Mirjana Pibernik-Okanović

The World Health Organization Quality of Life assessment (WHOQOL) : Development and general psychometric properties

This paper reports on the field testing, empirical derivation and psychometric properties of the World Health Organisation Quality of Life assessment (the WHOQOL). The steps are presented from the development of the initial pilot version of the instrument to the field trial version, the so-called WHOQOL-100. The instrument has been developed collaboratively in a number of centres in diverse cultural settings over several years; data are presented on the performance of the instrument in 15 different settings worldwide.

Quality of life following a change in therapy for diabetes mellitus.

Objective:The study objective was to evaluate and compare quality-of-life (QOL) parameters between patients with type 2 (non-insulin-dependent) diabetes mellitus who changed therapy from an oral hypoglycaemic agent (OHA) to insulin and those who remained on an OHA.Design:The World Health Organization Quality of Life Questionnaire (WHOQOL) was used to assess quality of life among 2 groups of patients with type 2 diabetes mellitus at baseline and after a 2-month follow-up period.Setting:The study was conducted in the outpatient department of the Vuk Vrhovac Clinic, a referral centre for registration, treatment and follow-up of patients with diabetes mellitus in Zagreb, Croatia.Participants and Interventions:32 consecutively recruited patients with type 2 diabetes mellitus who were switched from an OHA to insulin therapy (group 1) were compared with 28 patients who remained on OHA (group 2) with respect to QOL issues. The patient groups were comparable in terms of gender, age, duration of disease, education and family status. However, patients in group 1 had glycosylated haemoglobin (HbA1c) values greater than 9.5% on average during a period of approximately 6 months, which was the criterion used for switching to insulin therapy.Main Outcome Measures and Results:At baseline, various QOL ratings were higher among patients in group 2 than group 1, indicating better quality of life with respect to overall quality of life (t = −2.31, p = 0.03), physical health (t = −2.36, p = 0.02), psychological state (t = −2.01, p = 0.05) and level of independence (t = −2.75, p = 0.001), while no differences were found between groups with respect to the social domain, personal beliefs and environmental QOL aspects. After the follow-up period, the groups were comparable in all QOL aspects other than overall quality of life (t = −2.18, p = 0.03) and level of independence (t = −3.49, p = 0.001), both of which remained higher for patients in group 2. No changes in QOL parameters were detected within group 2 from baseline to the end of the 2-month follow-up period, whereas patients in group 1 showed significant improvement in psychological QOL determinants (t = −2.14, p = 0.04).Conclusion:Results of the study indicate that introducing insulin therapy in patients with type 2 diabetes mellitus and sustained elevated HbA1c levels might positively affect their quality of life.

Psychometric properties of the World Health Organisation quality of life questionnaire (WHOQOL-100) in diabetic patients in Croatia.

UNLABELLED The aim of the study was to analyse psychometric properties of the WHOQOL-100, a multidimensionally conceptualised, generic, 100-item quality of life (QoL) instrument in a pilot sample of 63 type 2 diabetic patients (age 60.4 (10.1) years), 55% women, disease duration 10.2 (6.2) years, education 10 (5.2) years, 78% married. While covering the subjective perception and evaluation of the overall QoL and general health, as well as four broad domains (physical health, psychological state, social relationships and environment), the instrument may be useful in integrating the individual perception of the QoL. The properties tested referred to reliability, validity in discriminating patients with different disease characteristics, and responsiveness to change. METHODS Reliability was determined by Cronbachs alpha coefficients of internal consistency. Discriminant validity was determined by comparing the groups of patients with poor and satisfactory glycaemic control, the first group being switched to insulin therapy (intervention group) and the second (comparison group) remaining on oral therapy (35 and 28 patients respectively). Responsiveness to change was determined by comparing the two groups after a 2-month follow-up period. RESULTS The obtained alpha coefficients were 0.95 for the physical domain, 0.89 for the psychological domain, 0.76 for the social relationships domain, and 0.92 for the domain referring to environment. The interventional and comparison groups rated their QoL differently, primarily in the physical and psychological domains (P<0.01; P<0.05). After a 2-month follow-up period, the intervention group was improved in some QoL determinants (psychological domain), while no differences were found in the control group. CONCLUSION Relying on the data obtained from the groups of diabetic patients in Croatia, the WHOQOL-100 can be considered as acceptably reliable and valid instrument for the QoL assessment in this particular population of health care users.

Emotional adjustment and metabolic control in newly diagnosed diabetic persons

Emotional reactions to diagnosis were examined in a random sample of newly detected diabetic patients (n = 71) and compared with the indicators of glycemic control in a one-year-follow-up period. The social and emotional factors subscale of the diabetes care profile was used to determine the subjectively experienced burden, negative feelings and positive coping abilities. The initial struggle against the disease indicated three characteristic emotional patterns. Feelings of being able to cope with the disease predominated in group 1 (n = 36), negative emotional reactions, but with the ability to cope were observed in group 2 (n = 17) and negative feelings combined with weak coping abilities in group 3 (n = 18). The long-term indicators of glycemic control were shown to be worst in group 3 and best in group 1. Subjective perception of the disease was not associated with sociodemographic variables, with the exception of perceived coping abilities which were better in more educated persons and those with more familial support.

Quality of life in diabetic, otherwise III and healthy persons

Sixty-five diabetic persons were compared with 185 otherwise ill and 50 healthy persons in order to highlight quality of life issuess. The samples were balanced with respect to gender, education and family status, while age was lower in the healthy persons group (diabetic: 46.6 yrs +/-15.6 ; otherwise ill: 45.4 years +/-15.5 ; healthy persons 38.8 yrs +/-14.6 p=0.014). The World Health Quality of Life questionnaire (WHOQOL-100) was applied to assess the individual quality of life. The WHOQOL inquires into the respondents perception and subjective evaluation of overall quality of life and general health, as well as 6 quality of life domains: physical, psychological, level of independence, social relationships, environment and spirituality/religion/personal beliefs domain. Analysis of variance was used to compare diabetic versus otherwise ill and healthy subjects. The group variability was statistically significant with regard to physical domain (F=18.98 p=0.0001), and level of independence (F=26.83 p=0.0001). The Scheffe test revealed that healthy persons gave significantly higher ratings, indicating better quality of life, than both unwell groups. Diabetic persons gave higher ratings for the physical domain than other unwell persons. F ratio significance remained unchanged with age as covariate. The results in particular facets indicate that diabetic persons are mostly disturbed with regard to their energy level, mobility, activities of daily living and working capacity, but do not differ from the healthy persons in positive feelings, negative feelings, self-esteem, body image, cognitive abilities and social relationships.