Once considered a terminal illness, HIVAIDS has become a chronic illness as those infected are living longer. Given the longevity achievable with the current prophylactic and therapeutic strategies for people living with HIV/AIDS (PLWHA), quality of life has emerged as a significant measure of health outcome, and quality of life enhancement is an important goal. However, little is known about quality of life in impoverished developing countries such as Zambia. Furthermore, in Zambia, there is significant variation in the impact of the HIV pandemic, with much higher HIV prevalence rates occurring in women than men and in urban versus rural areas.
The purpose of the study was threefold. First, the study was to test the quality of life factor structure of the Zambian sample using the World Health Organization Quality of Life HIV (WHOQOL-HIV) instrument. Second, the study was to determine quality of life of the Zambian sample using the resultant factor structure of quality of life. Last, the study was to examine the effect of gender and residence on the quality of life of the Zambian sample using resultant factor structure of quality of life.
A cross-sectional descriptive, correlational, four-group 2x2 factorial design on a convenience sample of 160 PLWHA was conducted using both the WHOQOL-HIV Model and instrument. Factor analysis yielded three new scales: “Zambian WHOQOL-HIV, Zambian WHOHIV Medication Dependence, and Zambian WHOHIV Spirituality Religion Personal Beliefs (SRPB)” and validated the “Overall Quality of Life and General Health Perceptions” scale. The quality of life of the Zambian sample was found to be above average on all the four scales. There were no gender effects on any of the four scales. There was a significant medication dependence residence effect showing that urban participants were more dependent on medication than their rural counterparts. However, this effect disappeared when controlling for individual and clinical characteristics. There was a significant gender by residence interaction effect on spirituality/religion/personal beliefs (SRPB) showing that urban females and rural men had better SRPB than rural women and urban men. This effect was stronger when controlling for individual characteristics were controlled for, but disappeared when clinical characteristics were controlled for. The study also showed that symptomatic patients had lower quality of life and SRPB.
The study is important to nursing because it tested the WHOQOL-HIV instrument among a Zambian sample which has not been done before. This study validated one scale that can be used regularly to assess “overall quality of life and general health perceptions” and provided three scales that can be used for comprehensive assessment of quality of life in order to monitor disease progression and response to care. These assessments of quality of life will lead to development of holistic nursing interventions based on an individual’s perception of their quality of life.