Downloaded by [Tulane University] at 08:09 12 January 2015 Table III. Cronbach a coefficient in the domains. WHOQOL-100 WHOQL-HIV Physical 0.87 0.88 Psychological 0.91 0.93 Level of Independence 0.91 Social Relations 0.87 0.87 Environment 0.90 Spirituality 0.87 0.87 domain) and spiritual connection/personal spiritual experience (Spirituality domain). The Pearson coefficient values between each item and the score of the facet in which it is included, calculated from its own exclusion (correlation between item/total corrected) are included. All correlation coefficients are above 0.30, except for the security facet, where the lowest range value is 0.10. The WHOQOL-HIV, with an additional 7 HIVspecific facets in comparison to the WHOQOL- 100, maintained satisfactory internal consistency (Table III). The Physical and Psychological domains showed a small increase in the Cronbach alpha value; in Social Relations and Spirituality they remain constant. In the Level of Independence and Environment domains there are no HIV-specific facets. Discriminant validity. Table IV shows the mean scores (9Standard Deviation) obtained by asymptomatic, symptomatic and AIDS patients in the domains and facets of the WHOQOL-HIV. AIDS patients consistently scored lower than the remaining patient groups. Statistical differences were found in all domains, though specifically in the environment domain, AIDS patients’ scores were significantly lower only in relation to the symptomatic patients. Concurrent validity. The correlation between the WHOQOL-HIV domains and the General Quality of Life facets (originally a facet of the WHOQOL- 100) was examined with the Pearson correlation coefficient (Table V). In all domains correlations were significant (p B0.01), being that all coefficient values were above or equal to 0.5. Sociodemographic and clinical variables. The study revealed sociodemographic variables and their relation with WHOQOL-HIV scores. Women, younger (B35 years) and married patients were associated with a lower QOL, while a higher socioeconomic and educational level favour a better quality of life. Among clinical variables, it is of interest that the use of 2 or more anti-retroviral drugs was correlated with lower scores in the Psychological and Level of Independence domains (pB 0,05). Quality of life in HIV-positive Brazilians 927 Discussion The WHOQOL-HIV revealed good psychometric properties when applied to a sample of Brazilian living with HIV/AIDS. Satisfactory reliability, construct validity, discriminant validity and concurrent validity were detected. The above observations are in accordance with findings in the literature (Starace et al., 2002). Analysis of scores distribution in our sample revealed absence of ‘ceiling’ and ‘floor’ effects for all WHOQOL-HIV facets. ‘Ceiling’ and ‘floor’ effects are the percentage of subjects who had scored the highest 100 or the lowest 0-possible score, respectively, and were considered substantial if] 20% (McHorney et al., 1994; Holmes & Shea, 1997). When examined alongside stages of HIV infection, the domain scores of the WHOQOL-HIV worsen as the disease progresses. In all domains, significant differences appeared between the AIDS group and the asymptomatic and symptomatic groups, the last two showing a similar scoring profile. The exception occurs in the Environment domain, where the AIDS group scored significantly lower when compared to the symptomatic group only. The significant differences in the QOL of the AIDS group compared to the remaining groups indicate that the dividing line for QOL in this sample of PLHAs is the manifestation of the disease in it’s most advanced clinical stage. In the Psychological domain there were significant lower QOL scores only in AIDS stage. Nevertheless, this discriminant property of the Psychological domain is not always evident (Starace et al., 2002). As the disease progresses, Physical and Level of Independence domains scores decreased, as expected, as the clinical aggravation of the infection impacts the body and self-management capability. AIDS patients consistently scored lower than the remaining patient groups in all domains. The researchers expected that the scores in the Spirituality domain, at least, would increase as the disease progressed (Kramer, 1998; Fryback & Reinert, 1999; Saxena et al., 2002). This was not evident as the symptomatic group reported the highest scores and, the AIDS group scoring the lowest of the three groups. This result suggests that the patient’s most introspective and subjective stage correlates with the appearance of the first symptoms, followed by the seroconversion stage and not necessarily during the final and most debilitating stages. Further research is necessary to explain this point. Also in the Spirituality domain, the three groups showed the highest standard deviation, suggesting large variability in personal beliefs. The study revealed sociodemographic variables and their relation with WHOQOL-HIV scores.
