DESIGNING A SCALE FOR SCHIZOPHRENICS: QUALITY OF LIFE ASSESSMENT IN KINSHASA. [Original Research]
KASWA KJ, MD*, MAMPUNZA S, PhD*, HAWORTH A, PhD**, YASSA P, PhD**, ODIMBA BFK, PhD**, KASWA KM, MD***, TCHIKARA MD****
*Department of Psychiatry CNPP, University of Kinshasa, Democratic Republic of Congo.
**University Teaching Hospital, Lusaka, Zambia.
***Mycobacteriology Laboratory, David Axeirod Institute Albany, NY 121208, Science in the Pursuit of Health, USA.
****Parirenyatwa Hospital, Harare, Zimbabwe.

[emedpub – Psychiatry and Mental Health: Vol 1:5] [Date of Publication: 08.18.2013]
ISSN 2231-6019

August 18, 2013 at 3:41 AM

Correspondence:

Jean Kasiama KASWA, MD, Department of Psychiatry CNPP, University of Kinshasa – RDC

E-mail: doctakaswa@gmail.com, Site Web: http://kaswa.blog4ever.com, www.scibd.com/doctakaswa

RESUME:

Contexte. Mesurer constitue une composante essentielle de la recherche, tant en sciences sociales, qu’en médecine et en biologie. La prise de décisions médicales repose souvent sur des critères dits objectifs qui n’intègrent pas de vision qualitative alors qu’aujourd’hui, l’appréciation de la qualité de vie quantifie les états de santé et éclaire la décision en médecine. Pour évaluer la qualité de vie des schizophrènes stabilisés dans nos services, il faut disposer d’un instrument de mesure. Devant la multitude d’échelles et d’index de qualité de vie, il n’est pas facile de sélectionner le “bon instrument”, surtout qu’il n’existe aucun standard universellement reconnu. Le fait qu’il n’y a aucun consensus sur le concept de qualité de vie,  c’est déjà un défi majeur dans le développement d’outils pour l’évaluer. Le  But des échelles de qualité de vie subjective est de  mesurer le retentissement des troubles.

Objectif. Evaluer la qualité de vie des schizophrènes stabilisés par les neuroleptiques avec un outil propre à nos services psychiatriques et adapté à notre contexte socioculturel.

Méthodes. Pour évaluer la qualité de vie des schizophrènes, nous développons ici un instrument simple  qui va mesurer les aspects de l’aspiration de l’individu, mieux une échelle subjective. La méthode de collecte des données, les caractéristiques des items, la source des données et le temps d’administration approximatif sont très importants. Il s’agit de la construction d’un auto- questionnaire qui sera utilisée à des fins thérapeutiques.

Résultats. Nous avons une échelle d’une haute consistance interne (alpha Cronbach = 0.89), dénommée Échelle d’Evaluation de la Qualité de vie des Schizophrènes (EQVS) avec 11 domaines et 44 items, Idéale en clinique parce que le patient répond aux questions sans intervention extérieure.

Conclusion. Bien que non encore validé, cette échelle reste sensible aux modifications de l’état clinique ; elle est   complètement indiquée pour les chercheurs, cliniciens et tous les autres personnes qui souhaitent apprendre sur les mesures de la qualité de la vie des schizophrènes dans notre environnement culturel.

ABSTRACT:

Context. Research on quality of life is an essential component in social studies.  Quality of life determines an individual’s state of health and their medicine-based decisions. In order to evaluate the quality of life for schizophrenics, there is need to have a measuring instrument. Before the multitude of scales and indexes of life quality that are available today, it was not easy to select a ‘good instrument,’ especially since no universally recognized standard exists. The fact that there is no consensus on the concept of life quality, it is already a major challenge to evaluate it using our current set of tools. The goal of the scales of subjective life quality is to measure the reverberation of the unrests in an individual.

Objective. To evaluate the quality of life of the schizophrenics using a clean tool in our psychiatric services and adapt it to our socio-cultural context.

Methods. We developed a simple instrument that measures the aspects of the individual’s aspiration on a subjective scale. The method of data collection, the features of the items, the source of data, and the approximate administration time are very important. It is about the construction of an auto – questionnaire that will be used for therapeutic purpose.

Results. We have designed a scale of a high internal consistence (Cronbach alpha = 0.89), which is named Scale of Assessment of the Quality of Life of the Schizophrenics (SAQLS) with 11 domains and 44 items. This is ideal for a clinical environment because the patient answers the questions without outside intervention.

