Shiraz E-Medical Journal Vol. 14, No. 3, July 2013 http://semj.sums.ac.ir/vol14/jul2013/92014.htm
Quality of Life in Patients with Type 2 Diabetes: Application of WHOQoL-BREF Scale Ali Gholami 1, 2*, Mohammad Azini 3, Abasalt Borji 1, Faramarz Shirazi 3, Zahra Sharafi 3, Esmail Zarei 4 1
Nursing Department, Neyshabur University of Medical Sciences, Neyshabur, IR Iran 2 Students’ Research Committee, Neyshabur University of Medical Sciences, Neyshabur, IR Iran 3 Disease Prevention Group, Neyshabur University of Medical Sciences, Neyshabur, IR Iran 4 Occupational Health Department, Neyshabur University of Medical Sciences, Neyshabur, IR Iran
* Corresponding Author: Ali Gholami, Neyshabur University of Medical Sciences, Razi Avenue, Istgah Street, Neyshabur, IR Iran, Tel: +98-5513336610, Fax: +985513333964, E-mail:
[email protected]
Received for Publication: May 9, 2013, Accepted for Publication: June 8, 2013 Abstract Background: Diabetes is one of the most important chronic diseases which may have a negative effect on the quality of life (QoL) of diabetic patients. The objective of this study was to evaluate QoL in patients with type 2 diabetes living in rural regions of Neyshabur (a city in the northeast of Iran) as well as determine some factors associated with it, by using the WHOQoL-BREFE scale. Methods and Materials: In this cross-sectional study, a total of 1847 patients with type 2 diabetes were studied in Neyshabur from April to July 2012. The Iranian version of the WHOQoL-BREF questionnaire was used to measure QoL. Linear Regression Model was conducted to determine the relation between QoL of study population and various variables. The level of significance was set at p < 0.05 for all analyses. Data were analyzed using SPSS software ver16. Results: The mean age of the study population was 59.65 ± 12.3 yr (Range: 30-97 yr). The majority of participants were female (69.8%). The overall observed Cronbach’s alpha coefficient for WHOQoL-BREF was 0.93 and for each domain of it ranged from 0.69 to 0.86. The total mean score of WHOQoL-BREF was 12.18. The lowest and the highest mean scores were observed in Psychological health domain (11.73) and Social relationship domain (12.66), respectively. Backward multiple linear re162
gression model revealed that Education levels, Marital Status and Household Income were significantly associated with all domains of WHOQoL-BREF (P < 0.05). Conclusions: The findings from this study appear that surveyed diabetic patients have WHOQoL-BREF scores that might be considered to indicate a moderate to low QoL, so it seems that providing international programs is necessary to improve QoL of them Keywords: Type 2 Diabetes; Quality of Life; WHOQoL-BREF; Neyshabur Introduction
tionnaire is one of the instruments that
Diabetes is one of the most important
is used to measure QoL in different
chronic diseases in population that oc-
patients groups (3-7). The WHOQoL-
curs either when the pancreas does not
BREF questionnaire is available in
produce enough insulin or when the
many languages (8) and also it has
body cannot effectively use the insulin
been translated into Persian and then
it produces. Type 1 diabetes known as
validated in Iran by Nedjat (9). Infor-
insulin-dependent, juvenile or child-
mation on the QoL of diabetic patients
hood-onset and Type 2 diabetes known
is important for health policy makers
as non-insulin-dependent or adult-
and physicians in order to identify and
onset. Type 2 diabetes comprises 90%
implement interventional programs for
of people with diabetes around the
improving the QoL of them. Some
world, and is largely the result of ex-
studies assessed QoL in diabetic pa-
cess body weight and physical inactiv-
tients and they suggest a decrease in
ity (1). Diabetes and its complications
their QoL (10-13). This study con-
may have negative effect on QoL of
ducted in order to assess QoL of dia-
patients, but relatively little is known
betic patients that they live in rural re-
about it. QoL is defined by World
gions of Neyshabur as well as deter-
Health Organization (WHO) as “an
mine some factors associated with it
individual's perception of their position
with use of WHOQoL-BREF scale.
