Purpose
Assesses the quality of life in people living with HIV/AIDS
Link to Instrument
Acronym
WHOQOL-HIV-Bref
Primary Image
WHOQOL-HIV BREF
Populations
Key Descriptions
- Includes 26 questions from WHOQOL-BREF and an additional 5 questions that represent additional facets of WHOQOL-HIV
- Unlike the WHOQOL-BREF, the facets belonging to the domains Level of Independence and Spiritual/Religion/Personal Beliefs are not incorporated to the physical and psychological domains
- Self-reported or administered by an interviewer
- 31 items address 6 quality of life domains and 2 general health questions:
1) Physical (4 items)
2) Psychological (5 items)
3) Level of Independence (4 items)
4) Social Relations (4 items)
5) Environment (8 items)
6) Spiritual/Religion/Beliefs (4 items)
7) Overall quality of life and general health (2 items)
Number of Items
31
Equipment Required
- WHOQOL-HIV manual
Time to Administer
10-15 minutes
Required Training
Reading an Article/ManualInstrument Reviewers
Valencia Cotchery, MPA
ICF Domain
ActivityParticipation
Environment
Body Function
Considerations
-
Despite the widespread distribution and the use of the WHOQOL-HIV BREF, difficulties in interpreting the instrument syntax limits use of the tool (Pedroso et al., 2011).
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Culture and values influence quality of life, so diverse cultures may comprehend and interpret questions differently (Meemon et al., 2016).
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All domains sensitively differentiate between patients with fewer and less severe symptoms than those with more intense symptoms (Hsiung et al., 2011).
Mixed Populations
back to PopulationsNormative Data
Individuals with HIV/AIDS (Middle-aged & Older Adults): (Pereira et al., 2014; n = 185; mean age = 57.84 (6.79) years; mean CD4 + T-cell count = 433.06 (275.65); mean years since diagnosis = 6.34 (5.20) years)
- Mean (SD) WHOQOL-HIV-Bref Overall QoL score; 51.57 (21.69)
|
|
Mean |
SD |
|
Domain 1-Physical |
59.24 |
21.91 |
|
Domain 2- Psychological |
57.83 |
19.17 |
|
Domain 3-Level of Independence |
60.78 |
22.85 |
|
Domain 4- Social Relationships |
58.38 |
20.48 |
|
Domain 5-Environment |
56.14 |
15.41 |
|
Domain 6-Spirituality |
57.49 |
22.48 |
Individuals with HIV/AIDS (Thai Patients): (Meemon et al., 2016; n = 329; mean age= 41.95 (7.82) years; mean CD4 + T-cell count = 489.51(249.35); mean years since diagnosis = 10.40 (6.04) years)
- Mean (SD) WHOQOL-HIV-Bref Overall QoL score; 3.30(0.69)
|
|
Mean |
SD |
|
Domain 1-Physical |
14.48 |
2.68 |
|
Domain 2- Psychological |
14.99 |
2.48 |
|
Domain 3-Level of Independence |
13.35 |
2.39 |
|
Domain 4- Social Relationships |
13.32 |
2.76 |
|
Domain 5-Environment |
13.91 |
2.21 |
|
Domain 6-Spirituality |
14.90 |
3.42 |
Test/Retest Reliability
Individuals living with HIV/AIDS (Malay Version): (Saddaki et al., 2009); n = 157; mean age = 35.7 (7.50) years; Male = 59.9%, Female = 40.1%; HIV Stage = Asymptomatic (59.9%), Symptomatic (40.1%), AIDS (0.0%))
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Excellent test-retest reliability: Physical needs (ICC = 0.87)
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Adequate test-retest reliability: Spirituality needs (ICC = 0.71)
-
Excellent test-retest reliability: Psychological (ICC = 0.78)
-
Adequate test-retest reliability: Environmental needs (ICC = 0.64)
-
Adequate test-retest reliability: Social Relationships (ICC = 0.60)
Individuals living with HIV/AIDS (Chinese Version): (Zhu, Liu, & Ou, 2017) ; n = 1100; mean age = 39.62 (12.73) years; Male = 87.7%, Female = 12.3%; HIV Stage = Asymptomatic (62.8%), Symptomatic (37.2%))
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Excellent test-retest reliability: Physical needs (ICC = 0.76)
-
Adequate test-retest reliability: Spirituality needs (ICC = 0.72)
-
Adequate test-retest reliability: Psychological (ICC = 0.73)
-
Adequate test-retest reliability: Environmental needs (ICC = 0.74)
-
Excellent test-retest reliability: Social Relationships (ICC = 0.80)
Interrater/Intrarater Reliability
Individuals living with HIV/AIDS: (Zhu, Liu, & Ou, 2017)
-
Excellent interrater and intrarater reliability (ICC = 0.93) (Zhu, Liu, & Ou, 2017)
Internal Consistency
Individuals living with HIV/AIDS (Chinese Version):
-
Excellent internal consistency (overall Cronbach’s alpha=.93) (Zhu, Liu & Ou, 2017):
-
Adequate internal consistency (Spirituality Cronbach’s alpha=.66) (Zhu, Liu & Ou, 2017):
Individuals living with HIV/AIDS (European Portuguese Version):
-
Excellent internal consistency (overall Cronbach’s alpha=0.93); (Cronbach’s alpha values ranged from 0.78-0.80 across 4 domains) (Canavarro & Pereira, 2011):
-
Adequate internal consistency (Spirituality Cronbach’s alpha = 0.61) (Canavarro & Pereira, 2011):
-
