Abstract
The Functional Assessment of Human Immunodeficiency Virus (HIV) Infection (FAHI) quality of life instrument was developed using a combination of conceptual and empirical strategies. The core, general health-related quality of life instrument is the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire. The FACT-G was selected to enable comparison of data across two similar, life-threatening conditions and because of its desirable psychometric properties. Initial data on both the relevance (applicability) of the FACT-G to the HIV population and the generation and testing of questions for an HIV-specific subscale were encouraging. Consequently, the FACT-G and a 9-item HIV-specific subscale were combined and tested in 196 patients in three categories: an English-speaking stress management sample from Chicago, Illinois (n=110); an English-speaking urban, mixed race sample from Chicago (n=71); and a Spanish-speaking urban sample from Chicago and San Juan, Puerto Rico (n=64). With the exception of the Social Well-being subscale, the subscales of the FACT-G demonstrated good internal consistency reliability across all three samples (α range=0.72–0.88). Total FAHI scores produced consistently high alpha coefficients (0.89–0.91). Concurrent validity data included moderately strong associations with other measures of similar concepts and an ability to distinguish groups of patients by activity level and disease severity. Sensitivity to change in mood disturbance and responsiveness to a stress management intervention were also evident. The 9-item HIV-specific subscale demonstrated relatively low α coefficients (range=0.53–0.71) and marginal sensitivity to change, leading to supplementation of content with an additional 11 items, creating a 20-item HIV-specific subscale that is currently being tested. Clinical trial and clinical practice investigators are encouraged to use the FACT-G in its current (version 3) form when evaluating group differences and within-group change over time. It should prove particularly useful when comparing clinical trial and clinical practice data for cancer vs. HIV-infected patients and in the evaluation of treatments for HIV disease and HIV-related malignancy. The supplemental 20 questions comprising the revised HIV-specific subscale are undergoing further testing, and may ultimately enhance the value of this measurement system.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
WiniarskiMG. AIDS-related psychotherapy. New York: Pergamon Press, 1991.
OsmondDH. HIV disease progression from infection to CDC-defined AIDS: Incubation period, cofactors, and laboratory markers. In: CohenPT, SandeMA, VolberdingPA, eds. The AIDS Knowledge Base. Boston: Little, Brown, 1994a: 1.7.1–1.7.19.
OsmondDH. Trends in HIV disease survival time. In: CohenPT, SandeMA, VolberdingPA, eds. The AIDS Knowledge Base. Boston: Little, Brown, 1994a: 1.3.1–1.3.7.
CohenPT, VolberdingPA. Clinical spectrum of HIV disease. In: CohenPT, SandeMA, VolberdingPA, eds. The AIDS Knowledge Base. Boston: Little, Brown, 1994a: 4.1.1–4.1.15.
CellaDF. Quality of life: Concepts and definition. J Pain Symp Mgmt 1994b; 9: 186–192.
WuAW, RubinHR. Measuring health status and quality of life in HIV and AIDS. Psychol Health 1992; 6: 251–264.
LeeBL, SafrinS. Drug interactions and toxicities in patients with HIV disease. In: CohenPT, SandeMA, VolberdingPA, eds. The AIDS Knowledge Base. Boston: Little, Brown, 1994a: 4.6.1–4.6.18.
PerryS, JacobsbergG, FishmanB, WeilerPH, GoldJWM, FrancesA. Psychological responses to serological testing for HIV. AIDS 1990; 4: 145–152.
SchaffnerB. Psychotherapy with HIV-infected persons. New Dir Mental Health 1990; 48: 5–20.
PizziM, MukandJ, FreedMM. HIV infection and occupational therapy. In: MukandJ, ed. Rehavilitation for Patients with HIV Disease. New York: McGraw-Hill, 1991: 283–326.
HaysRD, ShapiroMF. An overview of generic health-related quality of life measures for HIV research. Qual Life Res 1992; 1: 91–97.
TsevatJ. Methods for assessing health-related quality of life in HIV-infected patients. Psychol Health 1994; 9: 19–30.
KaplanRM, McCutchanJA, NavarroAM, AndersonJP. Quality adjusted survival analysis: A neglected application of the Quality of Well-being Scale. Psychol Health 1994; 9: 131–141.
RagsdaleD, MorrowJR. Quality of life as a function of HIV classification. Nursing Res 1990; 39: 355–359.
WuAW, RubinHR, MathewsWC, et al. A health status questionnaire using 30 items from the Medical Outcomes Study. Med Care 1991; 29: 786–798.
LubeckDP, FriesJF. Changes in quality of life among persons with HIV infection. Qual Life Res 1992; 1: 359–366.