928 R. R. Zimpel & M. P. Fleck Table IV. Mean score (9standard deviation) in domains and facets of WHOQOL-HIV. Domains HIV Asymp (n131) HIV Symp (n91) AIDS (n86) F 2; 305$ p test% Tukey Test (pB0,05) Downloaded by [Tulane University] at 08:09 12 January 2015 Physical 56.3916.1 51.3916.6 43.6916.5 15.6 0.000 AIDS versus Asymp AIDS versus Symp Pain and discomfort 47.5920.6 54.2920.9 62.0918.9 Energy and fatigue 60.0919.6 55.6920.1 44.4919.1 Sleep and rest 62.5921.9 60.3927.8 53.1925.0 HIV Symptoms* 50.1920.9 43.5921.9 39.1921.7 Psychological 60.5915.6 62.5915.3 52.7915.7 10.1 0.000 AIDS versus Asymp AIDS versus Symp Positive Feelings 59.5919.1 64.1917.4 52.4919.7 Cognition 61.4916.1 64.7916.4 56.8917.0 Self-esteem 64.4918.8 67.1918.4 58.1918.9 Body image and appearance 64.7920.3 65.4921.8 53.7922.0 Negative feelings 47.6920.3 48.2922.2 56.8923.1 Body image and appearance* 60.2923.2 61.9926.0 53.8924.0 Negative Feelings* 60.9920.7 62.7924.0 50.6922.8 Level of Independence 64.0917.9 59.9917.2 47.5918.3 22.9 0.000 AIDS versus Asymp AIDS versus Symp Mobility 66.7922.7 64.3920.8 53.8925.2 Daily Activities 65.2921.4 65.5922.6 48.4921.5 Medication or Treatment 43.8925.7 57.4926.6 64.6921.3 Dependency Aptitude for work 67.9921.5 67.4924.3 52.4925.4 Social Relations 60.2917.5 63.9916.7 53.8917.9 7.6 0.001 AIDS versus Asymp AIDS versus Symp Personal Relationships 63.5919.1 70.1919.4 56.1919.3 Social support 59.8921.4 64.8923.1 54.3921.5 Sexual activity 57.4920.4 55.7921.9 49.2923.2 Social Inclusion* 59.9921.9 65.1922.0 55.8923.1 Environment 53.0912.0 55.9912.4 50.6912.3 4.2 0.015 AIDS versus Symp Physical security 46.2915.5 47.8914.7 45.5914.5 Housing 58.5920.2 68.8918.2 56.2922.2 Financial Resources 41.7917.8 40.3920.1 36.2919.4 Health/social work 57.6917.9 59.4919.2 59.1918.0 Learning opportunity 57.1916.1 61.0919.9 55.2918.0 Leisure opportunity 55.0920.5 53.7919.3 47.6921.3 Physical environment 52.3917.0 57.4915.4 52.0917.4 Transportation 55.9918.9 59.0923.8 53.0920.1 Spirituality 58.8917.0 60.4918.0 52.4917.6 5.3 0.006 AIDS versus Asymp AIDS versus Symp Spirituality, religion, personal 63.8920.2 75.7919.0 64.2920.9 beliefs Forgiveness* 56.8924.1 49.7927.1 43.4925.3 Spiritual connection and 58.3920.6 59.5923.4 53.1923.1 personal spiritual experience* Death and dying* 56.2925.5 56.7927.6 48.9925.9 Notes: *Facets of the HIV module. $ F Value (Analysis of Variances); % Analysis of Variances. Women, younger (B35 years) and married patients were associated with a lower QOL. Other studies point to this data regarding women (O’Connell et al., 2003; Mrus et al., 2005) and question whether in fact females live a life of inferior quality or if they respond to questionnaires in a different style (Lenderking et al., 1997). It is surprising that married patients also show this result, since social, and specifically familial support would favour increased well-being. This is an issue that deserves further examination. Not surprising were the findings that a higher socioeconomic and educational level favour a better quality of life. Among clinical variables, it is of interest that the use of 2 or more anti-retroviral drugs was correlated with lower scores in the Psychological and Level of