{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,9]],"date-time":"2026-06-09T23:47:18Z","timestamp":1781048838754,"version":"3.54.1"},"reference-count":36,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T00:00:00Z","timestamp":1765497600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Society for Family Health"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The well-being of people living with HIV (PLHIV) remains a significant public health concern. Despite advancements in ART, PLHIV face various challenges impacting their quality of life (QOL). Measuring the QOL of PLHIV is essential for improving care, shaping policy, and evaluating intervention. However, the extent to which the measurement properties of the World Health Organization Quality of Life HIV BREF (WHOQOL-HIV BREF) tool, in the Nigeria context is limited. This study evaluated the psychometric performance of the WHOQOL-HIV BREF in a Nigerian population, with the aim of examining its construct validity, reliability, and sensitivity when used to assess the well-being of PLHIV.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a cross-sectional quantitative study involving of 790 PLHIV aged 18 years and older in Bauchi State, Nigeria. Data was collected between May and October 2023. Quality of life was assessed using the 31-item WHOQOL-HIV BREF which assesses QOL based on the 6 domains, including Physical, Psychological, Level of Independence, Social Relationships, Environmental, and Spirituality\/Religion\/Personal Beliefs. The general quality of life and general health perception was also assessed. The psychometric evaluation of the instrument in this population included analyses of internal consistency reliability, confirmatory factor analysis (CFA) to assess construct validity, and sensitivity analysis to examine measurement responsiveness.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Confirmatory factor analysis of the WHOQOL-HIV BREF in the sample indicated poor model fit (CFI\u2009=\u20090.807, TLI\u2009=\u20090.767, RMSEA\u2009=\u20090.110, SRMR\u2009=\u20090.136), indicating that the original six-domain structure was not well supported in the study population and context. Internal consistency (Cronbach\u2019s alpha) varied widely across domains, ranging from very low to acceptable: Physical Health (\u03b1\u2009=\u20090.386), Psychological Health (\u03b1\u2009=\u20090.722), Level of Independence (\u03b1\u2009=\u20090.531), Social Relationships (\u03b1\u2009=\u20090.693), Environment (\u03b1\u2009=\u20090.775), and Spirituality (\u03b1\u2009=\u20090.304). The Global Quality of Life score demonstrated high reliability (\u03b1\u2009=\u20090.884). Nonetheless, high scores were observed for general quality of life (Mean\u2009=\u20093.86) and health perception (Mean\u2009=\u20093.65), as well as for independence (Mean\u2009=\u200914.84) and social relationships (Mean\u2009=\u200914.93). Moderate scores were found in physical health (Mean\u2009=\u200913.99), psychological health (Mean\u2009=\u200913.95), environmental (Mean\u2009=\u200912.74), and spiritual well-being (Mean\u2009=\u200913.77).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>This study revealed limited structural validity and varied internal consistency in this sample, with some domains of the WHOQOL-HIV BREF performing poorly. These findings reinforce concerns raised by researchers about the use of the tool without proper contextual adaptation. Further research is needed to better understand QOL in the Nigeria population, by refining and validating the QOL assessment tools for the country, to ensure adequate monitoring of the health of PLHIV.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338095","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T18:32:15Z","timestamp":1765564335000},"page":"e0338095","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":1,"title":["Psychometric performance of the WHOQOL-HIV BREF among people living with HIV on antiretroviral therapy in Bauchi State, Nigeria"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8151-0616","authenticated-orcid":true,"given":"Ekerette Emmanuel","family":"Udoh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adesola Zaidat","family":"Musa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tubosun Alex","family":"Olowolafe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taiwao Mofadeke","family":"Jaiyeola","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,12]]},"reference":[{"key":"pone.0338095.ref001","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/978-981-13-6958-2_1","article-title":"Introduction: An Overview of the Concept of Quality of Life","author":"BRK Sinha","year":"2019","journal-title":"Multidimensional Approach to Quality of Life Issues. Springer Singapore"},{"issue":"9","key":"pone.0338095.ref002","article-title":"Psychological and Social Factors That Influence Quality of Life: Gender, Age and Professional Status Differences","volume":"7","author":"T Gaspar","year":"2017","journal-title":"JPR"},{"key":"pone.0338095.ref003","article-title":"HIV AIDS and Socioeconomic Status","volume-title":"Encyclopedia of Mental