Study of Quality of Life and Its Determinants among People Living with HIV/AIDS
|School||Central South University|
|Course||Epidemiology and Biostatistics,|
|Keywords||people living with HIV/AIDS(PLWHA) quality of life SF-36 associated factors structural equation model (SEM)|
Objective:The study was to examine the health-related quality of life (HRQOL) and its associated factors in a sample of people living with HIV/AIDS(PLWHA).we explored the relationship among these factors and assessed how they impacted HRQOL in order to proivide health care providers valuable information to facilitate the development of treatment,researh and policy-maiking,which would improve the HRQOL of PLWHA.Methods:The subjects were recruited among PLWHA who were registered and under the observation of CD4+T cell by Hengyang CDC during the months of January and December 2008 and then administered questionare about the QOL measured by SF-36. Data on sociodemgraphic characteristics, individual behaviors and clinical information,social support and mental status were also collected.The reliability and validity of the SF-36 were evaluated.Discriptive analysis was used to explain the general characteristics and t test,one-way ANOVA and non-parameter test were used for univariate analysis. Liner regression and structural equation model were used for multivariate analysis.Results:(1) 294 PLWHA were selected as the subjects,with eligible rate being 94.2%. The mean age of participants was 39.12 years (standard deviation(SD)=8.43). 77.21% were male,53.06% had CD4 counts<200 cells/ml.84% had negative emotions of different levels.The overall score of social support ranged from 20-50(mean= 27.16,SD=8.04), significantly lower than the normal population (P=0.000).The average overall score of QOL was 45.41(SD:19.76,Median:41.98),significantly lower than the normal population as well as its eight scales (P=0.000). (2) SF-36 had good reliability and validity for assessing the QOL of PLWHA.The general Cronbach’sαvalue for internal consistency was 0.928.All scales exceeded the 0.70 level recommended for group comparisons, with the exception of the social functioning(SF) scale.The split-half reliability was 0.887.The success rate for convergent and discriminant validity was 100% for all scales except for the physical functioning(PF) and general health(GH) scales with definite success being 94.29%,97.14% respectively.The criterion validity was 0.595.Most of the inter-scale correlation coefficients were low to medium, and higher coefficient was found between vitality(VT) and mental health(MH).Factor analysis was carried out to test construct validity and seven components with eigenvalues greater than 1 were extracted, which accounted for 67.63% of the total variance in SF-36 scores. Construction of items and scales were basicaly similar to the theoretical hypothesis, however,some deference still existed,for example,the items measuring the vitality(VT)and mental health (MH)were kind of overlaping.Bodily pain(BP) and social functioning(SF) were included in the same sacle.In addition,noteworthy ceiling and floor effects were seen in physical functioning(PF) and role-emotional (RE) scales. (3) The results of multivariate liner regression were as follows.The elder PLWHA were,the worse QOL they had in overall QOL and physical functioning(PF), vitality (VT) scales. Men had better QOL in regard to general health(GH) and social functioning(SF) than women. PLWHA with per-captia annual household income of more than 3000 yuan had better QOL in physical functioning(PF) and vatality (VT) than their opposites. PLWHA who had correct awareness of HIV transmission routs had better QOL in vitality (VT).The better relationship with family,the better QOL PLWHA had in role-physical(RP), bodily pain(BP), general health(GH),vitality(VT),social functioning(SF) and mental health(MH).Drug users had worse QOL in bodily pain(BP) as well as in overall QOL.CD4 counts were shown to be correlated negatively with QOL. The lower the counts, the worse the overall QOL and the eight scales.Previoius health problems made negative impacts on overall QOL,physical functioning(PF),bodily pain(BP), general health(GH),vitality (VT),social functioning(SF) and role-emotional (RE). Co-infection with tuberculosis (TB) was found to be negatively associated with QOL in role-emotional (RE).PLWHA who gained more social support had better overall QOL,physical functioning(PF) and mental health(MH).The more severe the negative emostions,the worse the QOL PLWHA had in role-physical(RP),general health (GH),vitality (VT), social functioning(SF),mental health(MH) and overall QOL. (4) Two latent variables,QOL and social support,were extracted through structural equation modeling which confirmed personal factors (age,sex,per-captia annual household income,relationship with family,HIV awareness and drug-using),clinical or medical factors (CD4 counts,TB co-infection,previous health problems),socaial support and negative emotions were significantly associated with QOL of PLWHA.According to the standardized regression weights,clinical factors affected quality of life mostly (-0.513),followed by netative emotions (-0.278),social support(0.226) and personal factors ranked last (0.205).Social support had not only a direct effect on QOL,but also affected it indirectly thouth mediating negative emotions.Moreover, the direct effect on negative emotions was greater than that on QOL(0.159). Clinical factors also had an indirect effect on QOL through sharpening netative emotions (0.279). The impact of personal factors on QOL could be either through a direct effect or through an indirect effect by influencing social support (0.256),which is greater than the former(0.147).Conclusions:(1) SF-36 coulde be used to assess the QOL of PLWHA feasibly(2) Both the overall QOL and all the scales of PLWHA were significantly lower than the normal population.They had low level of social support and accompanied with severe negative emotions.(3) Factors influencing QOL of PLWHA included age,sex,per-captia annual household income,relationship with family,HIV awareness,drug-using,CD4 counts,TB co-infection,previous health problems,socaial support and negative emotions.Clinical factors affected it mostly,followed by negative emotions.Personal factors,social support and clinical factors affected QOL through a direct effect and also an indirect effect.