Are the WHOQOL-HIV-Bref and 15D adequate measures of quality of life in HIV-infected adults?

Nuno Nobre1,2, Marco Pereira3, Risto P. Roine4,5, Jussi Sutinen6 and
Harri Sintonen2

1Haartman Hospital, Emergency Department, Helsinki, Finland; 2Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland; 3Faculty of Psychology and Educational Sciences, University of Coimbra, Coimbra, Portugal; 4Research Centre for Comparative Effectiveness and Patient Safety, University of Eastern Finland, Kuopio, Finland; 5University of Helsinki and Helsinki University Hospital, Helsinki, Finland; and 6Division of Infectious Diseases, Inflammation Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland

Abstract
Background: The WHOQOL-HIV-Bref has been widely used in the assessment of quality of life (QoL) in HIV, but it has never been simultaneously evaluated with any generic health-related QoL (HRQoL) instrument. The aim of this study was to test the psychometric properties of the WHOQOL-HIV-Bref and compare it with the generic 15D HRQoL instrument in a sample of Finnish HIV-infected patients.
Methods: The sample comprised 382 participants, followed at the Infectious Disease Clinic of Helsinki University Hospital. Participants completed the following self-reported questionnaires: WHOQOL-HIVBref and 15D.
Results: Both the Finnish version of the WHOQOLHIV- Bref (Cronbach’s alpha range: 0.67–0.86 across domains) and the 15D (Cronbach’s alpha: 0.87) showed good reliability. A confirmatory factor analysis provided support for the original six-domain model. Construct validity of the WHOQOL-HIV-Bref was satisfactory for all domains (all r>0.48; P<0.001). Convergent validity of the WHOQOL-HIV-Bref with the 15D was good in relation to psychological health, but not equally satisfactory in relation to physical and physiological health. Neither the WHOQOL-HIV-Bref nor the 15D were able to discriminate between different CD4+ T cell count subgroups.
Conclusions: These results offer support for the use of the WHOQOL-HIV-Bref and 15D as measures of QoL of HIV-infected patients in Finland. A novel finding was that the WHOQOL-HIV-Bref may assess primarily psychosocial aspects of health, but may not entirely address the domain of physical and physiological health. Its complementary use with the generic 15D HRQoL questionnaire may be valuable and economical, both in clinical and research settings.
Keywords: HIV, quality of life, WHOQOL-HIV-Bref, 15D, reliability, validity