HIV and AIDS and met the eligibility criteria. The PROMs were assessed for 9 psychometric properties, evaluated in each included study following the COSMIN methodology by assessing the following: the methodological quality assessed using the COSMIN risk of bias checklist; overall rating of results; level of evidence assessed using the modified Grading of Recommendations, Assessment, Development, and Evaluation approach; and level of recommendation.

RESULTS

A total of 88 PROMs classified into 8 categories, assessing the psychometric properties of PROMs for adults living with HIV and AIDS, were identified in 152 studies including 79,213 people living with HIV and AIDS. The psychometric properties of most included PROMs were rated with insufficient evidence. The PROMs that received class A recommendation were the Poz Quality of Life, HIV Symptom Index or Symptoms Distress Module of the Adult AIDS Clinical Trial Group, and People Living with HIV Resilience Scale. In addition, because of a lack of evidence, recommendations regarding use could not be made for most of the remaining assessed PROMs (received class B recommendation).

CONCLUSIONS

This systematic review recommends 3 PROMs to assess health outcomes in adults living with HIV and AIDS. However, all these PROMs have some shortcomings. In addition, most of the included PROMs do not have sufficient evidence for assessing their psychometric properties and require a more comprehensive validation of the psychometric properties in the future to provide more scientific evidence. Thus, our findings may provide a reference for the selection of high-quality HIV-specific PROMs by health care providers and researchers for clinical practice and research.

Prevalence of Gynecological Related Symptoms and Quality of Life in Women Living with HIV/AIDS: a Secondary Analysis from an Online, Cross-Sectional Survey in China

Objective

Our study aims to completely understand the experience of gynecological related symptoms (GRS) and the association between GRS and quality of life (QOL) among HIV-infected women in China.

Design

A cross-sectional, multicenter survey.

Setting

The HIV/AIDS designated medical institutions of seven regions in China.

Participants

One hundred and fifty-three women with HIV infection.

Primary and Secondary Outcome Measures

Primary outcome measures included the score of GRS and QOL from analysis sample.

Results

Among 153 participants, 60.13% were asymptomatic, and 39.87% were symptomatic according to their self-report data. In the symptomatic group, 47.54% reported only one symptom, 18.03% reported 2 symptoms, others reported more than 3 symptoms. The most common symptoms were vaginal discharge (25.49%), followed by irregular period (18.95%), bad cramps (13.07%), vaginal odor (11.11%), and vaginal itching (10.46%). The mean score of QOL was 86.82 ± 15.53. The symptomatic group had higher score than the asymptomatic group on each domain of QOL. GRS were negatively correlated with QOL after adjustment for confounding factors. Correlation matrix of GRS and six domains of QOL demonstrated significant negative correlation with each domain of QOL, especially the most strongly negative correlation with physical function of participants. But the association between GRS and environmental domain was weaker.

Conclusion

These findings present the multidimensionality of common gynecologic related symptoms and highlight the clinically meaningful associations between GRS and quality of life among women with HIV infection in China. There is an urgent need to take measures to increase vaginal care and education in advance, delivered by trusted health professionals.

Positive Coping as a Mediator of Mobile Health Intervention Effects on Quality of Life Among People Living With HIV: Secondary Analysis of the Randomized Controlled Trial Run4Love

BACKGROUND

The effectiveness of psychosocial interventions on quality of life (QOL) among people living with HIV has been validated, including mobile health (mHealth) interventions. However, it is unclear which components of such interventions account for these effects.

OBJECTIVE

This study aims to examine positive coping as a potential mediator of the effects of an mHealth intervention on QOL among people living with HIV.

METHODS

For this secondary analysis, we used data from an mHealth-based randomized controlled trial, Run4Love, which was conducted to improve QOL and mental health outcomes of people living with HIV. A total of 300 participants were randomly assigned to the intervention group to receive the adapted cognitive-behavioral stress management courses and regular physical activity promotion or the waitlist control group in a 1:1 ratio. Our analysis focused on positive coping and QOL, which were repeatedly measured at baseline and at 3-, 6-, and 9-month follow-ups. Latent growth curve models were constructed to explore the mediating role of positive coping in the effects of the mHealth intervention on QOL.

