Health-related quality of life among Kenyan adolescents in the context of HIV: measurement issues and risk factors

Denge,  Adam Mabrouk Adan

Health-related quality of life among Kenyan adolescents in the context of HIV: measurement issues and risk factors

Thesis / Dissertation

2023

Publisher

University of Cape Town

Department

Centre for Public Mental Health

Faculty

Faculty of Health Sciences

Abstract

. Background: Lack of validated health-related quality of Life (HRQoL) measures is one of the significant challenges in describing HRQoL among adolescents in sub-Saharan Africa andparticularly Kenya. The aims of this study were (i) to assess the reliability and validity of the Swahili version KIDSCREEN-52 (a measure of HRQoL) when administered to adolescents in Coastal Kenya and (ii) to investigate risk factors associated with poor HRQoL as measured by KIDSCREEN-52 among these adolescents. Method: KIDSCREEN-52 was translated from its original language (English) to Swahilifollowing the translation guidelines developed by the original KIDSCREEN group. Data analysis was performed from 558 adolescents (158 adolescents living with HIV, 200 HIV exposed uninfected and 200 community controls) aged 11-17 to examine the reliability, construct validity and divergent validity of the Swahili version of KIDSCREEN-52. Multivariable linear regression was conducted to determine the correlates of HRQoL among adolescents. Results: The Swahili version of KIDSCREEN-52 demonstrated good internal consistency with Cronbach alpha ranges of 0.74-0.91 and McDonald's omega ranges of 0.71-0.93 across the three study groups. The measure had a good construct validity, and the one-factor structure of the tool was obtained from the confirmatory factor analysis (CFA) ([overall Comparative Fit Index = 1.00, Tucker Lewis Index = 1.04, Root Mean Square of Error Approximation = 0.000 and p-value of 1.00]. The Swahili version of KIDCSREEN-52 significantly correlated with PHQ-9 scores (r = -0.107, p= 0.011) indicating divergent validity. Among all adolescents (i.e. from the three groups),HIV status, male sex and depressive symptoms were independent predictors of poor HRQoL. Conclusion: The findings demonstrate that the Swahili version of KIDSCREEN-52 is a reliable and valid HRQoL assessment tool. Additionally, the results indicate that we need to prioritize interventions to enhance the quality of life of prenatally infected adolescents alongside those who present with depressive symptoms.