Development and Validation of a Cross-Cultural Heart Failure-Specific Quality of Life Questionnaire

Abstract

Objectives: Heart failure (HF) is a common clinical syndrome with an enormous impact on prognosis and lifestyle. Accordingly, rehabilitation measures need to be patient-specific and consider various sociocultural factors so as to improve the patient’s quality of life (QOL). This study aimed to develop and validate a HF-specific QOL (HFQOL) questionnaire within a multicultural setting. Methods: This study took place at the National Heart Institute and Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia, between March 2013 and March 2014. A self-administered 75-item HFQOL questionnaire was designed and administrated to 164 multi-ethnic Malaysian HF patients. Exploratory factor analysis was performed to assess the instrument’s construct validity. Cronbach’s alpha coefficients were used to determine internal consistency. Results: A total of 33 out of 75 items were retained in the final tool. The HFQOL questionnaire had three common factors—psychological, physical-social and spiritual wellbeing—resulting in a cumulative percentage of total variance of 44.3%. The factor loading ranges were 0.450–0.718 for psychological wellbeing (12 items), 0.394–0.740 for physical-social wellbeing (14 items) and 0.449–0.727 for spiritual wellbeing (seven items). The overall Cronbach’s alpha coefficient of the questionnaire was 0.82, with coefficients of 0.86, 0.88 and 0.79 for the psychological, physical-social and spiritual wellbeing subdomains, respectively. Conclusion: The HFQOL questionnaire was found to be a valid and reliable measure of QOL among Malaysian HF patients from various ethnic groups. Such tools may facilitate cardiac care management planning among multi-ethnic patients with HF.Keywords: Heart Failure; Quality of Life; Culturally Competent Care; Ethnic Groups; Questionnaire Design; Reliability and Validity; Malaysia.

The efficient biogeneration of Ag and NiO nanoparticles from VPLE and a study of the anti-diabetic properties of the extract

“…A probable mechanism explaining the above-mentioned effects would be disturbances in the cellular architecture of diabetics, evoked by severe pro-oxidative stress. 38,39 The production of oxidants can induce apoptosis in hepatocytes and can induce oxidative stress, which is an indicator of these disturbances. 38 Notably, it is found that hyperglycemia decreases the synthesis and activity of some antioxidizing enzymes, such as SOD and GPx, likely via a glycation process.…”

“…The inhibitory effects of VPLE could be related to the antioxidant activity of VPLE. 38,53,54 The remarkable free radical scavenging activity of VPLE could be a potential reason for its effects on reversing lipid peroxidation levels and on the antioxidant activities of SOD and GPx enzymes.…”

“…Considering hepatopathy as one of the most important diabetes-induced complications, 38,55 we performed histological examinations of H&E stained liver samples and tested pathological tissue variations. Histopathological examinations revealed that VPLE administration (either at a dose of 250 or 500 mg kg À1 ) may reverse the degeneration of liver tissue structures and lead to the reappearance of hyperplastic hepatocytes in damaged liver, as shown in Fig.…”

“…[33][34][35] Liver disease is considered as one of the major complications related to oxidative stress disorders like DM 36 and ethological studies have provided many evidence that chronic hyperglycemia causes complicated diabetic hepatopathy. 37,38 Oxidative stress provides an effective mechanism by which the glycation process, a precise enzyme-controlled process related to glucose metabolism, the hyper-production of free-radical precursors, and a decrease in the efficiency of antioxidants all contribute to a surge in disease severity. 37,39 It has been shown that Vitex constituents have protective effects against experimentally induced diabetic complications through increasing the antioxidant enzyme activity.…”

The self-care behaviour association with quality of life among Chinese ethnic with heart failure in Malaysia

“…It is when the heart muscle is not able to efficiently pump sufficient blood and oxygen in order to meet the needs of the body. In accordance to that, rehabilitation measures need be tailored to the patients considering various sociocultural factors as a result to improve the quality of life (QOL) among the patients (Mohamed, Ghazali, Yaacob, Azan & Maskon, 2018). Past research have suggested that HF patients have suffered from a bad quality of life (Napier, McNulty, Eton, Redfield, AbouEzzeddine & Dunlay, 2018).…”