RESULTS

Positive coping served as a mediator in the effect of the mHealth intervention on QOL for up to 9 months. The mHealth intervention had a significant and positive indirect effect on the slope of QOL via the slope of positive coping (b=2.592×1.620=4.198, 95% CI 1.189-7.207, P=.006). The direct effect of the intervention was not significant (b=0.552, 95% CI -2.154 to 3.258, P=.69) when controlling for the mediator.

CONCLUSIONS

The longitudinal findings suggest that positive coping could be a crucial mediator of the mHealth intervention in enhancing QOL among people living with HIV. These findings underscore the importance of improving positive coping skills in mHealth interventions to improve QOL among people living with HIV.

Psychometric properties of the Persian version of Depression Anxiety Stress Scale-21 Items (DASS-21) in a sample of health professionals: a cross-sectional study

Background

Although the Depression Anxiety Stress Scale-21 Items (DASS-21) has been used in different countries and translated into different languages, the Persian version of this scale has not been validated for healthcare professions in Iran. Therefore, the purpose of this study was to examine the psychometric properties of the Persian version of DASS-21 for nurses.

Methods

This cross-sectional study was conducted among 1135 nurses working in public hospitals, who were selected through convenience sampling. DASS-21, which consists of 21 items and three dimensions (depression, anxiety, and stress), has been translated into Persian, and there is an online version available. A confirmatory factor analysis (CFA) was performed to examine the factor structure of this scale. Cronbach’s alpha coefficient was also measured to establish internal consistency. Besides, the intraclass correlation coefficient (ICC) was calculated to assess the test-retest reliability.

Results

The Cronbach’s alpha coefficient was acceptable for anxiety (0.79), stress (0.91), and depression (0.93). An acceptable test-retest reliability (0.740-0.881, P < 0.01) was also reported for DASS-21 and its three dimensions. The results of CFA showed acceptable model fit (χ²/(df) = 1457/(186), P < 0.001), root mean square error of approximation (RMSEA = 0.078), Tucker-Lewis index (TLI = 0.906), comparative fit index (CFI = 0.917), and standardized root mean square residual (SRMR = 0.047). Fifty-seven nurses were included in the test-retest. The ICCs for all dimensions ranged from 0.75 to 0.86, indicating the acceptable test-retest reliability of the scale.

Conclusion

The Persian version of DASS-21 showed good psychometric characteristics, and it was confirmed as a valid and reliable tool for evaluating depression, anxiety, and stress among Iranian nurses. However, further validation studies of the Persian DSASS-21 are needed among other healthcare professionals, including physicians, midwives, and allied health professionals.

Psychometric properties of self-reported measures of health-related quality of life in people living with HIV: a systematic review

Objective

To identify and assess the psychometric properties of patient-reported outcome measures (PROMs) of health-related quality of life (HRQoL) in people living with HIV (PLWH).

Methods

Nine databases were searched from January 1996 to October 2020. Methodological quality was assessed by using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) Risk of Bias Checklist. We used the COSMIN criteria to summarize and rate the psychometric properties of each PROM. A modified Grading, Recommendations, Assessment, Development, and Evaluation (GRADE) system was used to assess the certainty of evidence.

Results

Sixty-nine studies reported on the psychometric properties of 30 identified instruments. All studies were considered to have adequate methodological quality in terms of content validity, construct validity, and internal consistency. Limited information was retrieved on cross-cultural validity, criterion validity, reliability, hypothesis testing, and responsiveness. High-quality evidence on psychometric properties was provided for the Medical Outcomes Study HIV Health Survey (MOS-HIV), the brief version of the World Health Organization's Quality of Life Instrument in HIV Infection (WHOQoL-HIV-BREF), 36-Item Short Form Survey (SF-36), Multidimensional Quality of Life Questionnaire for Persons with HIV/AIDS (MQoL-HIV), and WHOQoL-HIV.

Conclusions

The findings from the included studies highlighted that among HIV-specific and generic HRQoL PROMs, MOS-HIV, WHOQoL-HIV-BREF, SF-36, MQoL-HIV, and WHOQoL-HIV are strongly recommended to evaluate HRQoL in PLWH in research and clinics based on the specific aims of assessments and the response burden for participants.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-021-01910-w.

Dose-Response Effects of Patient Engagement on Health Outcomes in an mHealth Intervention: Secondary Analysis of a Randomized Controlled Trial

Background

The dose–response relationship between patient engagement and long-term intervention effects in mobile health (mHealth) interventions are understudied. Studies exploring long-term and potentially changing relationships between patient engagement and health outcomes in mHealth interventions are needed.

