Research Article: Quality of Life among Persons with HIV/AIDS in Iran: Internal Reliability and Validity of an International Instrument and Associated Factors

Date Published: January 12, 2012

Publisher: Hindawi Publishing Corporation

Author(s): Pedram Razavi, Kaveh Hajifathalian, Behtash Saeidi, Gholamreza Esmaeeli Djavid, Mehrnaz Rasoulinejad, Mahboube Hajiabdolbaghi, Koosha Paydary, Parastoo Kheirandish, Mahsa Foroughi, SeyedAhmad SeyedAlinaghi, Minoo Mohraz, Willi McFarland.


The purpose of this cross-sectional study on 191 HIV/AIDS patient was to prepare the first Persian translation of complete WHOQOL-HIV instrument, evaluate its reliability and validity, and apply it to determine quality of life and its associated factors in Tehran, Iran. Student’s t-test was used to compare quality of life between groups. Mean Cronbach’s α of facets in all six domains of instrument were more than 0.6 indicating good reliability. Item/total corrected correlations coefficients had a lower limit of more than 0.5 in all facets except for association between energy and fatigue facet and physical domain. Compared to younger participants, patients older than 35 years had significantly lower scores in overall quality of life (P = 0.003), social relationships (P = 0.021), and spirituality/religion/personal beliefs (P = 0.024). Unemployed patients had significantly lower scores in overall quality of life (P = 0.01), level of independence (P = 0.004), and environment (P = 0.001) compared to employed participants. This study demonstrated that the standard, complete WHOQOL-HIV 120 instrument translated into Farsi and evaluated among Iranian participants provides a reliable and valid basis for future research on quality of life for HIV and other patients in Iran.

Partial Text

Quality of life is defined not only by one’s general health but also by psychological well-being and social status. The psychosocial aspects of quality of life may be increasingly important in patients with HIV infection as the disease becomes more chronic in nature during the era of more effective antiretroviral treatment (ART). Studies show that HIV patients often experience a decline in quality of life due to factors other than disease stage and physical condition [1–4], such as poverty, addiction, depression, and violence [5]. Understanding such factors and their influence helps to establish better social services to address multidimensional issues related to quality of life in these patients. However, the measurement of quality of life with its diverse dimensions is complex. The World Health Organization disseminates a standardized quality-of-life instrument specifically adapted for HIV patients (WHOQOL-HIV) which has been widely used and shown to be a valuable tool for evaluating patients’ perception of their quality of life [6].

This is a cross-sectional survey of patients living with HIV/AIDS visiting the Imam Khomeini Hospital consultation center for patients with behavioral disorders conducted over a one year period in 2009-2010. The purpose, procedures, and potential risks and benefits of the study were explained to patients, and all those agreeing to participate provided written informed consent. Parents provided written informed consent for minor participants. The study was approved by the hospital and the Tehran University Medical School ethics committee. The study was conducted in two stages. The first stage prepared a valid and reliable Farsi translation of the complete WHOQOL-HIV instrument, which was used to collect data during the second phase. The inclusion criteria were being 18 years of age or older, being an HIV-positive patient, and not having cognitive or communicative disabilities or psychotic disorders such as schizophrenia. Illiterate participants completed the form with assistance of an experienced clinician cooperating with the study.

A total of 191 patients with HIV/AIDS were enrolled. Of these, 159 (83.2%) were male. The mean age was 35.7 years (±8.05) with a range of 11 to 60 years. Mean age of male participants did not differ from that of females (36.1 ± 8.2 versus 34.1 ± 7.1, respectively; P = 0.189). A summary of patients’ characteristics is presented in Table 2. Of all participants, 95 (49.7%) were single and 69 (36.1%) married. The majority of patients report their level of education as having junior-high or high-school diplomas. From 191 patients, 113 (59.2%) had a history of incarceration, and 108 (56.5%) had history of intravenous substance abuse. The most common transmission modes were intravenous substance abuse (52.4%) and extramarital sexual relationship (25.1%). Of 191 participants, 75 (39.3%) were under highly active antiretroviral therapy (HAART). The mean number of family members of participants was 3.5 (±1.9), and 97 (50.8%) of them were heads of their households. Most (63.3%) patients declared that they have no income, and only 19 (10%) had monthly income of more than 200 dollars. Nearly half (44.5%) were home owners, 72 (37.7%) lived in rented houses, and 20 (10.5%) lived with their relatives.

The present study was the first to assess the quality of life in a substantial number of patients living with HIV/AIDS in Iran using a field-tested Farsi version of the standard, complete WHOQOL-HIV 120 instrument. In the event, our Farsi version of the WHOQOL-HIV developed for this study had good reliability and validity. All main domains of questionnaire had Cronbach’s α scores of more than 0.6, supporting an acceptable internal consistency for instrument. Structural validity assessed using item/total corrected correlations for association between each domain and their facets were in the range of 0.50–0.91 in all 29 facets with the exception of the energy and fatigue facet of the physical domain, and the correlations between individual domains of instrument were satisfactory with coefficients of more than 0.4.




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