WHOQOL-HIV BREF

Last Updated

October 01, 2017

Purpose

Assesses the quality of life in people living with HIV/AIDS

Link to Instrument

Instrument Details

Acronym WHOQOL-HIV-Bref

Administration Mode

Paper & Pencil

Cost

Free

Actual Cost

$0.00

Mixed Populations

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

WHOQOL-HIV manual

10-15 minutes

Required Training

Reading an Article/Manual

Instrument Reviewers

Valencia Cotchery, MPA

ICF Domain

Activity
Participation
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).
Culture and values influence quality of life, so diverse cultures may comprehend and interpret questions differently (Meemon et al., 2016).
All domains sensitively differentiate between patients with fewer and less severe symptoms than those with more intense symptoms (Hsiung et al., 2011).

Normative 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%))

Excellent test-retest reliability: Physical needs (ICC = 0.87)
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%))

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)
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. https://doi.org/10.1080/09540121.2011.630362

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. https://doi.org/10.1080/09540121.2010.543881

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. https://doi.org/10.1016/j.jana.2016.04.007

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 http://cdn.intechweb.org/pdfs/22273.pdf

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. https://doi.org/10.1007/s11136-014-0707-7

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. https://doi.org/10.1080/09540120902803216

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. https://doi.org/10.1136/bmjopen-2017-016382