Department of Nursing, College of Health Sciences, Makerere University, Kampala, Uganda.
Department of Medical Oncology, Uganda Cancer Institute, Kampala, Uganda.
Health Qual Life Outcomes. 2021 Apr 23;19(1):131. doi: 10.1186/s12955-021-01769-x.
Self-reported measures play a crucial role in research, clinical practice and health assessment. Instruments used to assess self-reported health-related quality of life (HRQoL) need validation to ensure that they measure what they are intended to, detect true changes over time and differentiate between subjects. A generic instrument measuring HRQoL adapted for use among people living with cancer in Uganda is lacking; therefore, this study aimed to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 in patients with cancer in Uganda.
Adult patients with various types of cancer (n = 385) cared for at the Uganda Cancer Institute answered the EORTC QLQ-C30 in Luganda or English language, the two most spoken languages in the country. The two language versions were evaluated with regard to data quality (floor and ceiling effects and missing responses), reliability (internal consistency) and validity (construct, known-group and criterion). Construct validity was examined through confirmatory factor analysis (CFA). Mean scores were compared between groups differing in disease stage to assess known-group validity. Criterion validity was examined according to associations between two QLQ-C30 subscales (Global quality of life and Physical function) and the Karnofsky Performance Scale (KPS).
Floor and ceiling effects were observed for several scales in the Luganda and English versions. All EORTC scales with the exception of Cognitive function (Luganda α = 0.66, English α = 0.50) had acceptable Cronbach's alpha values (0.79-0.96). The CFA yielded good fit indices for both versions (RMSEA = 0.08, SRMR = 0.05 and CFI = 0.93). Known-group validity was demonstrated with statistically significant better HRQoL reported by patients with disease stages I-II compared to those in stages III-IV. Criterion validity was supported by positive correlations between KPS and the subscales Physical function (Luganda r = 0.75, English r = 0.76) and Global quality of life (Luganda r = 0.59, English r = 0.72).
The Luganda and English versions of the EORTC QLQ-C30 appear to be valid and reliable measures and can be recommended for use in clinical research to assess HRQoL in adult Ugandans with cancer. However, the cognitive scale did not reach acceptable internal consistency and needs further evaluation.
自我报告的测量在研究、临床实践和健康评估中起着至关重要的作用。用于评估与健康相关的生活质量（HRQoL）的工具需要经过验证，以确保它们测量的是预期的内容，能够检测到随时间的真实变化，并区分不同的受试者。在乌干达，缺乏一种针对癌症患者的通用的、经改编的测量 HRQoL 的工具；因此，本研究旨在评估欧洲癌症研究与治疗组织（EORTC）生命质量核心问卷 30 版（QLQ-C30）在乌干达癌症患者中的心理测量特性。
在乌干达癌症研究所接受治疗的不同类型癌症的成年患者（n=385）以卢干达语或英语回答 EORTC QLQ-C30，这两种语言是该国使用最广泛的语言。评估了这两种语言版本的数据质量（地板效应和天花板效应以及缺失反应）、信度（内部一致性）和效度（结构、已知组和标准）。通过验证性因子分析（CFA）检验结构效度。通过比较疾病阶段不同的组之间的平均得分来评估已知组的有效性。根据两个 QLQ-C30 子量表（总体生活质量和身体功能）与卡诺夫斯基绩效量表（KPS）之间的关联来检验效标效度。
卢干达语和英语版本的多个量表都存在地板效应和天花板效应。除认知功能量表外（卢干达语 α=0.66，英语 α=0.50），所有 EORTC 量表的克朗巴赫 α 值均在可接受范围内（0.79-0.96）。两个版本的 CFA 都得出了较好的拟合指数（RMSEA=0.08，SRMR=0.05 和 CFI=0.93）。通过疾病阶段 I-II 的患者报告的生活质量明显优于疾病阶段 III-IV 的患者，表明具有已知组的有效性。效标效度得到了支持，因为 KPS 与身体功能量表（卢干达语 r=0.75，英语 r=0.76）和总体生活质量量表（卢干达语 r=0.59，英语 r=0.72）之间存在正相关。
卢干达语和英语版的 EORTC QLQ-C30 似乎是有效的、可靠的测量工具，可以推荐用于临床研究，以评估乌干达成年癌症患者的 HRQoL。然而，认知量表的内部一致性未达到可接受水平，需要进一步评估。
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