Conclusions. Although not validated, this scale remains appropriate and sensitive to the modifications of the clinical state; it is designed for use by the researchers, clinicians and all other scientists who wish to learn the measures of the quality of life of schizophrenics in our socio-cultural environment.

INTRODUCTION:

Today, schizophrenia afflicts 1% of the population and constitutes a real martyrdom for patients, their families, and society. To improve the lives of schizophrenics leaving the mental hospitals, it is necessary for their communities to investigate medication, give psychological support, and improve the efforts of rehabilitations and quality of life research. Among numerous definitions of quality of life that exist, we are interested in the World Organization of Health’s definition: the quality of life of a person is the individual perception of his position in life according to his culture, his values, his goals, his waiting, and his preoccupations (3, 4). Here, one introduces two important characters: the notion of culture and of personal vision. In other words, the quality of life measures, at one particular moment, the difference between an individual’s hope and patience and his present experience. In order to evaluate a schizophrenic’s happiness, it is best to ask the patient and take into account the clinic’s research and questions. Quality of life becomes increasingly important within medical assessments with political and health interference. The ideal instrument to measure quality of life-if one must exist-is one that is brief, comprehensible, easy to score, and has an understanding of the patient, family, clinician, and researcher.

Here is why we conceived our study at the medical school of the University of Kinshasa. This questionnaire is meant to evaluate the conditions in which schizophrenics are taken in by our psychiatric services in the Neuro – Psycho – Pathological – Center (NPPC). The goal of these measures is to enable us to evaluate the impact of the illness and the medicinal treatment of these people daily.

MATERIAL AND METHOD:

To measure the subjective quality of life of the patient, each individual will give us their opinion on their own personal satisfaction with life. The instruments of assessment of quality of life are the standardized tools: the methodology of construction and analysis of the questionnaire is established and recognized by the international community; one of the applications of these new measures is the assessment by the patients themselves about their state of health (1, 2).

MATERIAL:

We referred to the instrument of the World Organization of Health (3). The WHOQOL-100 is an orchestrate that has been developed in more than15 cultural settings over several years. Its psychometric properties have been proven satisfactory in some cultures. A pilot version of 235 articles has been tested in 15 countries and the questionnaire has been refined to become an auto – managed version of 100 items. We are inspired by these three scales of assessment whose psychometric qualities are recognized: the specificity for the schizophrenic, the subjectivity, the auto assessment, the feasibility, reliability, and validity. Only defer the presentation, the domains of life, the number and the type of items as well as the time required for the investigation. It is about the following scales: the S-QoL of Marseille (5), the SQL’s of Oxford Outcomes (6), and the QL of Lehman (7) that are among the most recent and up-to-date. Of these tools, we are especially interested in Lehman, which seemed to look more in-depth into the domains of life reviewed by the maintenance of assessment of life quality.

METHODS:

We adopted from suggestions made by the professionals of mental health and by the patients consolidated in the Neuro – Psycho-Pathological-Center (NPPC) of the University of Kinshasa. The relevance of our instrument will be determined by the answers regarding quality of life among 49 schizophrenic patients, consolidated, according to the DSM IV, of which the evolution of the illness varied 1 to 5 a year.

Before conceiving this tool of measure, it is important to us to know some psychometric principles in order to assure us that we really measure the quality of life of the patients (8). Although a complete analysis of this process extends past the scope of this document, we are obliged to consult the conception of investigation plans within the present case, Portney and Watkins, 1993.

We want a subjective instrument because subjectivity is paramount in measuring the quality of life. It is constructed from an auto – managed questionnaire and is related to multiple factors of health: to perceptions, attitudes in relation to health, well-being, daily habits, as well as functional limitations (autonomy, sociability, and inability). We prefer an auto – estimated questionnaire so that we may avoid the effects of contamination and social desirability slant. At all times, we remember that the possibility of mistakes in the project’s conception is always a potential threat. However, we take every effort to apply ourselves to the application of the instruments, increase the precision of the instrument, and discover any and all possibilities of mistake (8). We try to maintain consistency between data maintain reliability and confidence in our results.

To preserve the validity of the instrument (degree of truth), we have to keep in mind these questions:   What does one measure really? What do the results mean? Do the results apply to other people?  What brings us to think on the domains of life and its items?

The analysis has been achieved with the software SPSS-10, between September 1998 and April 2000.