Objective

This study aims to examine dose–response relationships between patient engagement and 3 psychosocial outcomes in an mHealth intervention, Run4Love, using repeated measurements of outcomes at baseline and 3, 6, and 9 months.

Methods

This study is a secondary analysis using longitudinal data from the Run4Love trial, a randomized controlled trial with 300 people living with HIV and elevated depressive symptoms to examine the effects of a 3-month mHealth intervention on reducing depressive symptoms and improving quality of life (QOL). We examined the relationships between patient engagement and depressive symptoms, QOL, and perceived stress in the intervention group (N=150) using 4–time-point outcome measurements. Patient engagement was assessed using the completion rate of course assignments and frequency of items completed. Cluster analysis was used to categorize patients into high- and low-engagement groups. Generalized linear mixed effects models were conducted to investigate the dose–response relationships between patient engagement and outcomes.

Results

The cluster analysis identified 2 clusters that were distinctively different from each other. The first cluster comprised 72 participants with good compliance to the intervention, completing an average of 74% (53/72) of intervention items (IQR 0.22). The second cluster comprised 78 participants with low compliance to the intervention, completing an average of 15% (11/72) of intervention items (IQR 0.23). Results of the generalized linear mixed effects models showed that, compared with the low-engagement group, the high-engagement group had a significant reduction in more depressive symptoms (β=−1.93; P=.008) and perceived stress (β=−1.72; P<.001) and an improved QOL (β=2.41; P=.01) over 9 months. From baseline to 3, 6, and 9 months, the differences in depressive symptoms between the 2 engagement groups were 0.8, 1.6, 2.3, and 3.7 points, respectively, indicating widening between-group differences over time. Similarly, between-group differences in QOL and perceived stress increased over time (group differences in QOL: 0.9, 1.9, 4.7, and 5.1 points, respectively; group differences in the Perceived Stress Scale: 0.9, 1.4, 2.3, and 3.0 points, respectively).

Conclusions

This study revealed a positive long-term dose–response relationship between patient engagement and 3 psychosocial outcomes among people living with HIV and elevated depressive symptoms in an mHealth intervention over 9 months using 4 time-point repeat measurement data. The high- and low-engagement groups showed significant and widening differences in depressive symptoms, QOL, and perceived stress at the 3-, 6-, and 9-month follow-ups. Future mHealth interventions should improve patient engagement to achieve long-term and sustained intervention effects.

Trial Registration

Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019

Factors affecting healthrelated quality of life of HIVinfected key population in Myanmar

This cross-sectional study examined factors affecting Health-related Quality of Life (HRQoL) among 273 HIV-infected key populations. This included, men who have sex with men (MSM), people, who inject drugs (PWID), and sex workers (SW), who were currently receiving antiretroviral therapy (ART) in Myanmar. Participants were recruited from four non-government clinics in four main cities. Overall HRQoL score derived from the WHOQOL-HIV BREF questionnaire was 86.08 ± 10.78. The lowest score was found in the environment domain (13.64 ±  2.06), while the highest score was found in the spirituality domain (15.54 ± 3.04). According to the multiple logistic regression analysis, participants, reported having an adequate income (OR = 3.32, P = 0.006), regularly taking meditation (OR = 3.79, P = 0.009), living in Tachileik (OR = 15.43, P = 0.011), and reported having no symptoms during previous 2 weeks (OR = 14.50, P < 0.001), were more likely to have good HRQoL level. In contrast, patients receiving ART < 1 year (OR = 0.163, P = 0.028) reported having low ART adherence (OR = 0.17, P = 0.018) and reported anticipated stigma (OR = 0.23, P < 0.001) and internalized stigma (OR = 0.29, P = 0.006) were less likely to have good HRQoL level.

Mediating Effects of Stigma and Depressive Symptoms in a Social Media-Based Intervention to Improve Long-term Quality of Life Among People Living With HIV: Secondary Analysis of a Randomized Controlled Trial

BACKGROUND

Mobile health (mHealth) interventions have been shown to effectively improve the quality of life (QOL) among people living with HIV. However, little is known about the long-term effects of mHealth interventions.

OBJECTIVE

This study aims to explore the intervention mechanisms of a social media-based intervention, Run4Love, on the QOL of people with HIV over across a 9-month follow-up period.

