A partial validation of the WHOQOL-OLD in a sample of older people in South Africa
Van Biljon, Lizanle
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This article describes the psychometric properties of the WHOQOL-OLD (an add-on module to the World Health Organization's Quality of Life measure for older people) in a South African sample. International literature cites three short versions of the WHOQOL-OLD instrument. The psychometric properties associated with these three short versions of the WHOQOL-OLD are also described. The unique challenges posed by ageing populations are evident in both developed and developing countries. In South Africa the elderly population is also increasing dramatically. There is a disproportionate distribution of older persons per ethnic group, with white older people representing the largest group of older South Africans (21%, proportional to ethnic group). Regardless of integration policies in post-apartheid South Africa, especially in terms of housing arrangements, the majority of long-term care facilities in South Africa remain to be occupied predominantly by white older people. For this reason the participants of this study were mostly older white South Africans. It is, however, projected that this picture will change in future times due to more aggressive transformation-driven policies. A national audit of residential care facilities by the Department of Social Development in 2010 indicated a need for psychosocial interventions since the QoL of residents was found to be undetermined. QoL research in South Africa has largely been conducted from socio-economic and health-care perspectives and has tended to focus on specific societies in which older people are usually not explicitly included. Evidence exists of various qualitative studies among older people living in long-term care facilities, from a psychological perspective. However, the short supply of quantitative studies in this setting is significant. The lack of measurements developed for an older population also resulted in an increasing need for the development of gerontological QoL measurements with sound psychometric properties. Internationally, various measures of QoL utilised in older age groups have become increasingly popular. This study took particular interest in the WHOQOL-OLD instrument. Under the auspices of the World Health Organization Quality of Life group, a collaborative effort among numerous researchers from various countries has led to the development of a measure focussing on the QoL in older population cohorts. The initial development of the generic WHOQOL measures of quality of life occurred in 15 different centres worldwide, excluding South Africa. In the development of an add-on module, 22 centres around the world were involved (again excluding South Africa). It cannot be assumed that measuring instruments developed in a Western context are applicable in an African context. South Africa is a very diverse nation - the majority of ethnic groups lead a collectivistic existence. As a result the determination of the psychometric properties of such instruments, for use within South Africa, was needed. It is of importance to note that the participants of this study were more individualistically inclined, which is comparable to Western societies. This study was the first step in exploring the instrument’s reliable use within South Africa. Surveys were completed by 176 older people who were fluent in both Afrikaans and English. Participants of the study resided in long-term care facilities in Potchefstroom in the North-West province of South Africa. Their ages varied between 61 and 95 and the mean age of participants was 77 years. Of the respondents, 50 were male and 126 were female. All reported average to good health and cognitive ability. The current study found encouraging results related to the original factor structure of the WHOQOL-OLD as well as the three shorter versions of this instrument. Results from the data of the current sample seem to fit the original structure model well. The reliabilities associated with the various sub-dimensions point to a reliable instrument. The original WHOQOL-OLD questionnaire with its 24 items or any of the three short versions of this instrument can therefore be utilised in a South African context.
- Health Sciences