title: Feasibility, reliability and validity of health-related quality of life questionnaire among adult pulmonary tuberculosis patients in urban Uganda: cross-sectional study.
abstract: BACKGROUND
  Despite the availability of standard instruments for evaluating health-related quality life (HRQoL), the feasibility, reliability, and validity of such instruments among tuberculosis (TB) patients in different populations of sub-Saharan Africa where TB burden is of concern, is still lacking.
  
  
  OBJECTIVE
  We established the feasibility, reliability, and validity of the Medical Outcomes Survey (MOS) in assessing HRQoL among patients with pulmonary tuberculosis in Kampala, Uganda.
  
  
  METHODS
  In a cross-sectional study, 133 patients with known HIV status and confirmed pulmonary TB disease were recruited from one public and one private hospital. Participants were enrolled based on duration of TB treatment according to the following categories: starting therapy, two months of therapy, and eight completed months of therapy. A translated and culturally adapted standardized 35-item MOS instrument was administered by trained interviewers. The visual analogue scale (VAS) was used to cross-validate the MOS.
  
  
  RESULTS
  The MOS instrument was highly acceptable and easily administered. All subscales of the MOS demonstrated acceptable internal consistency with Cronbach's alpha above 0.70 except for role function that had 0.65. Each dimension of the MOS was highly correlated with the dimension measured concurrently using the VAS providing evidence of validity. Construct validity demonstrated remarkable differences in the functioning status and well-being among TB patients at different stages of treatment, between patients attending public and private hospitals, and between men and women of older age. Patients who were enrolled from public hospital had significantly lower HRQoL scores (0.78 (95% confidence interval (CI); 0.64-0.95)) for perceived health but significantly higher HRQoL scores (1.15 (95% CI; 1.06-1.26)) for health distress relative to patients from private hospital. Patients who completed an 8 months course of TB therapy had significantly higher HRQoL scores for perceived health (1.93 (95% CI; 1.19-3.13)), health distress subscales (1.29 (95% CI; 1.04-1.59)) and mental health summary scores (1.27 (95% CI; 1.09-1.48)) relative to patients that were starting therapy in multivariable analysis. Completion of 8 months TB therapy among patients who were recruited from the public hospital was associated with a significant increase in HRQoL scores for quality of life subscale (1.26 (95% CI; 1.08-1.49)), physical health summary score (1.22 995% CI; 1.04-1.43)), and VAS (1.08 (95% CI; 1.01-1.15)) relative to patients who were recruited from the private hospital. Older men were significantly associated with lower HRQoL scores for physical health summary score (0.68 (95% CI; 0.49-0.95)) and VAS (0.87 (95% CI; 0.75-0.99)) relative to women of the same age group. No differences were seen between HIV positive and HIV negative patients.
  
  
  CONCLUSIONS
  The study provides evidence that the MOS instrument is valid, and reliably measures HRQoL among TB patients, and can be used in a wide variety of study populations. The HRQoL differed by hospital settings, by duration of TB therapy, and by gender in older age groups.
authors.affiliation: School of Public Health, College of Health Sciences, Makerere University P O Box 7072 Kampala, Uganda. babikako@yahoo.com
authors.forename: Harriet M
authors.initials: HM
authors.lastname: Babikako
authors.forename: Duncan
authors.initials: D
authors.lastname: Neuhauser
authors.forename: Achilles
authors.initials: A
authors.lastname: Katamba
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Mupere
mesh_terms: D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005240:Feasibility Studies; D005260:Female; D015658:HIV Infections / Q000150:complications; D006304:Health Status; D006801:Humans; D008297:Male; D011594:Psychometrics; D011788:Quality of Life; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires / Q000592:standards*; D014397:Tuberculosis, Pulmonary / Q000150:complications / Q000523:psychology*; D014454:Uganda; D014505:Urban Population
references.citation: Appl Nurs Res. 2007 Nov;20(4):164-70
references.pmid: 17996802
references.citation: Bull World Health Organ. 1992;70(1):17-21
references.pmid: 1568278
references.citation: J Health Econ. 1986 Mar;5(1):1-30
references.pmid: 10311607
references.citation: Int J Tuberc Lung Dis. 1999 Oct;3(10):869-77
references.pmid: 10524583
references.citation: Soc Sci Med. 1995 Dec;41(12):1685-92
references.pmid: 8746868
references.citation: Qual Life Res. 1997 Aug;6(6):481-93
references.pmid: 9330549
references.citation: J Clin Epidemiol. 2001 Nov;54(11):1081-5
references.pmid: 11675158
references.citation: Qual Life Res. 1997 Aug;6(6):531-54
references.pmid: 9330553
references.citation: AIDS Care. 2004 Jan;16(1):81-94
references.pmid: 14660146
references.citation: Health Policy. 1990 Dec;16(3):199-208
references.pmid: 10109801
references.citation: J Clin Epidemiol. 1989;42(5):459-71
references.pmid: 2732774
references.citation: Med Care. 1998 Feb;36(2):126-37
references.pmid: 9475468
references.citation: Med Care. 1992 Jun;30(6):473-83
references.pmid: 1593914