METHODS

We recruited people living with HIV who were concurrently experiencing elevated depressive symptoms from an HIV outpatient clinic in South China. A total of 300 eligible participants were randomized either to the intervention group or the control group in a 1:1 ratio after they provided informed consent and completed a baseline survey. The intervention group received a 3-month WeChat-based intervention, comprising cognitive-behavioral stress management (CBSM) courses and physical activity promotion. The control group received a printed brochure on nutrition guidelines in addition to the usual care for HIV treatment. Neither participants nor the research staff were blinded to group assignment. All patients were followed at 3, 6, and 9 months. The primary outcome was depressive symptoms. Structural equation model (SEM) with longitudinal data was conducted to examine the sequential mediating effects of HIV-related stigma and depressive symptoms on the long-term intervention effects on participants' QOL.

RESULTS

About 91.3% (274/300), 88.3% (265/300), and 86.7% (260/300) of all participants completed follow-up surveys at 3, 6, and 9 months, respectively. Results showed that the intervention had significantly improved participants' QOL at 9 months, via complete mediating effects of reduced HIV-related stigma at 3 months and decreased depressive symptoms at 6 months. No adverse events were reported.

CONCLUSIONS

These findings underscore the critical roles of HIV-related stigma and depressive symptoms in an mHealth intervention with long-term effects on QOL improvements. We call for targeted mHealth interventions to improve QOL among people living with HIV, especially social media-based interventions that can address HIV-related stigma and alleviate depressive symptoms.

TRIAL REGISTRATION

Chinese Clinical Trial Registry ChiCTR-IPR-17012606; https://www.chictr.org.cn/showproj.aspx?proj=21019.

Longitudinal trajectory of the association between quality of life and depression among people living with HIV in China: a mixed effects model

ABSTRACTAlthough depression has been associated with low QOL, limited research has quantified the change of depression to improvement of QOL among naïve PLHIV using ART in Shanghai, China. This study examined the association between depression symptoms and QOL among Chinese PLWH in a six-month longitudinal study. Data were collected from 111 people living with HIV at baseline, 3rd month and 6^th month after initiating ART, using the WHOQOL-HIV BREF and the Center for Epidemiologic Studies Depression Scale (CES-D), and analyzed using a mixed effects model. QOL is improved after initiating ART, while the symptoms of depression did not decrease significantly. The depression symptoms were strong and negatively associated with QOL and all domains of QOL, and the strength of this association decreased over time in the six months follow-up. ART had different impacts on depression symptoms and QOL. Besides, depression symptoms were strong and negatively associated with QOL among PLHIV over time. Mental health practitioners and nurses should consider the ART and time factors when designed interventions to improve QOL by targeting depression symptoms. Interventions designed to improve QOL and depression symptoms should be developed targeting both ART and self-management among PLHIV.

Quality of life among older Chinese people living with HIV/AIDS: a cross-sectional study in Hunan

BACKGROUND

There is little research to date in the area of quality of life (QoL) among older Chinese people living with HIV/AIDS (PLWHA). This study aims to explore the QoL and its influential factors among older PLWHA in China.

METHODS

Cross-sectional data of 242 adults with HIV/AIDS aged 50-84 y from Hunan were analyzed to evaluate the associations of demographic characteristics, illness-related factors, HIV-related stigma and social support with QoL. The WHO QOL-HIV BREF questionnaire was used to measure QoL on six domains (physical, psychological, independence, social relationships, environment and spirituality).

RESULTS

A total of 242 older PLWHA completed the survey, of whom 150 (62.0%) were males. Multivariate linear regression analyses identified that females, side effects of highly active antiretroviral therapy, chronic non-communicable diseases and higher levels of perceived negative self-image were negatively associated with QoL, especially in the physical, independence and spirituality domains; whereas higher education or annual income, retired and elevated levels of subjective social support or support availability were positively associated with QoL, especially in the psychological, independence, social relationships and environment domains.

CONCLUSIONS

The study findings suggest that interventions to improve QoL should focus on reducing HIV-related stigma and side effects and on enhancing economic situations and social support.

