WHOQOL-BREF用于评价HIV感染者生活质量的信、效度研究

徐迪; 端琼丽; 潘玲; 黄能梅; 韩晶; 李健

doi:10.16462/j.cnki.zhjbkz.2022.05.015

WHOQOL-BREF用于评价HIV感染者生活质量的信、效度研究

doi: 10.16462/j.cnki.zhjbkz.2022.05.015

徐迪¹,
端琼丽²,
潘玲¹,
黄能梅²,
韩晶¹,
李健^1, ,

1.
102206 北京，中国疾病预防控制中心性病艾滋病预防控制中心
2.
661199 蒙自，红河哈尼族彝族自治州疾病预防控制中心艾滋病防制科

基金项目:

中国疾病预防控制中心性病艾滋病预防控制中心青年科研基金 2018AFQN004

详细信息

通讯作者:
李健，E-mail: jli@chinaaids.cn

中图分类号: R512.91
计量
- 文章访问数: 633
- HTML全文浏览量: 198
- PDF下载量: 77
- 被引次数: 0
出版历程
- 收稿日期: 2021-11-17
- 修回日期: 2022-02-15
- 网络出版日期: 2022-05-11
- 刊出日期: 2022-05-10

Assessment on the validity and reliability of the WHOQOL-BREF among HIV cases

1.
National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
2.
Department of AIDS Control and Prevention, Center for Disease Control and Prevention of Hani-Yi Autonomous Prefecture of Honghe, Mengzi 661199, China

Funds:

The Project Sponsored by the Young Scholar Scientific Research Foundation of NCAIDS, China CDC 2018AFQN004

More Information

Corresponding author: LI Jian, E-mail: jli@chinaaids.cn

摘要

摘要: 目的评价世界卫生组织生活质量测定简表(World Health Organization quality of life scale-brief form questionnaire, WHOQOL-BREF)在测定HIV感染者生活质量中应用的信度和效度，比较不同特征HIV感染者的生活质量，为下一步评价感染者的生活质量和制定有效的关怀措施提供参考依据。方法采用方便抽样的方法在云南省红河哈尼族彝族自治州选择符合条件的HIV感染者。采用Cronbach’s α系数和分半信度评价其信度；探索性因子分析(exploratory factor analysis, EFA)和验证性因子分析(confirmatory factor analysis, CFA)检验其效度；单因素方差分析比较不同特征感染者在WHOQOL-BREF各维度上的得分情况。结果共获得410份有效问卷。WHOQOL-BREF及生理领域、心理领域、社会领域和环境领域的Cronbach’s α系数分别为0.901、0.779、0.819、0.729和0.743，分半信度分别为0.798、0.716、0.822、0.736和0.697。EFA共获取4个公因子，对总体方差的贡献率为54.542%；CFA结果显示最终拟合模型的主要指标χ²/df和估计误差均方根(root-mean-square error of approximation, RMSEA)分别为2.169和0.076；拟合优度模型指数(goodness of fit index, GFI)、比较拟合指数(comparative fit index, CFI)和Tucker-Lewis指数(Tucker-Lewis index, TLI)分别为0.820、0.861和0.844，均接近0.900，表示拟合结果可以接受。单因素方差分析结果显示，是否接受抗逆转录病毒治疗、民族、职业、文化程度和最近一次CD4⁺T淋巴细胞计数等不同特征感染者的生活质量有所不同。结论 WHOQOL-BREF在测定HIV感染者的生活质量具有较好的信度和效度，不同特征感染者的生活质量有所差异，在制定有针对性的干预策略和措施时需加以考虑。
- HIV /
- 生活质量: 世界卫生组织生活质量测定简表 /
Abstract: Objective The objective of the study was to assess the reliability and validity of the World Health Organization quality of life scale-brief form questionnaire (WHOQOL-BREF) and compare the quality of life among HIV cases, providing a basis for evaluating the quality of life and formulating effective measures of HIV cases. Methods HIV cases were recruited through convenience sampling method in Honghe Hani-Yi Autonomous Prefecture, Yunnan Province. Reliability was assessed by using Cronbach's α and split-half reliability, while exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to assess its validity. ANOVA were used to compare the scores of different characteristics. Results A total of 410 valid questionnaires were obtained. Cronbach's α of WHOQOL-BREF and physical, psychological, social relationships, environment of WHOQOL-BREF were 0.901, 0.779, 0.819, 0.729, 0.743 respectively. The related correlation coefficients of split half were 0.798, 0.716, 0.822, 0.736, 0.697 respectively. Exploratory factor analysis obtained four communal factors, with a contribution of 54.542% to the overall variance. The results of the confirmatory factor analysis showed that the main indicators of the fitted model were χ²/df and the root-mean-square error of approximation (RMSEA), and the value were 2.169 and 0.076 respectively. Goodness of fit index (GFI), comparative fit index (CFI) and Tucker-Lewis index (TLI) were 0.820, 0.861 and 0.844 respectively. All value were closed to 0.900, indicating an accepted level. ANOVA results showed that there were different quality of life among HIV cases with different characteristics such as receiving antiretroviral therapy or not, ethnicity, occupation, education and last CD4⁺T lymphocyte count. Conclusion The reliability and validity of the WHOQOL-BREF are good, and quality of life varied by different characteristics of HIV cases prompting the intervention strategies pertinently.
- HIV /
- Quality of life /
- WHOQOL-BREF