LubeckDP, FriesJF: Changes in health status after one year for persons at-risk for and with HIV infection. Psychol Health 1994; 9: 79–92.
deBoerJB, SprangersMAG, AaronsonNK, LangeJMA, vanDamFSAM. The feasibility, reliability and validity of the EORTC QLQ-C30 in assessing the quality of life of patients with asymptomatic HIV infection or AIDS (CDC IV). Psychol Health 1994; 9: 65–77.
GanzPA, SchagCAC, KahnB, PetersenL. Assessing the quality of life of HIV infected persons: Clinical and descriptive information from studies with the HOPES. Psychol Health 1994; 9: 93–110.
GanzPA, SchagCAC, KahnB, PetersenL, HirijK. Describing the health-related quality of life impact of HIV infection: Findings from a study using the HIV Overview of Problems-Evaluation System (HOPES). Qual Life Res 1993; 2: 109–119.
SchagCAC, GanzPA, PetersenL. Assessing the needs and quality of life of patients with HIV infection: Development of the HIV Overview of Problems-Evaluation System (HOPES). Qual Life Res 1992; 1: 397–413.
CellaDF. F.A.C.T. manual: Manual for the Functional Assessment of Cancer Therapy (FACT) scales and the Functional Assessment of HIV Infection (FAHI) scale. Chicago: Rush-Presbyterian-St. Luke's Medical Center, 1994a.
McCainNL, CellaDF. Correlates of stress in HIV disease. Western J Nur Res 1995; 17: 141–155.
CellaDF, McCainNL. Validation of a quality of life instrument for people with human immunodeficiency virus infection [Abstract]. Proceedings of the 16th Annual Meeting of the Society of Behavioral Medicine. Washington: Society of Behavioral Medicine, 1995.
CellaDF, TulskyDS, GrayG, et al. The Functional Assessment of Cancer Therapy scale: Development and validation of the general measure. J Clin Oncol 1993; 11: 570–579.
AaronsonNK, BullingerM, AhmedzaiS. A modular approach to quality-of-life assessment in cancer clinical trials. Rec Results Cancer Res 1988; 11: 231–249.
CellaDF, TulskyDS. Measuring quality of life today: Methodological aspects. Oncol 1990; 4: 29–38.
CellaDF, BonomiAE. Measuring quality of life: 1995 update. Oncol 1995; 9: 47–60.
CellaDF, BonomiAE. The Functional Assessment of Cancer Therapy (FACT) and Functional Assessment of HIV Infection (FAHI) quality of life measurement system. In: SpilkerB, ed. Quality of Life and Pharmacoeconomics in Clinical Trials (2nd ed). New York: Raven Press, 1995: 203–214.
McCain NL, Zeller JM, Cella DF, Urbanski PA, Novak RM. The influence of stress management training in HIV disease. Nursing Res In press.
KarnofskyDA, AbelmannWH, CraverLF, BurchenalJH. The use of the nitrogen mustards in the palliative treatment of carcinoma. Cancer 1948; 1: 634–656.
McCainNL, GramlingLF. Living with dying: Coping with HIV-disease. Issues in Mental Health Nursing 1992; 13: 271–284.
CellaDF, JacobsenPB, OravEJ, HollandJC, SilberfarbPM, RaflaS. A brief POMS measure of distress for cancer patients. J Chronic Dis 1987; 40: 939–942.
HorowitzM, WilnerN, AlvarezW. Impact of Event Scale: A measure of subjective stress. Psychosom Med 1979; 41: 209–218.
MishelMH. The measurement of uncertainty in illness. Nurs Res 1981; 30: 258–263.
MishelMH. Perceived uncertainty and stress in illness. Res Nurs Health 1984; 7: 163–171.
Centers for Disease Control (CDC). 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. Morbidity and Mortality Weekly Report 1992; 41 (No. RR-17).
ZubrodCG, SchneidermanM, FreiEIII, et al. Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. J Chronic Dis 1960; 11: 7–33.
NunnallyJC. Psychometric Theory (2nd ed). New York: McGraw-Hill, 1978.
DeVellisRF. Scale Development: Theory and Applications. Newbury Park, CA: Sage, 1991.
HelmstadterGC. Principles of psychological measurement. New York: Appleton-Century-Crofts, 1964.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Cella, D.F., McCain, N.L., Peterman, A.H. et al. Development and validation of the functional assessment of human immunodeficiency virus infection (FAHI) quality of life instrument. Qual Life Res 5, 450–463 (1996). https://doi.org/10.1007/BF00449920
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00449920