Feasibility, reliability and validity of health-related quality of life questionnaire among adult pulmonary tuberculosis patients in urban Uganda: cross-sectional study
Open Access
- 1 January 2010
- journal article
- research article
- Published by Springer Science and Business Media LLC in Health and Quality of Life Outcomes
- Vol. 8 (1), 93
- https://doi.org/10.1186/1477-7525-8-93
Abstract
Despite the availability of standard instruments for evaluating health-related quality life (HRQoL), the feasibility, reliability, and validity of such instruments among tuberculosis (TB) patients in different populations of sub-Saharan Africa where TB burden is of concern, is still lacking. We established the feasibility, reliability, and validity of the Medical Outcomes Survey (MOS) in assessing HRQoL among patients with pulmonary tuberculosis in Kampala, Uganda. In a cross-sectional study, 133 patients with known HIV status and confirmed pulmonary TB disease were recruited from one public and one private hospital. Participants were enrolled based on duration of TB treatment according to the following categories: starting therapy, two months of therapy, and eight completed months of therapy. A translated and culturally adapted standardized 35-item MOS instrument was administered by trained interviewers. The visual analogue scale (VAS) was used to cross-validate the MOS. The MOS instrument was highly acceptable and easily administered. All subscales of the MOS demonstrated acceptable internal consistency with Cronbach's alpha above 0.70 except for role function that had 0.65. Each dimension of the MOS was highly correlated with the dimension measured concurrently using the VAS providing evidence of validity. Construct validity demonstrated remarkable differences in the functioning status and well-being among TB patients at different stages of treatment, between patients attending public and private hospitals, and between men and women of older age. Patients who were enrolled from public hospital had significantly lower HRQoL scores (0.78 (95% confidence interval (CI); 0.64-0.95)) for perceived health but significantly higher HRQoL scores (1.15 (95% CI; 1.06-1.26)) for health distress relative to patients from private hospital. Patients who completed an 8 months course of TB therapy had significantly higher HRQoL scores for perceived health (1.93 (95% CI; 1.19-3.13)), health distress subscales (1.29 (95% CI; 1.04-1.59)) and mental health summary scores (1.27 (95% CI; 1.09-1.48)) relative to patients that were starting therapy in multivariable analysis. Completion of 8 months TB therapy among patients who were recruited from the public hospital was associated with a significant increase in HRQoL scores for quality of life subscale (1.26 (95% CI; 1.08-1.49)), physical health summary score (1.22 995% CI; 1.04-1.43)), and VAS (1.08 (95% CI; 1.01-1.15)) relative to patients who were recruited from the private hospital. Older men were significantly associated with lower HRQoL scores for physical health summary score (0.68 (95% CI; 0.49-0.95)) and VAS (0.87 (95% CI; 0.75-0.99)) relative to women of the same age group. No differences were seen between HIV positive and HIV negative patients. The study provides evidence that the MOS instrument is valid, and reliably measures HRQoL among TB patients, and can be used in a wide variety of study populations. The HRQoL differed by hospital settings, by duration of TB therapy, and by gender in older age groups.Keywords
This publication has 14 references indexed in Scilit:
- Characteristics of anti-tuberculosis medication adherence in South AfricaApplied Nursing Research, 2007
- Measuring quality of life among HIV-infected women using a culturally adapted questionnaire in Rakai district, UgandaAIDS Care, 2004
- Problems of HRQL assessment: How much is too much?Journal of Clinical Epidemiology, 2001
- Socio-economic impact of tuberculosis on patients and family in India.1999
- Reliability and Validity of Physical and Mental Health Summary Scores from the Medical Outcomes Study HIV Health SurveyMedical Care, 1998
- Perception and social consequences of tuberculosis: A focus group study of tuberculosis patients in Sialkot, PakistanSocial Science & Medicine (1982), 1995
- The MOS 36-ltem Short-Form Health Survey (SF-36)Medical Care, 1992
- EuroQol - a new facility for the measurement of health-related quality of lifeHealth Policy, 1990
- Methodology for measuring health-state preferences—II: Scaling methodsJournal of Clinical Epidemiology, 1989
- Measurement of health state utilities for economic appraisal: A reviewJournal of Health Economics, 1986