Psychometric validation of PROQOL-HIV a contemporaneous and cross-cultural health-related quality-of-life (HRQL) questionnaire specific to HIV
Duracinsky, M., Lalanne, C., Acquadro, C., Herrmann, S., Lau, J., Lecoeur, S., Schechter, M., Berzins, B., Fournier-Nicolle, I., Sow, P.S. and Chassany, O. (2009) Psychometric validation of PROQOL-HIV a contemporaneous and cross-cultural health-related quality-of-life (HRQL) questionnaire specific to HIV. In: 5th IAS conference on HIV Pathogenesis Treatment and Prevention, 19 - 22 July, Cape Town, South Africa.
Background: Instruments measuring health-related quality-of-life (HRQL) in PLWHA were developed before HAART, and lacked relevant domains such as stigma, treatment perception and impact of side effects particularly lipodystrophy. This study evaluated the psychometric properties of the PROQOL-HIV, a new specific instrument to measure the HRQL of PLWHA from different cultures and language groups.
Methods: 830 patients were included in a cross-sectional survey in 8 countries: Australia, Brazil, Cambodia, China, France, Senegal, Thailand and the USA. Item reduction was based on content, distribution of responses and factorial analysis. Reliability (Cronbach's alpha), convergent validity (with the EQ-5D and MOS-HIV scores) and multi-trait scaling analysis, and clinical validity (with biological markers and socio-demographic data) were assessed. Test-retest reliability (Intraclass Coefficient Correlation) was evaluated.
Results: Mean age was 41±10 years, (37% women, 86% treated). CD4 mean number was 428±267 cells/µL, 75% had undetectable viral load. The PROQOL-HIV questionnaire was reduced from 70 items to a 39-item HRQL core questionnaire and 4 individual items (including Care Satisfaction and Financial Impact). Cronbach's alpha of the 8 scales ranged from 0.60 to 0.89. Total score and subscale correlations (0.47-0.72) were acceptable. Factor analysis identified 8 factors accounting for 60 % of the total variance. Intrascale correlations ranged from 0.30 to 0.77. Test-retest reliability was 0.86. From 8 factors, 9 dimensions were defined: General Health, Physical Health and Symptoms, Treatment Impact, Health Concerns, Intimate Relationship, Emotional Distress, Body Change, Stigma and Social Relationships. The PROQOL-HIV correlated significantly with the MOS-HIV and the EQ-5D. Significant differences in HRQL were shown according to sex, CD4, viral load, CDC stage, number of daily tablets, co-infections and comorbidities. PROQOL HIV showed consistent results across culture and language.
Conclusions: The PROQOL-HIV consisting of 39 items and 9 dimensions is a valid and reliable questionnaire to evaluate the HRQL of PLWHA from different linguistic backgrounds and cultures.
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