HTML全文

图 1 WHOQOL-BREF用于评价HIV感染者生活质量的验证性因子模型

Figure 1. WHOQOL-BREF validated factor model for evaluating quality of life in HIV infected population

下载: 全尺寸图片幻灯片

表 1 经异性性传播HIV感染者的基本情况特征[n(%)]

Table 1. Basic characteristics of HIV-infected individuals via heterosexual contact [n(%)]

变量	例数	变量	例数
性别		婚姻状况
男	266(64.88)	有配偶/固定性伴	194(47.32)
女	144(35.12)	无配偶/固定性伴	216(52.68)
年龄组(岁)		职业
19~ < 36	73(17.80)	农民及民工	253(61.71)
36~ < 46	115(28.05)	其他	157(38.29)
46~ < 56	97(23.66)	最近一次CD4⁺T淋巴细胞计数(个/μl)
≥56	125(30.49)	< 200	64(15.61)
民族		200~ < 350	122(29.76)
汉族	203(49.51)	350~ < 500	104(25.36)
少数民族	207(50.49)	≥500	89(21.71)
文化程度		未检测	31(7.56)
小学及以下	215(52.44)	治疗状态
初中	138(33.66)	治疗	145(35.37)
高中及以上	57(13.90)	未治疗	265(64.63)

下载: 导出CSV

表 2 WHOQOL-BREF各维度信度

Table 2. The dimensional reliability of WHOQOL-BREF

维度	Cronbach’s α系数	分半信度
生理领域	0.779	0.716
心理领域	0.819	0.822
社会领域	0.729	0.736
环境领域	0.743	0.697
总体	0.901	0.798

下载: 导出CSV

表 3 不同特征HIV感染者生活质量各维度和独立条目得分比较(x±s)

Table 3. Comparison of dimensions and independent item scores of quality of life among HIV-infected patients with different characteristics (x±s)