in life in the context of the culture and
Materials & Methods
value systems in which they live and in
This cross-sectional study was con-
relation to their goals, expectations,
ducted in 1847 patients with type 2
standards and concerns” (2). In order
diabetes. The data were collected be-
to study QoL, we must be able to
tween April and July 2012, at the all
measure it. In the world, many general
rural regions of Neyshabur. Of all dia-
instruments have been used to measure
betic patients (n = 2224), three hundred
QoL. The World Health Organization
and seventy seven persons were ex-
QoL-BREF (WHOQoL-BREF) ques-
cluded from the study because of their 163
avoidance to participate in the study
to participate in the study. Data were
(response rate: 83.05%). Individuals
analyzed with the use of SPSS16 soft-
with diabetes were identified based on
ware. Descriptive analyses were con-
the lists available in the Neyshabur ru-
ducted including frequencies, percent-
ral health centers. In this study for all
ages, ranges, means, and standard de-
study population provided informed
viations (SD). The reliability of the
consent after being acquainted with the
WHOQoL- BREF domains was as-
purpose of study. Questionnaires have
sessed using Cronbach's Alpha (0.70
been filled by participants (except illit-
and over were deemed acceptable)
erate persons and some special situa-
(16). We also assessed the reliability of
tions) and all of them were informed
the overall QoL. We examined the
that their responses would remain con-
level of agreement between four do-
fidential. In this study, we made use of
mains of the WHOQoL- BREF with
the
questionnaire
the use of Pearson’s correlation coeffi-
that was validated by Nedjat in Iran
cient. t-independent test and multiple
(9). The WHOQoL-BREF question-
linear regression model (with back-
naire contains 26 questions: two ques-
ward method) were used to investigate
tions from the Overall QoL and Gen-
the relation between participants' QoL
eral Health and 24 questions of satis-
and their characteristics including sex,
faction divided into four domains: 1.
age, BMI, education level, marital
Physical
Psychological
status, household income and distance
Health, 3. Social Relationships, and 4.
from the city. In this study transformed
Environmental Health. The responses
scores were used for statistical analy-
of each question are rated on a 5-point
ses in all domains and P values less
Likert scale and scored from 1 to 5.
than 0.05 were regarded as significant.
Raw scores in each domain were trans-
Results
formed to a 4–20 score according to
Overall, 1847 diabetic patients were
guideline (8). The mean score of ques-
studied. Table 1 presents the character-
tions in each domain is used to calcu-
istics of study population. The mean
late the domain score and finally they
age of participants was 59.65 ± 12.3 yr
transformed linearly to a 0–100-scale
(Rang: 30-97 yr). In this study majority
(14, 15). Higher scores are associated
of study population were female (sex
with a higher QoL. Inclusion criteria
ratio: 2.31). Cronbach’s alpha coeffi-
applied in the study included: (a) hav-
cient was applied to evaluate the inter-
ing diabetes type 2, (b) residence in
nal consistency of WHOQoL-BREF
Neyshabur rurals regions (c) agreement
scale and the four domains of it. The
WHOQoL-BREF
Health,
2.
164
observed Cronbach’s alpha coefficient
BREF (P < 0.05). Table 4 shows the
for all questions of WHOQoL-BREF
results of Backward Multiple Linear
was 0.93 and for each domain the val-
Regression; it shows that sex, age,
ues are: Physical health domain = 0.86,
education level, marital status and
Psychological health domain = 0.78,
household income are significantly as-
Social relationship domain = 0.69 and
sociated with total WHOQoL. Educa-
Environmental health domain = 0.76.
tion level, marital status and household
Table 2 displays correlations between
income are associated with four do-
four domains of WHOQoL-BREF; as
mains of WHOQoL. Age is associated
observed; there were significant cor-
with Physical Health and Psychologi-
relations between all domains (P
