Feasibility, reliability and validity of health-related quality of life questionnaire among adult pulmonary tuberculosis patients in urban Uganda: cross-sectional study

Abstract

BackgroundDespite 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.ObjectiveWe established the feasibility, reliability, and validity of the Medical Outcomes Survey (MOS) in assessing HRQoL among patients with pulmonary tuberculosis in Kampala, Uganda.MethodsIn 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.ResultsThe 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.ConclusionThe 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...

Health Status and Quality of Life in Tuberculosis: Systematic Review of Study Design, Instruments, Measuring Properties and Outcomes

“…The validation study from Taiwan [27] used WHOHRQOL -BREF (World Health Organization Health Related Quality of Life-BREF) also showed an adequate reliability. However, only one HRQOL instrument showed cross culture adaptability [26].…”

“…In this review, all kinds of TB patients pulmonary TB, extra pulmonary TB, active TB disease, late TB infection, current TB and recurrent TB were included. The methodology quality of six studies [15,23,26,27,37,39] was validated by the use of COSMIN check list and results were demonstrated on the scale from poor to excellent (Tables 5 and 6). None of these studies included the measurement error while one study showed cross cultural validity [26] measures mostly focused on perceptions which are subjective and without a gold standard.…”

“…The methodology quality of six studies [15,23,26,27,37,39] was validated by the use of COSMIN check list and results were demonstrated on the scale from poor to excellent (Tables 5 and 6). None of these studies included the measurement error while one study showed cross cultural validity [26] measures mostly focused on perceptions which are subjective and without a gold standard. Internal consistency was excellent for Functional Assessment of Chronic Illness Therapy-Tuberculosis (FACIT-TB) in one of the study from Malaysia [23].…”

“…The data was based on comparative studies of TB population from China , two from Malaysia [18,23], five from India [14,15,29,[35][36][37][38], four from Canada [5,24,25,30] one form each UK [17] Pakistan [35], Spain [36] Taiwan [28] South Africa [37] and Turkey [39]. Among the selected articles fourteen studies were cross sectional [5,14,26,27,30,33,[34][35][36][37][38][39][40] and sixteen were prospective cohort based studies [15][16][17][18][19][20][21][22][23][24][25][26]29,31,32,41]. An article published by Chamla et al …”

“…Internal consistency reliability coefficients scores were 0.92 and 0.93 for the subjects and control referents, correspondingly [27]. Babikako et al [26] carried out a validation study for the feasibility to use MOS instrument. All subscales have adequate internal consistency with Cronbach's alpha >0.7.…”