Development And Application Of Quality Of Life Instrument For Patients With Tuberculosis

PARTⅠA QUALITATIVE STUDY OF QUALITY OF LIFE AND ITS INFLUENCING FACTORS IN TUBERCULOSIS PATIENTSObjective To explore the quality of life(QOL)and its influencing factors for tuberculosis patients in physical,psychological,social and treatment domains using qualitative research methods.The objective is to provide foundation for the development of the instrument in the second section.Methods A Combination of focus group discussion and in-depth individual interview was applied to investigate the feelings and experiences of diagnosis and treatment in health workers and tuberculosis patients in the countryside to explore the quality of life and its influencing factors of tuberculosis.Results TB affected all predicted domains of QOL,including general health perceptions,somatic sensation,psychological health,and physical,social and role functioning;social stigma,pill burden,long duration of therapy,sexual dysfunction, loss of income and fear also impact the quality of life of patients. Conclusion Despite available curative therapy,TB and its treatment still have significant short and long-term consequences on patients' QOL.So during the course of their medical treatment,we must pay much more attention on health education, make them understand much knowledge about TB,eliminate inferiority feeling, improve their QOL. PARTⅡDEVELOPMENT AND EVALUATION OF QUALITY OF LIFE INSTRUMENT FOR PATIENTS WITH TUBERCULOSISObjective To develop and evaluate quality of life instrument that could be administered to patients with tuberculosis(TB)in China.The instrument can be used to appraise the quality of life for patient with TB and to evaluate curative effect.Methods According to the definition& quality of life from WHO,we proposed a theoretical scheme about the measurement instrument for tuberculosis. The development work was conducted by the programmed decision associated with domestic culture background.Literature review,nominal group and focus group discussions were used during the course of instrument development.The psychometric properties of the instrument were evaluated.The statistic methods used in this research included statistic descriptions,Pearson Correlation,Factor Analysis, Hierarchical Clustering Analysis,Chi-square Test and Paired t-test.Results(1)Content One 30-item general module(GM)for tuberculosis diseases was formed.There were three domains in GM:12-item for physical functioning(PH), 7-item for psychological functioning(PS),11-item for social functioning(SO).One 12-item specific module also was formed.Then a 30 plus 12 items instrument for patients of tuberculosis shortened as QLI-TB(V1.0)was yielded by combination.(2)Reliability The test-retest correlation coefficients of all domains and overall instrument all were larger than 0.70.The paired t-test indicated no statistically significant change between the first time and the second time(P＞0.05).Cronbach'sαcoefficient of the instrument was 0.923,Cronbach'sαcoefficients of all domains were from 0.848 to 0.905.Split-half reliability coefficients of all domains were from 0.750 to 0.938. (3)Validity Because the item pools were nominated and several-rounds selected by persons who are strongly related by QOL study,reflecting the definition of health and QOL proposed by WHO and specific problems among patients of TB,so the QLI-TB(V1.0)has a considerable content validities.The factor structure of the general module and the specific module were explored by using principle components analysis,with varimax rotation,8 and 4 principle components were extracted, respectively.Cumulative contribution rate is 72.51%and 68.33%,respectively.After Varimax orthogonal rotation,we found the results were coincident with the theoretical scheme.The result of item-domain correlations and factor analysis build evidences of structure validity.Because of no gold standard,we temporarily selected the second item of SF-36 as criteria,the coefficients between total scores and criterion are moderate,The three aspects above showed good validity of the instrument.(4)Responsiveness Nearly all domains and total scores differences between first time.point and third one had statistical significant(P＜0.05)except for PH domain in the instrument(P＞0.05),so the instrument has the ability to detect clinically change due to treatment and then has good responsiveness.(5)Feasibility About 15～20 minutes were spent in completing each instrument and the completed rate and recovery rate is 100%and 96%demonstrated that the good feasibility of the instrument.Conclusion The instrument was valid,reliable,sensitive and clinical feasibility and could be used to assess quality of life among patients of TB in our country. PartⅢTHE MEASUREMENT AND EVALUATION OF QUALITY OF LIFE FOR PATIENTS WITH TUBERCULOSISObjective To measure and assess the quality of life in patients with tuberculosis using self-designed instrument,understand the life quality of tuberculosis patients and its influencing factors and provide scientific basis for prevention and control of the disease.Methods QOL of 248 patients with tuberculosis and 248 healthy controls were marked by self-designed instrument and SF-36,information of affecting factors were collected by the questionnaire designed ourselves.T-test,single and multiple stepwise regression analysis were made to evaluate factors affecting QOL for tuberculosis patients.Results The average total score of SF-36,scores of physical functioning,role physical,mental health,role emotional,social functioning,vitality,bodily pain and general health were respectively 54±18,52±16,38±21,64±30,46±23,56±24, 33±17,43±22 and 60±17 in the tuberculosis group,while 81±14,78±20,75±19, 80±12,68±11,77±18,85±20,70±17 and 85±10 in the controls.Statistically significant differences were found between the two groups(all P values＜0.01).The average total score of QLI-TB,scores of physical functioning,psychological functioning,social functioning and specific module were respectively 95±16,23±_ 14,18±10,28±17 and 30±12 in the tuberculosis group,while 151±14,42±18,25±8,39±23 and 42±14 in the controls.Statistically significant differences were found between the two groups.There were statistically significant correlation among the total score of QLI-TB and SF-36.The influencing factors which influence the QOL of TB patients were age,gender,literacy,economical situation,positive or negative smear and complications. Conclusion The QLI-TB V1.0 instrumentis suitable for measurement of QOL of patients with tuberculosis,the quality of life of tuberculosis patients is low,so we must pay more attention on their quality of life during the course of their medical treatment.