Adaptation and validation of the short version WHOQOL-HIV in Ethiopia

Markos Tesfaye, Mette Frahm Olsen, Girmay Medhin, Henrik Friis, Charlotte Hanlon, Lotte Holm

Quality of life of patients is an important element in the evaluation of outcome of health care, social services and clinical trials. The WHOQOL instruments were originally developed for measurement of quality of life across cultures. However, there were concerns raised about the cross-cultural equivalence of the WHOQOL-HIV when used among people with HIV in Ethiopia. Therefore, this study aimed at adapting the WHOQOL-HIV bref for the Ethiopian setting. A step-wise adaptation of the WHOQOL-HIV bref for use in Ethiopia was conducted to produce an Ethiopian version-WHOQOL-HIV-BREF-Eth. Semantic and item equivalence was tested on 20 people with HIV. One hundred people with HIV were interviewed to test for measurement equivalence (known group validity and internal consistency) of the WHOQOL-HIV-BREF-Eth. Confirmatory factor analysis was conducted using data from 348 people with HIV who were recruited from HIV clinics. In the process of adaptation, new items of relevance to the context were added while seven items were deleted because of problems with acceptability and poor psychometric properties. The Cronbach's α for the final tool with twenty-seven items WHOQOL-HIV-BREF-Eth was 0.93. All six domains discriminated well between symptomatic and asymptomatic people with HIV (p < 0.001). Using confirmatory factor analysis, a second order factor structure with six first order indicator factors demonstrated moderate fit to the data ((χ(2) = 627.75; DF = 259; p < 0.001), CFI = 0.82, TLI = 0.77 and RMSEA = 0.064). The WHOQOL-HIV-BREF-Eth has been shown to be a valid measure of quality of life for use in clinical settings among people with HIV in Ethiopia.