Sexual orientation and quality of life of people living with HIV/AIDS in China: evidence from an institutional-based cross-sectional study

BACKGROUND

At the end of 2019, there were approximately one million people known to be living with HIV/AIDS (PLWHA) in China. Different sexual orientation groups were observed within the people living with HIV in general, and studies have found that socially marginalized groups exist among this population, such as men who have sex with men (MSM) and bisexual individuals. Correspondingly, sexual orientation may pose challenges to the emotional and psychological development of PLWHA. Under this background, we aim to analyze whether sexual orientation affects the health-related quality of life (HRQOL) of PLWHA in order to provide evidence and suggestions for how wellbeing can be enhanced for sexual minorities living with HIV/AIDS.

METHOD

An institutional-based cross-sectional study design was used to collect data from PLWHA in Yunnan province and Beijing municipality in China. In our study, sexual orientation was classified as heterosexual, homosexual and bisexual, and HRQOL was measured using the Chinese WHOQOL-HIV-BREF scale. Logistic regression model was used to analyze the relationships of participants' sexual orientation and HRQOL. In addition, multivariable stepwise liner regression model was used to analyze the factors influencing HRQOL of PLWHA.

RESULTS

In total, 2610 PLWHA were included in the study, 36.5% of the participants identified as homosexual and most were males, 13.8% were bisexuals and 49.7% were heterosexuals. For the overall HRQOL, the homosexual PLWHA group scored highest (81.53 ± 12.45) with a high HRQOL score signifying a better health-related quality of life, followed by bisexuals (79.72 ± 12.81) and heterosexuals (78.02 ± 13.06). However, the bisexual group showed a markedly higher level of spiritual health. In addition, there was no statistical difference in the total HRQOL scores and domains by sex roles among the homosexual group (p > 0.01). However, sexual orientation was statistically associated with the physical and spiritual domains of HRQOL (p < 0.05).

CONCLUSION

In terms of sexual orientation for those living with HIV/AIDS, a better quality of life was found for homosexual individuals, whilst being a heterosexual individual saw a negative impact on quality of life, especially in the physical and spiritual domains. Strengthening the individualized and comprehensive care for heterosexual group as well as other sexual minority populations is imperative. Moreover, heterosexual PLWHA are more likely to be ignored and require more support and care to improve their HRQOL than do those in sexual minorities.

Mortality and Attrition Rates within the First Year of Antiretroviral Therapy Initiation among People Living with HIV in Guangxi, China: An Observational Cohort Study

Objective

To assess the mortality and attrition rates within the first year of antiretroviral therapy (ART) initiation among people living with human immunodeficiency virus (PLHIV) in rural Guangxi, China.

Design

Observational cohort study. Setting. The core treatment indicators and data were collected with standard and essential procedures as per the Free ART Manual guidelines across all the rural health care centers of Guangxi. Participants. 58,115 PLHIV who were under ART were included in the study. Interventions. The data collected included sociodemographic characteristics that consist of age, sex, marital status, route of HIV transmission, CD4 cell count before ART, initial ART regimen, level of ART site, and year of ART initiation. Primary and Secondary Outcome Measures. Mortality and attrition rate following ART initiation.

Results

The average mortality rate was 5.94 deaths, and 17.52 attritions per 100 person-years within the first year of ART initiation among PLHIV. The mortality rate was higher among intravenous drug users (Adjusted Hazard Ratio (AHR) 1.27, 95% Confidence Interval (CI) 1.14-1.43), prefecture as a level of ART site (AHR 1.14, 95% CI 1.02-1.28), and county as the level of ART site (AHR 2.12, 95% CI 1.90-2.37). Attrition was higher among intravenous drug users (AHR 1.87, 95% CI 1.75-2.00), the first-line ART containing AZT (AHR 1.09, 95% CI 1.03-1.16), and first-line ART containing LVP/r (AHR 1.34, 95% CI 1.23-1.46).

Conclusion

The mortality and attrition rates were both at the highest level in the first year of post-ART; continued improvement in the quality of HIV treatment and care is needed.

Translation and cross-cultural adaptation of WHOQOL-HIV Bref among people living with HIV/AIDS in Pakistan

BACKGROUND

Reliable Health-Related Quality of Life (HRQoL) assessment will be useful in identifying health issues and in identifying health care actions. Due to the lack of a psychometrically valid tool in Urdu, we aim to translate and examine the psychometric and cross-cultural adaptation of WHOQOL HIV Bref among people living with HIV/AIDS (PLWHA) in Pakistan.

