Harding Richard, Jones Christopher Iain, Bremner Stephen, Bristowe Katherine, West Brian, Siegert Richard J, O'Brien Kelly K, Whetham Jennifer
Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, Cicely Saunders Institute, London, UK.
Primary Care and Public Health, Brighton and Sussex Medical School, Brighton, UK.
HIV Med. 2022 Jul;23(6):673-683. doi: 10.1111/hiv.13224. Epub 2022 Jan 11.
Despite successful treatment, people living with HIV experience persisting and burdensome multidimensional problems. We aimed to assess the validity, reliability and responsiveness of Positive Outcomes, a patient-reported outcome measure for use in clinical practice.
In all, 1392 outpatients in five European countries self-completed Positive Outcomes, PAM-13 (patient empowerment), PROQOL-HIV (quality of life) and FRAIL (frailty) at baseline and 12 months. Analysis assessed: (a) validity (structural, convergent and divergent, discriminant); (b) reliability (internal consistency, test-retest); and (c) responsiveness.
An interpretable four-factor structure was identified: 'emotional wellbeing', 'interpersonal and sexual wellbeing', 'socioeconomic wellbeing' and 'physical wellbeing'. Moderate to strong convergent validity was found for three subscales of Positive Outcomes and PROQOL (ρ = -0.481 to -0.618, all p < 0.001). Divergent validity was found for total scores with weak ρ (-0.295, p < 0.001). Discriminant validity was confirmed with worse Positive Outcomes score associated with increasing odds of worse FRAIL group (4.81-fold, p < 0.001) and PAM-13 level (2.28-fold, p < 0.001). Internal consistency for total Positive Outcomes and its factors exceeded the conservative α threshold of 0.6. Test-retest reliability was established: those with stable PAM-13 and FRAIL scores also reported median Positive Outcomes change of 0. Improved PROQOL-HIV score baseline to 12 months was associated with improved Positive Outcomes score (r = -0.44, p < 0.001).
Positive Outcomes face and content validity was previously established, and the remaining validity, reliability and responsiveness properties are now demonstrated. The items within the brief 22-item tool are designed to be actionable by health and social care professionals to facilitate the goal of person-centred care.
尽管治疗取得成功，但感染艾滋病毒的人仍面临持续且繁重的多方面问题。我们旨在评估“积极结果”（Positive Outcomes）这一用于临床实践的患者报告结局指标的有效性、可靠性和反应性。
来自五个欧洲国家的1392名门诊患者在基线和12个月时自行完成了“积极结果”、PAM - 13（患者赋权）、PROQOL - HIV（生活质量）和FRAIL（虚弱）量表的填写。分析评估了：（a）有效性（结构效度、聚合效度和区分效度、判别效度）；（b）可靠性（内部一致性、重测信度）；以及（c）反应性。
确定了一个可解释的四因素结构：“情绪健康”、“人际和性健康”、“社会经济健康”和“身体健康”。“积极结果”量表的三个子量表与PROQOL量表之间存在中度到高度的聚合效度（ρ = -0.481至 -0.618，所有p < 0.001）。总分的区分效度较弱（ρ = -0.295，p < 0.001）。判别效度得到证实，FRAIL组情况越差（比值比4.81倍，p < 0.001）以及PAM - 13水平越高（比值比2.28倍，p < 0.001），“积极结果”得分越差。“积极结果”总分及其各因素的内部一致性超过了保守的α阈值0.6。建立了重测信度：PAM - 13和FRAIL得分稳定的患者报告的“积极结果”中位数变化为0。从基线到12个月PROQOL - HIV得分的改善与“积极结果”得分的改善相关（r = -0.44，p < 0.001）。
“积极结果”量表的表面效度和内容效度先前已确立，现在展示了其余的效度、可靠性和反应性特征。这个简短的22项工具中的条目旨在供健康和社会护理专业人员采取行动，以促进以患者为中心的护理目标。