Domains and items of Quality of life:

Experts generally agree that regarding domains of life, such is not yet the case on the items; the questions vary from one instrument to the other, as well the way to formulate them that on their number (3, 10). Only the presentation, the number of the domains, the time required for investigation, and the types of items can vary. What one doesn’t find in an instrument regarding the level of domains or items, one can in another domain, either in the items or under – items; the remaining content, however, is the same. Without the shape, it is identical. It explains how we are going to proceed to a new development of the items in order to adapt them to our socio-cultural environment. Our intention is to construct an instrument that is of reasonable length and easy to score, coherent, flexible, and applicable, with one degree of precision and reliability. In regard to the conception of our instrument, we were inspired by the S-QoL of Marseille (5), the SQL’s of Oxford Outcomes (6), the QL of Lehman (7), and the presentation of the WHOQOL-100 (2,3)-the latter because of the suppleness and the easiness of its manipulation.

Around the domains of life, provide himself certain unanimity. We plan to borrow techniques and ideas from other tools and adapt them to our own socio-cultural context. To avoid being confronted by the cost of our assessment, we find it imperative to revise and reduce our items. It permits us to elaborate an auto – managed questionnaire with a system automated of data collection at the time of the assessment. Hundred and sixteen items were chosen in the beginning.  After the first analysis, we decreased progressively to 104 items, and then later to 81. Finally, it is about an auto – questionnaire for auto assessment, subjective and specific for the schizophrenic, who can answer it by him or herself with no help from an interviewer. The feasibility doesn’t pose a problem; the patient and his family, at the end, seem satisfied with it. The number of domains is of 11, and items are 44.

Contact with the schizophrenic

We want person-to-person interaction:

-          By taking into account his or her sensitivity;

-          By encouraging questions that generate good feelings and avoiding those that block it;

-          By eliminating fear, mercy, and provocation; and encouraging spontaneity-the human feeling;

-          By not letting the investigator pressure the interviewee with questions that they must feel obliged to answer;

-          By encouraging the interviewee to answer questions to the best of his or her ability and not stressing to find a “good answer”.

Modes of answers

Five modes of answers are kept:  Ever (0%), Rarely (25%), Sometimes (50%), Often (75%), and Always (100%).  It is “often” the good answer, the good quality of life (75%). This quality is excellent when it reaches 100% (always).

The score

We pulled the manner of scoring from S-QoL whose calculation is not influenced by the number of the domains nor items (5).

  • For an item: the value ranges from 0 (0%), which is worst quality of life, to 4 (100%), which is excellent quality of life.
  • For a domain:  the sum of the scores of the items (1 to 4) of the D domain multiplied by 100, divided by 4 (the number of items / domain) (3).

The formula for scoring, for example for Domain1 (HEALTH), executes itself in the following manner: if the answer is consistently always, score 4 for every question and excellence. It comes back to:

-          D1.1 score = 4 either 100%,

-          D1.2 score = 4 either 100%,

-          D1.3 score = 4 either 100%,

-          D1.4 score = 4 either 100%

Total score of 4 items (D1) HEALTH: 4 x 100 = 400, to divide by the product of the score maximum by item (=100) with the number of items by domain (=4). The calculation comes back for the D1 to:

100%. Therefore D1=100%; HEALTH is excellent.

For the assessment of the quality of life of the scale: the quality of life is the average of the sum of percentages (%) of all DS domains of the scale (the sum of % of D1 in D11) divided by 11(domains). It will be necessary for us to resort to the coefficient of test – retest constancy to indicate in what measure the answers to the same items are identical when one same test is managed by the same topics at different moments. In general, the indication of test – retest constancy is slightly lower than the internal consistency indication; a coefficient of > 0, 75 indicates a constancy sufficient test – retest.

RESULTS:

Questionnaire of assessment of the Quality of Life of the Schizophrenic (EQVS)

