Feasibility, reliability and validity of health-related quality of life questionnaire among adult pulmonary tuberculosis patients in urban Uganda: cross-sectional study
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Date
2010
Journal Title
Journal ISSN
Volume Title
Publisher
Health and quality of life outcome
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.
Objective: We established the feasibility, reliability, and validity of the Medical Outcomes Survey (MOS) in assessing
HRQoL among patients with pulmonary tuberculosis in Kampala, Uganda.
Methods: 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.
Results: 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.
Conclusion: 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.
Description
Keywords
Feasibility, Reliability, Health-related quality of life questionnaire, Adult pulmonary tuberculosis patients
Citation
Babikako, H. M., Neuhauser, D., Katamba, A., & Mupere, E. (2010). Feasibility, reliability and validity of health-related quality of life questionnaire among adult pulmonary tuberculosis patients in urban Uganda: cross-sectional study. Health and quality of life outcomes, 8(1), 1-8. doi:10.1186/1477-7525-8-93