Health","author":"RH Bradley","year":"2021","edition":"2"},{"issue":"3","key":"pone.0338095.ref004","doi-asserted-by":"crossref","first-page":"961","DOI":"10.1007\/s10461-020-03055-1","article-title":"Physical, Emotional, and Psychosocial Challenges Associated with Daily Dosing of HIV Medications and Their Impact on Indicators of Quality of Life: Findings from the Positive Perspectives Study","volume":"25","author":"P de Los Rios","year":"2021","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0338095.ref005","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1007\/s10461-016-1451-5","article-title":"How Does Stigma Affect People Living with HIV? The Mediating Roles of Internalized and Anticipated HIV Stigma in the Effects of Perceived Community Stigma on Health and Psychosocial Outcomes","volume":"21","author":"B Turan","year":"2017","journal-title":"AIDS Behav"},{"issue":"1","key":"pone.0338095.ref006","doi-asserted-by":"crossref","first-page":"16535","DOI":"10.1038\/s41598-023-43434-x","article-title":"Factors associated with poorer quality of life in people living with HIV in southwestern France in 2018-2020 (ANRS CO3 AQUIVIH-NA cohort: QuAliV study)","volume":"13","author":"D Barger","year":"2023","journal-title":"Sci Rep"},{"issue":"6","key":"pone.0338095.ref007","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1007\/s11904-021-00583-w","article-title":"Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV","volume":"18","author":"J Hoare","year":"2021","journal-title":"Curr HIV\/AIDS Rep"},{"issue":"1","key":"pone.0338095.ref008","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1001\/jama.2022.22246","article-title":"Antiretroviral Drugs for Treatment and Prevention of HIV Infection in Adults: 2022 Recommendations of the International Antiviral Society-USA Panel","volume":"329","author":"RT Gandhi","year":"2023","journal-title":"JAMA"},{"key":"pone.0338095.ref009","first-page":"671","article-title":"World Health Organization Quality of Life (WHOQOL)","year":"2020","journal-title":"A Compendium of Tests, Scales and Questionnaires. Psychology Press"},{"issue":"13","key":"pone.0338095.ref010","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1056\/NEJM199803263381301","article-title":"Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators","volume":"338","author":"FJ Palella","year":"1998","journal-title":"N Engl J Med"},{"key":"pone.0338095.ref011","doi-asserted-by":"crossref","first-page":"1201087","DOI":"10.3389\/frph.2023.1201087","article-title":"Challenges and barriers to HIV care engagement and care cascade: viewpoint","volume":"5","author":"K Bouabida","year":"2023","journal-title":"Front Reprod Health"},{"key":"pone.0338095.ref012","first-page":"5812650","article-title":"HIV-Stigma in Nigeria: Review of Research Studies, Policies, and Programmes","volume":"2017","author":"CO Odimegwu","year":"2017","journal-title":"AIDS Res Treat"},{"key":"pone.0338095.ref013","volume-title":"WHOQOL-HIV bref. 2012 revision","author":"World Health Organization","year":"2002"},{"issue":"4","key":"pone.0338095.ref014","doi-asserted-by":"crossref","DOI":"10.1002\/jia2.25902","article-title":"Use of quality-of-life instruments for people living with HIV: a global systematic review and meta-analysis","volume":"25","author":"Y Zhang","year":"2022","journal-title":"J Int AIDS Soc"},{"issue":"1","key":"pone.0338095.ref015","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12955-019-1208-8","article-title":"Assessing quality of life in people with HIV in Spain: psychometric testing of the Spanish version of WHOQOL-HIV-BREF","volume":"17","author":"MJ Fuster-RuizdeApodaca","year":"2019","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0338095.ref016","doi-asserted-by":"crossref","first-page":"234","DOI":"10.11604\/pamj.2014.18.234.2816","article-title":"Quality of life of Nigerians living with human immunodeficiency virus","volume":"18","author":"AO Akinboro","year":"2014","journal-title":"Pan Afr Med J"},{"issue":"1","key":"pone.0338095.ref017","doi-asserted-by":"crossref","DOI":"10.4314\/bjpm.v11i1.48823","article-title":"Quality Of Life Of People Living With Hiv\/Aids In Kogi State, Nigeria","volume":"11","author":"A Fatiregun","year":"2009","journal-title":"BJPM"},{"issue":"1","key":"pone.0338095.ref018","doi-asserted-by":"crossref","first-page":"1","DOI":"10.33094\/7.2017.2019.51.1.8","article-title":"Quality of Life, Health Perception and Meaning in Life among Selected People Living with HIV\/AIDS in a Hospital in South Western Nigeria","volume":"5","author":"BE Osamika","year":"2019","journal-title":"International Journal of Social Sciences Perspectives"},{"issue":"1","key":"pone.0338095.ref019","first-page":"35","article-title":"The Factor Structure of the Adapted WHO Quality of Life BREF questionnaire in a sample of adolescents in Nigeria","volume":"6","author":"OM Akpa","year":"2018","journal-title":"Arch Basic Appl Med"},{"key":"pone.0338095.ref020","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1186\/s13033-016-0062-x","article-title":"Adaptation and validation of the short version WHOQOL-HIV in Ethiopia","volume":"10","author":"M Tesfaye","year":"2016","journal-title":"Int J Ment Health Syst"},{"issue":"8","key":"pone.0338095.ref021","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1023\/A:1013867826835","article-title":"The WHO quality of life assessment instrument (WHOQOL-Bref): the importance of its items for cross-cultural research","volume":"10","author":"WHOQOL Group. World Health Organisation Quality Of Life","year":"2001","journal-title":"Qual Life Res"},{"key":"pone.0338095.ref022","unstructured":"NACA. National HIV and AIDS Strategic Framework 2021-2025. 