Adequate internal consistency (Physical Cronbach’s alpha = 0.71) (Canavarro & Pereira, 2011):
|
Domain |
Cronbach’s alpha |
|
Physical |
0.71 |
|
Psychological |
0.78 |
|
Level of Independence |
0.80 |
|
Social Relationships |
0.79 |
|
Environment |
0.78 |
|
Spirituality |
0.61 |
|
Total |
0.93 |
Individuals living with HIV/AIDS (Malay Version):
-
Excellent internal consistency (overall, Cronbach’s alpha = 0.93); (Cronbach’s alpha values ranged from 0.76 to 0.83 across 5 domains; Cronbach value of the whole scale was 0.93 (Saddaki et al., 2009):
-
Adequate internal consistency (Social Relationship, Cronbach’s alpha = 0.70) (Saddaki et al., 2009):
-
Adequate internal consistency (Psychological, Cronbach’s alpha = 0.74) (Saddaki et al., 2009):
|
Domain |
Cronbach’s alpha |
|
Psychological |
0.74 |
|
Environment |
0.81 |
|
Physical Needs |
0.83 |
|
Spirituality |
0.76 |
|
Social Relationship |
0.70 |
|
Total |
0.93 |
Criterion Validity (Predictive/Concurrent)
Concurrent validity:
Individuals living with HIV/AIDS (Taiwan Version): (Hsiung, et al., 2011)
- All WHOQOL-HIV BREF domains were found to have adequate associations with both self-perceived health status (r = 0.51 to 0.72) and overall happiness (r = 0.38 to 0.60)
Construct Validity
Individuals living with HIV/AIDS (Malay Version): (Saddaki et al., 2009; n = 157; mean age=35.7 (7.50) years; cross-sectional study)
- Adequate correlations between domain items and respective domain scores (r = 0.47 to 0.84) (Zhu, Liu, & Ou, 2017)
|
Domain |
Convergent Validity |
Discriminant Validity |
|
|
Physical |
0.66 to 0.72 |
0.24 to 0.66 |
Adequate Convergent & Discriminant Validity |
|
Psychological |
0.57 to 0.73 |
0.15 to 0.67 |
Adequate Convergent & Discriminant Validity |
|
Independence |
0.47 to 0.84 |
0.02 to 0.68 |
Adequate Convergent & Discriminant Validity |
|
Social Relationships |
0.68 to 0.78 |
0.26 to 0.57 |
Adequate Convergent & Discriminant Validity |
|
Environment |
0.65 to 0.72 |
0.19 to 0.64 |
Adequate Convergent & Discriminant Validity |
|
Spirituality |
0.50 to 0.84 |
0.14 to 0.65 |
Adequate Convergent & Discriminant Validity |
Content Validity
-
All item domain correlations were generally found to be adequate to excellent (r = 0.38 to 0.70), with the notable exceptions of the associations found between (1) dependence on medication or treatment and the level of independence domain (r = 0.23) and (2) religion/spirituality/personal beliefs and the spiritual domain (r = 0.25)
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These results indicate good content validity for the WHOQOL-HIV-Bref.
Face Validity
The widespread international use of WHOQOL measures provides a convincing rationale to assess its factor structure across culturally diverse HIV populations (Canavarro & Pereira, 2011)
Floor/Ceiling Effects
HIV/AIDS: (Saddki et al., 2009)
- No floor or ceiling effects in domains.
HIV/AIDS: (Zhu et al., 2017)
- The ceiling effect of the item measuring pain and discomfort was above the accepted threshold of 20%. It is likely that the ceiling effect is dependent on population distribution. Although previous studies have not reported the floor effects of the WHOQOL-HIV BREF, floor effects for social inclusion and financial resources was detected
|
Domain or Item |
Ceiling Effect |
|
Domain or Item |
Floor Effect |
|
Pain & Discomfort |
35.9% |
|
Social Inclusion |
22.4% |
|
|
|
|
Financial Resources |
24.2% |
Bibliography
Canavarro, M. C., & Pereira, M. (2012). Factor structure and psychometric properties of the European Portuguese version of a questionnaire to assess quality of life in HIV-infected adults: The WHOQOL-HIV Bref. AIDSCare, 24(6), 799-807.
Hsiung, P., Fang, C. Wu, C. Sheng, W., Chen, S., Wang, J., & Yao, G. (2011). Validation of the WHOQOL-HIV Bref among HIV-infected patients in Taiwan. AIDSCare, 23(8), 1035-1042.
Meemon, N., Paek, S. C., Yenchai, D., & Wan, T. H. (2016). Application of WHOQOL-HIV Bref questionnaire in HIV-infected Thai patients: Reliability and validity of the instrument. AIDSCare, 27(5), 698-708.
Pedroso, B., Gutierrez, G. L., Duarte, E., Pilatti, L. A., & Picinin, C. T. (2011). Quality of Life Assessment in People Living with HIV/AIDS: Clarifying the WHOQOL-HIV and WHOQOL-HIVBref Instruments. In V. Venketaraman (Ed.), Global View of HIV Infection. Retrieved from
Pereira, M., Martins, A., Alves, S., Canavarro, M. C. (2014). Assessing quality of life in middle-aged and older adults with HIV: psychometric testing of the WHOQOL-HIV Bref. Quality of Life Research, 23, 2473-2479.
Saddki, N., Noor, M. M., Norbanee, T. H., Rusli, M. A., Norzila, Z. (2009). Validity and reliability of the Malay version of WHOQOL-HIV Bref in patient with HIV infection. AIDSCare, 21(10): 1271-1278.
Zhu, Y., Liu, J., & Qu, B. (2017). 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. BMJ Open, 7, 1-11.