METHODS

The standard forward-backwards translation technique was used to convert English version of the WHOQOL HIV Bref into Urdu. After cognitive debriefing, final Urdu version of instrument was developed. Based on the principle of at least 5 subjects for each item, a sample of 182 patients was used using a universal random sampling technique from the Pakistan Institute of Medical Sciences, Islamabad. The Cronbach's alpha and intra-class correlation coefficients (ICC) were estimated to assess internal validity and reliability of the translated version. Exploratory factor analysis was carried out to determine the factor structure and independent associations between the instrument domains and CD-4T-cell count were assessed using multivariable linear regression RESULTS: High Cronbach alpha 0.93 was found for all WHOQOL HIV Bref facets. The test-retest reliability demonstrated a statistically significant ICC ranged from 0.88 to 0.98 (p < 0.001). In known group validity, lower CD-4 lymphocytes count was significantly related to poor scores for all six domains (p < 0.001). Similarly, symptomatic subjects had significantly lower scores compared to asymptomatic subjects on the physical, psychological, social relationship and independence domains (p < 0.05). Statistically significant positive correlation of all six domains of instrument with CD4 cells count (p < 0.001), exhibiting patients with higher CD-4 cells will have higher mean scores of all domains. Factor analysis revealed 5 domains, including physical health, psychological health, social relationship, environmental, and spiritual health. Multivariable linear regression analysis reported; only physical, psychological health and environment health domains were found significantly associated with higher CD-4 lymphocytes count (Beta = 0.121, p < 0.001, Beta = 0.103, p = 0.002, and Beta = 0.032, p = 0.032).

CONCLUSION

Findings suggested that the Urdu version of WHOQOL HIV Bref is a psychometrically valid and culturally well-adapted HRQoL measurement tool for PLWHA in Pakistan.

Psychometric properties of the critical thinking disposition assessment test amongst medical students in China: a cross-sectional study

BACKGROUND

Critical thinking disposition helps medical students and professionals overcome the effects of personal values and beliefs when exercising clinical judgment. The lack of effective instruments to measure critical thinking disposition in medical students has become an obstacle for training and evaluating students in undergraduate programs in China. The aim of this study was to evaluate the psychometric properties of the CTDA test.

METHODS

A total of 278 students participated in this study and responded to the CTDA test. Cronbach's α coefficient, internal consistency, test-retest reliability, floor effects and ceiling effects were measured to assess the reliability of the questionnaire. Construct validity of the pre-specified three-domain structure of the CTDA was evaluated by explanatory factor analysis (EFA) and confirmatory factor analysis (CFA). The convergent validity and discriminant validity were also analyzed.

RESULTS

Cronbach's alpha coefficient for the entire questionnaire was calculated to be 0.92, all of the domains showed acceptable internal consistency (0.81-0.86), and the test-retest reliability indicated acceptable intra-class correlation coefficients (ICCs) (0.93, p < 0.01). The EFA and the CFA demonstrated that the three-domain model fitted the data adequately. The test showed satisfactory convergent and discriminant validity.

CONCLUSIONS

The CTDA is a reliable and valid questionnaire to evaluate the disposition of medical students towards critical thinking in China and can reasonably be applied in critical thinking programs and medical education research.

Psychometric properties of the Chinese version of the TeamSTEPPS teamwork perceptions questionnaire to measure teamwork perceptions of Chinese residents: a cross-sectional study

OBJECTIVES

The purpose of this research was to evaluate the psychometric properties of the TeamSTEPPS Teamwork Perception Questionnaire (T-TPQ) among the Chinese residents.

DESIGN

Cross-sectional study.

SETTING

A clinical hospital of the China Medical University in Liaoning Province, China.

PARTICIPANTS

A total of 664 residents were enrolled in this research. The valid response rate was 83.0% (664 of 800 residents).

MAIN OUTCOME MEASURES

Internal consistency and test-retest reliability were used to assess the reliability of the questionnaire. The construct validity of the Chinese T-TPQ was evaluated by confirmatory factor analysis. Furthermore, the concurrent, convergent and discriminant validity were analysed.