2021. https:\/\/naca.gov.ng\/wp-content\/uploads\/2022\/03\/National-HIV-and-AIDS-Strategic-Framework-2021-2025-Final.pdf"},{"key":"pone.0338095.ref023","unstructured":"Zaccheus Onumba Dibiaezue Memorial Libraries. https:\/\/zodml.org\/discover-nigeria\/states\/bauchi-state. Accessed 2024 September 26."},{"key":"pone.0338095.ref024","unstructured":"Federal Ministry of Health. Nigeria HIV\/AIDS Indicator and Impact Survey - National Summary Sheet. 2019 Mar. Available: https:\/\/www.naiis.ng\/resource\/factsheet\/NAIISPANATIONALFACTSHEETFINAL.pdf"},{"key":"pone.0338095.ref025","unstructured":"World Health Organization. WHOQOL-HIV Instrument Users Manual Scoring and Coding for the WHOQOL-HIV Instruments. 2002. https:\/\/iris.who.int\/handle\/10665\/77776"},{"key":"pone.0338095.ref026","volume-title":"R: A Language and Environment for Statistical Computing","author":"R Core Team","year":"2023"},{"key":"pone.0338095.ref027","doi-asserted-by":"crossref","first-page":"53","DOI":"10.5116\/ijme.4dfb.8dfd","article-title":"Making sense of Cronbach\u2019s alpha","volume":"2","author":"M Tavakol","year":"2011","journal-title":"Int J Med Educ"},{"key":"pone.0338095.ref028","doi-asserted-by":"crossref","DOI":"10.2466\/03.CP.4.10","article-title":"Confirmatory Factor Analysis as a Tool in Research Using Questionnaires: A Critique,","volume":"4","author":"P Prudon","year":"2015","journal-title":"Comprehensive Psychology"},{"key":"pone.0338095.ref029","doi-asserted-by":"crossref","first-page":"95","DOI":"10.11604\/pamj.2023.44.95.36007","article-title":"Validation of Kiswahili version of WHOQOL-HIV BREF questionnaire among people living with HIV\/AIDS in Tanzania- a cross sectional study","volume":"44","author":"NA Kondo","year":"2023","journal-title":"Pan Afr Med J"},{"issue":"5","key":"pone.0338095.ref030","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/j.jana.2016.04.007","article-title":"Application of the WHOQOL-HIV-BREF Questionnaire in HIV-Infected Thai Patients: Reliability and Validity of the Instrument","volume":"27","author":"N Meemon","year":"2016","journal-title":"J Assoc Nurses AIDS Care"},{"issue":"1","key":"pone.0338095.ref031","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1186\/s12955-020-01451-8","article-title":"Assessing the psychometric properties of the French WHOQOL-HIV BREF within the ANRS CO3 Aquitaine Cohort\u2019s QuAliV ancillary study","volume":"18","author":"D Barger","year":"2020","journal-title":"Health Qual Life Outcomes"},{"issue":"1","key":"pone.0338095.ref032","doi-asserted-by":"crossref","DOI":"10.1186\/s12955-021-01693-0","article-title":"Translation and cross-cultural adaptation of WHOQOL-HIV Bref among people living with HIV\/AIDS in Pakistan","volume":"19","author":"A Ahmed","year":"2021","journal-title":"Health Qual Life Outcomes"},{"key":"pone.0338095.ref033","first-page":"671","article-title":"Quality of Life of People Living with HIV on Antiretroviral Therapy: A Cross-Sectional Study in Monastir, Tunisia","volume":"15","author":"L Berrezouga","year":"2023","journal-title":"HIV AIDS (Auckl)"},{"issue":"1","key":"pone.0338095.ref034","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1186\/s12955-019-1208-8","article-title":"Assessing quality of life in people with HIV in Spain: psychometric testing of the Spanish version of WHOQOL-HIV-BREF","volume":"17","author":"MJ Fuster-RuizdeApodaca","year":"2019","journal-title":"Health Qual Life Outcomes"},{"issue":"1","key":"pone.0338095.ref035","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/s12955-019-1130-0","article-title":"Measurement equivalence of the English, Chinese and Malay versions of the World Health Organization quality of life (WHOQOL-BREF) questionnaires","volume":"17","author":"YB Cheung","year":"2019","journal-title":"Health Qual Life Outcomes"},{"issue":"8","key":"pone.0338095.ref036","article-title":"Psychometric properties of the Chinese version of the WHOQOL-HIV BREF to assess quality of life among people living with HIV\/AIDS: a cross-sectional study","volume":"7","author":"Y Zhu","year":"2017","journal-title":"BMJ Open"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338095","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T18:32:27Z","timestamp":1765564347000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338095"}},"subtitle":[],"editor":[{"given":"Binh Thang","family":"Tran","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,12]]},"references-count":36,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,12]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0338095","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,12]]}}}