变量	总体生活感受	总体健康状况	家庭摩擦	食欲	生理领域	心理领域	社会领域	环境领域
性别
男	3.30±0.75	3.64±0.76	4.21±0.94	3.69±0.79	15.44±2.29	14.26±2.27	14.12±2.53	13.82±2.09
女	3.29±0.78	3.59±0.77	4.18±0.98	3.72±0.79	15.44±2.33	14.47±2.22	14.21±0.42	14.09±2.04
F值	0.011	0.491	0.082	0.170	2.473	0.997	0.039	0.445
P值	0.915	0.484	0.774	0.680	0.117	0.319	0.840	0.505
年龄(岁)
19~ < 36	3.29±0.69	3.60±0.78	4.19±0.87	3.78±0.68	15.65±2.36	14.17±1.99	14.13±2.01	13.81±1.92
36~ < 46	3.39±0.76	3.70±0.73	4.24±0.89	3.74±0.83	15.68±2.20	14.66±2.30	14.66±2.07	14.11±2.02
46~ < 56	3.27±0.77	3.66±0.72	4.11±0.98	3.67±0.78	15.23±2.25	13.81±2.38	14.07±2.21	13.79±2.21
≥56	3.23±0.82	3.62±0.81	4.22±1.03	3.65±0.82	15.27±2.41	14.54±2.20	13.84±2.07	14.89±2.11
F值	0.961	0.895	0.355	0.530	1.120	3.029	2.518	0.539
P值	0.411	0.443	0.786	0.662	0.341	0.029	0.058	0.658
民族
汉族	3.26±0.82	3.52±0.77	4.20±1.01	3.61±0.81	15.07±2.34	14.13±2.35	13.95±2.47	13.87±2.10
少数民族	3.33±0.71	3.72±0.74	4.20±0.90	3.79±0.76	15.81±2.22	14.54±2.14	14.40±2.28	13.96±2.05
F值	1.043	7.687	0.000	5.499	10.761	3.455	4.770	0.158
P值	0.308	0.006	0.991	0.020	0.001	0.064	0.043	0.692
文化程度
小学及以下	3.27±0.74	3.64±0.78	4.06±0.96	3.71±0.84	15.41±2.01	14.24±2.38	14.18±2.45	13.87±2.13
初中	3.31±0.75	3.65±0.72	4.33±0.87	3.71±0.70	15.55±2.40	14.39±2.06	14.12±2.34	13.94±2.05
高中及以上	3.35±0.90	3.77±0.78	4.36±0.99	3.65±0.79	15.09±2.60	14.46±0.14	14.30±2.25	14.94±1.91
F值	0.301	1.258	5.127	0.151	0.936	0.421	1.004	6.506
P值	0.741	0.285	0.006	0.860	0.393	0.656	0.367	0.002
婚姻状况
有配偶/固定性伴	3.22±0.75	3.63±0.73	4.23±1.01	3.71±0.80	15.56±2.31	14.25±2.38	14.23±2.49	13.92±2.06
无配偶/固定性伴	3.63±0.78	3.32±0.79	4.17±0.90	3.70±0.78	15.31±2.33	14.14±2.15	14.13±2.29	13.91±2.08
F值	3.418	0.030	0.480	0.008	1.213	0.510	0.206	0.001
P值	0.065	0.862	0.489	0.927	0.271	0.476	0.650	0.979
职业
农民及民工	3.30±0.74	3.69±0.74	4.32±0.93	3.76±0.80	15.64±2.36	14.36±2.29	14.21±2.45	13.90±2.15
其他	3.28±0.81	3.52±0.80	4.12±0.99	3.61±0.76	15.12±2.19	14.30±2.19	14.12±2.27	13.93±1.95
F值	0.047	4.718	4.036	3.265	5.046	0.077	0.139	0.015
P值	4.718	0.030	0.045	0.072	0.025	0.781	0.710	0.903
最近一次CD4⁺T淋巴细胞计数(个/μl)
< 200	3.16±0.69	3.55±0.68	3.65±0.84	3.58±0.67	14.58±2.22	13.45±1.80	13.87±1.61	13.19±1.70
200~ < 350	3.31±0.79	3.59±0.79	4.19±0.94	3.84±0.80	15.67±2.16	14.59±2.52	14.03±2.75	13.92±2.33
350~ < 500	3.28±0.75	3.61±0.80	4.13±1.04	3.57±0.86	15.33±2.48	14.30±2.24	14.21±2.38	13.90±2.05
≥500	3.35±0.71	3.66±0.73	4.39±0.88	3.70±0.75	16.01±2.33	14.67±2.22	14.52±2.32	14.20±2.20
未检测	3.30±0.85	3.63±0.78	4.28±0.90	3.82±0.73	15.21±2.08	14.20±2.20	14.02±2.39	13.89±1.99
F值	0.365	0.166	4.000	2.032	2.937	2.022	0.760	1.378
P值	0.833	0.955	0.003	0.089	0.020	0.091	0.552	0.241
治疗状态
未治疗	3.23±0.73	3.60±0.74	3.77±0.80	3.62±0.72	15.17±2.49	13.18±1.90	13.21±1.91	13.04±1.67
治疗	3.33±0.78	3.64±0.78	4.43±0.91	3.75±0.82	15.59±2.19	14.80±2.30	14.42±2.57	14.39±2.12
F值	1.653	0.232	50.066	2.425	3.236	35.403	8.992	42.568
P值	0.199	0.630	< 0.001	0.120	0.073	< 0.001	0.003	< 0.001

下载: 导出CSV

参考文献(24)