RESULTS

Cronbach's α coefficient of the T-TPQ in Chinese language was 0.923. Except for the communication dimension (0.649), the Cronbach's α coefficient of all dimensions were satisfactory. The T-TPQ and its five dimensions reported a good test-retest reliability (0.740-0.881, p<0.01). Moreover, the results of the confirmatory factor analysis demonstrated that the construct validity of the Chinese T-TPQ was satisfactory. All dimensions significantly correlated with the Hospital Survey on Patient Safety Culture (HSOPSC) teamwork within units dimension and the Safety Attitudes Questionnaire (SAQ) teamwork climate dimension (p<0.01), and the questionnaire showed satisfactory convergent and discriminant validity.

CONCLUSIONS

The T-TPQ in Chinese language demonstrated good psychometric characteristics and was a reliable and valid questionnaire to measure the Chinese health professionals' perception of teamwork. Thus, the Chinese version of the T-TPQ could be applied in teamwork training programmes and medical education research.

Assessing the psychometric properties of the French WHOQOL-HIV BREF within the ANRS CO3 Aquitaine Cohort's QuAliV ancillary study

BACKGROUND

Antiretroviral therapy has prolonged the lives of those with human immunodeficiency virus (HIV), but the effects of chronic infection on their health-related quality of life (HRQoL) remain a concern. Numerous instruments have been developed to measure HRQoL, yet evidence of their cross-cultural equivalence and continued applicability is limited. We adapted the WHOQOL-HIV BREF to French and assessed its psychometric properties in a sample of community-dwelling adults living with HIV who were mostly virally suppressed.

METHODS

We conducted a cross-sectional study within the ANRS CO3 Aquitaine cohort from July 2018 to May 2019. Five hundred eighty-six participants were consecutively enrolled at their HIV-consultations and completed either a web-based (n = 406) or paper self-administered assessment (n = 180). The means and standard deviations for items and domains were computed and the presence of floor and ceiling effects assessed. We evaluated internal consistency by calculating Cronbach's alpha coefficients per domain. We assessed construct validity by performing a Confirmatory Factor Analysis (CFA). Concurrent, convergent and discriminant validity were assessed with Pearson's correlations and known-group validity was assessed according to CD4 cell count, viral load, Centers for Disease Control and Prevention clinical categories for HIV, and hospitalization of more than 48 h within 2 years of the most recent consultation using one-way analysis of variance and independent t-tests.

RESULTS

Five hundred eighty-six PLWH were included in this analysis. Their median age was 55; 73% were male; 85% were of French descent; 99% were on ART and 93% were virally suppressed. We found floor effects for one and ceiling effects for 11 items. Four of the six domains showed good internal consistency (α range: 0.63-0.79). CFA showed that the WHOQOL-HIV BREF's six-domain structure produced an acceptable fit (SRMR = 0.059; CFI = 0.834; RMSEA = 0.07; 90% CI: 0.06-0.08). It showed good concurrent, convergent and discriminant validity. There was some evidence of known-group validity. The personal beliefs domain had the highest score (15.04 ± 3.35) and the psychological health domain had the lowest (13.70 ± 2.78).

CONCLUSIONS

The French WHOQOL-HIV BREF has acceptable measurement properties. Its broad conceptualisation of HRQoL, going beyond physical and mental health, may be of particular value in our older, treatment-experienced and virally suppressed population.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03296202 (Archived by WebCite at http://www.webcitation.org/6zgOBArps ).

Assessing quality of life in people with HIV in Spain: psychometric testing of the Spanish version of WHOQOL-HIV-BREF

Background

The assessment of health-related quality of life (HRQoL) in people living with HIV (PLHIV) has become crucial to evidence-based practice. The goals of this study are to analyze the psychometric properties and evidence of the validity of the Spanish version of WHOQOL-HIV-BREF in a sample of PLHIV in Spain and to examine the more impaired HRQoL facets and dimensions and identify the PLHIV who show the most vulnerable profile.

Methods

A total of 1462 PLHIV participated in an observational cross-sectional ex-post-facto study. Data were collected at 33 Spanish sites through an online survey. In addition to measuring HRQoL, the study used other tools to measure treatment adherence (CEAT-VIH 2.0 version), psychological well-being (GHQ-12) and HIV-related stigma (HSSS). Cronbach’s alpha, first- and second-order confirmatory factor analysis (CFA), the Pearson coefficient and one-way ANOVA were used to evaluate reliability, construct validity and concurrent and known-group validity, respectively. Differences according to the socio-demographic and epidemiological profiles of participants were analyzed.

