Assessing quality of life in people with HIV in Spain: psychometric testing of the Spanish version of WHOQOL-HIV-BREF

Abstract

Background The assessment of health-related quality of life (HRQoL) in people living with HIV (PLHIV) has become crucial to evidence-based practice. The goals of this study are to analyze the psychometric properties and evidence of the validity of the Spanish version of WHOQOL-HIV-BREF in a sample of PLHIV in Spain and to examine the more impaired HRQoL facets and dimensions and identify the PLHIV who show the most vulnerable profile. Methods A total of 1462 PLHIV participated in an observational cross-sectional ex-post-facto study. Data were collected at 33 Spanish sites through an online survey. In addition to measuring HRQoL, the study used other tools to measure treatment adherence (CEAT-VIH 2.0 version), psychological well-being (GHQ-12) and HIV-related stigma (HSSS). Cronbach’s alpha, first- and second-order confirmatory factor analysis (CFA), the Pearson coefficient and one-way ANOVA were used to evaluate reliability, construct validity and concurrent and known-group validity, respectively. Differences according to the socio-demographic and epidemiological profiles of participants were analyzed. Results First- and second-order CFAs confirmed a six-domain first-order structure of the Spanish version of WHOQOL-HIV-BREF and one second-order factor related to overall HRQoL with an acceptable fit to the data, although some minor changes would improve it. The six-domain structure showed an acceptable internal consistency (Cronbach’s alpha ranged from .61 to .81). Significant moderate to large correlations between domains and overall HRQoL, adherence, psychological well-being and negative self-image were found. Significant differences were found according to participants’ self-reported CD4+ cell count in several HRQoL facets and domains. Being female, heterosexual, having low socio-economic and educational statuses, having acquired HIV through an unsafe injection and living more years with HIV were related to poorer HRQoL. PLHIV older than 50 presented lower scores in 19 HRQoL facets. Conclusions This study demonstrates that the Spanish version of the WHOQOL-HIV-BREF is a valid instrument. It also presents the most recent data about HRQoL in PLHIV in Spain with the largest sample to date. Electronic supplementary material The online version of this article (10.1186/s12955-019-1208-8) contains supplementary material, which is available to authorized users.

Self-rated health among people living with HIV in Spain in 2019: a cross-sectional study

“…Similarly to other studies in Spain [8,21] and abroad [16,22], educational level and employment status were strongly associated with self-rated health in PLHIV, in both ART treated and virologically suppressed. Both variables are considered a proxy of socio-economic status, which has been shown to be associated with self-rated health among the general population in Spain [19].…”

“…A longer time with a diagnosed HIV infection has been associated with lower scores of HQoL [8,30]. In contrast, our results shown that having had an HIV diagnosis less than two years ago was associated with worse self-rated health.…”

“…In a cross-sectional study among PLHIV in Canada, a great impact of employment status was found on both physical and mental health quality of life and the authors suggested a bidirectional relationship between both variables: a higher quality of life would be necessary to maintain employment and employment may be a bene t of health and well-being [23]. In our study, being retired was also associated with poor self-rated health suggesting that a person's nancial situation is an important determinant [8].…”

“…Other studies have described associations between homeless or marginally-housed PLHIV and poor access and adherence to ART, as well as poor retention in care, highlighting the vulnerability of this group of people [24]. On the other hand, lack of social support has been linked to poor health status among PLHIV, either as an independent factor or mediated by depression, isolation or marginalization [8,22,25,26].…”

“…Aging has been associated with worse HQoL [8,22]. Some studies have reported a greater impact of age on physical than on mental health [26]; other authors have described a lower prevalence of depression and anxiety in older people [25], related to development of resilience and coping strategies [30].…”