[1]	Group TW. The Development of the World Health Organization Quality of Life Assessment Instrument (the WHOQOL)[M]. Quality of Life Assessment: International Perspectives, 1994.
[2]	Bernaud C, Sécher S, Michau C, et al. HIV-infected patients aged above 75 years[J]. Médecine et Maladies Infectieuses, 2020, 50(1): 43-48. DOI: 10.1016/j.medmal.2019.04.001.
[3]	韩晶, 李健, 臧春鹏, 等. 我国2016-2018年报告HIV/AIDS首次随访后的跨省流动情况和抗病毒治疗效果分析[J]. 中华流行病学杂志, 2021, 42(1): 126-130. DOI: 10.3760/cma.j.cn112338-20200603-00805. Han J, Li J, Zang CP, et al. Analysis of inter-provincial movement and the effect of antiretroviral therapy of HIV/AIDS cases after first follow up in China, 2016-2018[J]. Chin J Epidemiol, 2021, 42(1): 126-130. DOI: 10.3760/cma.j.cn112338-20200603-00805.
[4]	莫小云, 曾志励, 梁冰林, 等. 艾滋病高发区HIV/AIDS患者生活质量影响因素研究[J]. 国际护理学杂志, 2017, 36(16): 2181-2184. DOI: 10.3760/cma.j.issn.1673-4351.2017.16.006. Mo XY, Zeng ZL, Liang BL, et al. Study of influence factors on the living quality of HIV/AIDS patients in the high incidence area of AIDS[J]. Int J Nurs, 2017, 36(16): 2181-2184. DOI: 10.3760/cma.j.issn.1673-4351.2017.16.006.
[5]	Group W. Development of the World Health Organization WHOQOL-BREF quality of life assessment[J]. Psychol Med, 1998, 28(3): 551-558. DOI: 10.1017/s0033291798006667.
[6]	冼君定, 谭健烽, 万崇华, 等. WHOQOL-BREF量表用于精神分裂症和抑郁症的信效度研究[J]. 中华疾病控制杂志, 2015, 19(5): 500-503. DOI: 10.16462/j.cnki.zhjbkz.2015.05.019. Xian JD, Tan JF, Wan CH, et al. Reliability and validity of WHOQOL-BREF in measurements of quality of life in patients with depression and schizophrenia[J]. Chin J Dis Control, 2015, 19(5): 500-503. DOI: 10.16462/j.cnki.zhjbkz.2015.05.019.
[7]	World Health Organization. WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment: field trial version, December 1996[M]. Geneva: World Health Organization, 2012.
[8]	李程, 熊帮洁, 陈禹存, 等. 大连市MSM中HIV阳性者的生活质量及其影响因素[J]. 中国艾滋病性病, 2015, 21(9): 782-785. DOI: 10.13419/j.cnki.aids.2015.09.10. Li C, Xiong BJ, Chen YC, et al. Study on quality of life and its influencing factors among MSM living with HIV/AIDS[J]. Chin J AIDS STD, 2015, 21(9): 782-785. DOI: 10.13419/j.cnki.aids.2015.09.10.
[9]	端琼丽, 张维义, 常铃, 等. 云南省红河州HIV抗体双阳夫妻的流行病学分析[J]. 中国艾滋病性病, 2016, 22(4): 260-262. DOI: 10.13419/j.cnki.aids.2016.04.11. Duan QL, Zhang WY, Chang L, et al. Analysis of epidemiological characteristics among HIV-1 positive couples in Honghe Prefecture, Yunnan Province, China[J]. Chin J AIDS STD, 2016, 22(4): 260-262. DOI: 10.13419/j.cnki.aids.2016.04.11.
[10]	孙亚清. Logistic回归样本量确定所需自变量事件数的模拟研究[D]. 广州: 南方医科大学, 2016. DOI: 10.7666/d.Y3117200. Sun YQ. A simulation study on the number of events needed of independent variables for sample size determination of Logistic regression[D]. Guangzhou: Southern Medical University, 2016. DOI: 10.7666/d.Y3117200.
[11]	Charter RA. Sample size requirements for precise estimates of reliability, generalizability, and validity coefficients[J]. J Clin Exp Neuropsychol, 1999, 21(4): 559-566. DOI: 10.1076/jcen.21.4.559.889.
[12]	Mcdonald RP, Ho MH. Principles and practice in reporting structural equation analyses[J]. Psychol Methods, 2002, 7(1): 64-82. DOI: 10.1037/1082-989x.7.1.64.
[13]	刘淼, 何耀, 张迪, 等. 社区老年人群健康综合评估工具的研发及信度和效度研究[J]. 中华流行病学杂志, 2016, 37(2): 210-213. DOI: 10.3760/cma.j.issn.0254-6450.2016.02.012. Liu M, He Y, Zhang D, et al. Reliability and validity of a newly developed tool to be used for the comprehensive geriatric assessment on community elderly[J]. Chin J Epidemiol, 2016, 37(2): 210-213. DOI: 10.3760/cma.j.issn.0254-6450.2016.02.012.