Results

First- and second-order CFAs confirmed a six-domain first-order structure of the Spanish version of WHOQOL-HIV-BREF and one second-order factor related to overall HRQoL with an acceptable fit to the data, although some minor changes would improve it. The six-domain structure showed an acceptable internal consistency (Cronbach’s alpha ranged from .61 to .81). Significant moderate to large correlations between domains and overall HRQoL, adherence, psychological well-being and negative self-image were found. Significant differences were found according to participants’ self-reported CD4+ cell count in several HRQoL facets and domains. Being female, heterosexual, having low socio-economic and educational statuses, having acquired HIV through an unsafe injection and living more years with HIV were related to poorer HRQoL. PLHIV older than 50 presented lower scores in 19 HRQoL facets.

Conclusions

This study demonstrates that the Spanish version of the WHOQOL-HIV-BREF is a valid instrument. It also presents the most recent data about HRQoL in PLHIV in Spain with the largest sample to date.

Electronic supplementary material

The online version of this article (10.1186/s12955-019-1208-8) contains supplementary material, which is available to authorized users.

Perceived discrimination and cognitive function in middle-aged and older adults living with HIV in China

Middle-aged and older adults with HIV experience double discrimination and cognitive impairment due to both their HIV status and their age. However, the relationship between perceived discrimination and self-reported cognitive ability in middle-aged and older people living with HIV (PLWH) is less clear. We measured self-reported perceived discrimination and cognitive ability using the Expanded Everyday Discrimination Scale and the subscale of the AIDS Health Assessment Questionnaire (AIDS-HAQ). The study sample included 324 middle-aged and older PLWH (over 45 years old) from five designated HIV hospitals in three regions (east coast, middle, and southwest regions) of China. The descriptive analysis showed that 45.37% of the participants reported perceiving discrimination at least once in the past twelve months, and 47.22% reported having at least one type of cognitive impairment. Multiple linear regression results showed that higher levels of perceived discrimination (β = -0.121, P = 0.036) were significantly associated with lower levels of self-reported cognitive ability after controlling for several covariates, including sociodemographic variables, mental health status, health behaviors, and social support. A longer duration of HIV was also related to a lower level of self-reported cognitive ability. Our findings indicate that perceived discrimination is related to self-reported cognitive ability and suggest that counseling services and support systems should be developed to reduce age- and disease-associated discrimination. A reduction in perceived discrimination would improve not only overall wellbeing but also cognitive ability in later life.

Quality of life among elderly residents in the Gaza Strip: a community-based study

BACKGROUND

In Palestine, persons older than 60 years of age comprise 4.6% of the population in this decade and will remain relatively stable until the year 2020, when it is expected to begin to rise. The quality of life (QoL), which reflects well-being and health status, is under-reported in this vulnerable group in the Gaza Strip.

OBJECTIVE

Determine QoL and associated factors in persons aged older than 60 years.

DESIGN

A community-based cross-sectional study.

SETTING

Five Gaza Strip governorates.

SUBJECTS AND METHODS

Subjects were selected by convenience sampling. We used the validated Arabic WHOQOL-BREF to assess QoL and used descriptive, univariate and multivariate methods to analyze the data.

MAIN OUTCOME MEASURES

QoL, overall satisfaction with health and factors associated with good QoL.

SAMPLE SIZE

235 community-dwelling elderly.

RESULTS

The response rate was 85.5% (201/235). Mean age (SD) was 69 (7.95) years old and females accounted for 57.7% (116/201) of the sample. Almost half (44.2%, 90/201) of the elderly scored in the category of good QoL. The mean (SD) for overall QoL and perceived satisfaction with health was 3.3 (1.1) and 3.4 (1.0), respectively, on a 5-point Likert scale. The social relationship domain had the highest QoL score (65.4 [15.3]), whereas physical and environmental domains received equally lower scores (60.5 [15.2] and 60.5 [12.5] respectively). Multivariate analysis showed that factors associated with good QoL were higher education (OR: 3.1, CI 95%: 1.03-9.4) and perceived high satisfaction with health (OR: 3.6, CI 95%: 1.8-7.3).

CONCLUSION

More years of education and higher satisfaction with health were associated with a better perception of QoL. Interventions should be focused more on physical and environmental aspects in the life of elderly persons.

LIMITATIONS

Cross-sectional design, use of convenience sample and some possibly important factors not studied.

CONFLICT OF INTEREST

None.