[14]	Liu H, Xu Y, Sun Y, et al. Measuring HIV stigma at the family level: psychometric assessment of the Chinese Courtesy Stigma Scales (CCSSs)[J]. Plos One, 2014, 9(3): e92855. DOI: 10.1371/journal.pone.0092855.
[15]	安胜利, 陈平雁. 量表的信度及其影响因素[J]. 中国社会医学杂志, 2002, 19(1): 23-27. DOI: 10.3969/j.issn.1673-5625.2002.01.008. An SL, Chen PY. Measurement scales: reliability and affecting factors[J]. Chinese Journal of Social Medicine, 2002, 19(1): 23-27. DOI: 10.3969/j.issn.1673-5625.2002.01.008.
[16]	杨廷忠, 阮哈建, 李甫中. 结构方程模型方法在流行病学研究中的应用[J]. 中华流行病学杂志, 2005, 26(4): 297-300. DOI: 10.3760/j.issn:0254-6450.2005.04.017. Yang YZ, Ruan HJ, Li FZ. The application of structural equation model approach in epidemiological research[J]. Chin J Epidemiol, 2005, 26(4): 297-300. DOI: 10.3760/j.issn:0254-6450.2005.04.017.
[17]	Andersson GZ, Reinius M, Eriksson LE, et al. Stigma reduction interventions in people living with HIV to improve health-related quality of life[J]. Lancet HIV, 2020, 7(2): e129-e140. DOI: 10.1016/S2352-3018(19)30343-1.
[18]	王华东, 陈薇, 谢文琴, 等. 安徽省皖北地区艾滋病病毒感染者和艾滋病病人生存质量评价[J]. 中华疾病控制杂志, 2016, 20(8): 772-776. DOI: 10.16462/j.cnki.zhjbkz.2016.08.005. Wang HD, Chen W, Xie WQ, et al. Life quality assessment of people living with HIV/AIDS in Northern Anhui Province[J]. Chin J Dis Control, 2016, 20(8): 772-776. DOI: 10.16462/j.cnki.zhjbkz.2016.08.005.
[19]	刘倩, 赵芮, 吴谦, 等. 心理护理对艾滋病患者生活质量影响的Meta分析[J]. 中华流行病学杂志, 2017, 38(7): 972-976. DOI: 10.3760/cma.j.issn.0254-6450.2017.07.025. Liu Q, Zhao R, Wu Q, et al. Meta-analysis on influence of psychological nursing on quality of life of AIDS patients[J]. Chin J Epidemiol, 2017, 38(7): 972-976. DOI: 10.3760/cma.j.issn.0254-6450.2017.07.025.
[20]	Donald KA. Health-related quality of life of people with HIV in Zambia and South Africa[J]. Lancet Glob Health, 2017, 5(11): e1058-e1059. DOI: 10.1016/S2214-109X(17)30384-4.
[21]	Thomas R, Burger R, Harper A, et al. Differences in health-related quality of life between HIV-positive and HIV-negative people in Zambia and South Africa: a cross-sectional baseline survey of the HPTN 071 (PopART) trial[J]. Lancet Glob Health, 2017, 5(11): e1133-e1141. DOI: 10.1016/S2214-109X(17)30367-4.
[22]	高美霞, 陈宇婧, 胡建华, 等. 经济因素对HIV感染者/艾滋病患者生活质量影响的调查研究[J]. 中国预防医学杂志, 2016, 17(5): 385-387. DOI: 10.16506/j.1009-6639.2016.05.016. Gao MX, Chen YJ, Hu JH, et al. Study on the impact of economic factors on the quality of life of people living with HIV/AIDS[J]. China Preventive Medicine, 2016, 17(5): 385-387. DOI: 10.16506/j.1009-6639.2016.05.016.
[23]	董晓梅, 彭淋, 张思恒, 等. 广东省HIV感染者/艾滋病患者生活质量及其影响因素分析[J]. 中华流行病学杂志, 2014, 35(1): 40-44. DOI: 10.3760/cma.j.issn.0254-6450.2014.01.010. Dong XM, Peng L, Zhang SH, et al. Quality of life and related factors among people living with HIV/AIDS in Guangdong province[J]. Chin J Epidemiol, 2014, 35(1): 40-44. DOI: 10.3760/cma.j.issn.0254-6450.2014.01.010.
[24]	杨小东, 粟斌, 张彤. HIV-1感染者免疫重建不良研究进展[J]. 国际病毒学杂志, 2020, 27(1): 82-85. DOI: 10.3760/cma.j.issn.1673-4092.2020.01.020. Yang XD, Su B, Zhang T. Research progress on immune reconstruction in HIV-1 infected patients[J]. Int J Virol, 2020, 27(1): 82-85. DOI: 10.3760/cma.j.issn.1673-4092.2020.01.020.