1. HEALTH

D1.1 My body has energy

never rarely sometimes often always

0               1               2                3           4

D1.2 My suckles are quiet

never rarely sometimes often always

0            1                2               3          4

D1.3 Also, I have time to amuse myself

never rarely sometimes often always

0           1            2                   3            4

D1.4 I am satisfied with my sleep and rest

never rarely sometimes often always

0           1               2                3           4

2. PSYCHOLOGICAL SYMPTOMS

D2.1 I am happy with my body image

never rarely sometimes often always

0           1               2                3           4

D2.2 I remember events and concentrate on my work

never rarely sometimes often always

0           1               2                3           4

D2. 3 I believe in my future

never rarely sometimes often always

0           1               2                3           4

D2.4 I am in a good mood

never rarely sometimes often always

0           1               2                3           4

3. SELF-ESTEEM / WELL-BEING

D3.1 I am confident

never rarely sometimes often always

0           1               2                3           4

D3.2 My family respects my authority

never rarely sometimes often always

0           1               2                3           4

D3.3 I am at ease in public

never rarely sometimes often always

0           1               2                3           4

D3.4 I am satisfied with what I make

never rarely sometimes often always

0           1               2                3           4

4. RELATIONSHIP WITH MY FAMILY

D4.1 I am in good terms with my family members

never rarely sometimes often always

0           1               2                3           4

D4.2 My family listens to me

never rarely sometimes often always

0           1               2                3           4

D4.3 In case of difficulties, my family helps me

never rarely sometimes often always

0           1               2                3           4

D4.4 I like my family members, and I am liked

never rarely sometimes often always

0           1               2                3           4

5. SOCIAL AND IN LOVE REPORTS

D5.1 I have a (e) friend (e)

never rarely sometimes often always

0           1               2                3           4

D5.2 My friends visit me

never rarely sometimes often always

0           1               2                3           4

D5.3 I have sexual activity

never rarely sometimes often always

0           1               2                3           4

D5.4 I am satisfied with my sexual life

never rarely sometimes often always

0           1               2                3           4

6. RECREATION/ CREATIVITY

D6.1 I visit my friends

never rarely sometimes often always

0           1               2                3           4

D6.2 I go to market

never rarely sometimes often always

0           1               2                3           4

D6.3 in the evening, I like to watch television

never rarely sometimes often always

0           1               2                3           4

D6.4 On feasts, I like to dance

never rarely sometimes often always

0           1               2                3           4

7. COMMUNITY INVOLVEMENT / PRODUCTIVITY 

D7.1 I take part in demonstrations in my district

never rarely sometimes often always

0           1               2                3           4

D7.2 And I like to speak with my setting

never rarely sometimes often always

0           1               2                3           4

D7.3 I have a need to have some information

never rarely sometimes often always

0           1               2                3           4

D7.4 I manage to achieve my projects

never rarely sometimes often always

0           1               2                3           4

8. RELIGION

D8.1 I believe in God

never rarely sometimes often always

0           1               2                3           4

D8.2 I read the Bible, (the Koran), God’s Speech

never rarely sometimes often always

0           1               2                3           4

D8.3 I go to the cult/a the Mass

never rarely sometimes often always

0           1               2                3           4

D8.4 Prayer brings me something in life

never rarely sometimes often always

0           1               2                3           4

9. FINANCIAL SITUATION

D9.1 I know how to pay for my transportation

never rarely sometimes often always

0           1               2                3           4

D9.2 I buy my own medicines

never rarely sometimes often always

0           1               2                3           4

D9.3 I am able to feed myself

never rarely sometimes often always

0           1               2                3           4

D9.4 I am satisfied with my financial situation

never rarely sometimes often always

0           1               2                3           4

10. CONDITIONS OF LIFE

D10.1 In the house, I have my own bed

never rarely sometimes often always

0           1               2                3           4

D10.2 At home, I have water

never rarely sometimes often always

0           1               2                3           4

D10.3 In my district, I am in good terms with my neighbors

never rarely sometimes often always

0           1               2                3           4

D10.4 I live in a sure and secure place

never rarely sometimes often always

0           1               2                3           4

11. AUTONOMY

D11.1 I know how to work without the help of others and take medicines

never rarely sometimes often always

0           1               2                3           4

D11.2 I choose my own clothes

never rarely sometimes often always

0           1               2                3           4

D11.3 I know how to take my own transportation

never rarely sometimes often always

0           1               2                3           4

D11.4 I am capable of working

never rarely sometimes often always

0           1               2                3           4

Answer scores

Table 1: how to answer

answers
items never

0

0 %

rarely

1

25%

sometimes

2

50 %

often

3

75%

always

4

100%

Score of QV

Table 2: Score of 49 topics

Frequency Per cent Percentage validates accumulated Percentage
Validate 30 1 2,0 2,0 2,0
35 1 2,0 2,0 4,1
36 2 4,1 4,1 8,2
37 1 2,0 2,0 10,2
42 1 2,0 2,0 12,2
44 1 2,0 2,0 14,3
47 1 2,0 2,0 16,3
48 1 2,0 2,0 18,4
49 1 2,0 2,0 20,4
51 1 2,0 2,0 22,4
52 2 4,1 4,1 26,5
53 3 6,1 6,1 32,7
55 2 4,1 4,1 36,7
57 1 2,0 2,0 38,8
58 3 6,1 6,1 44,9
59 1 2,0 2,0 46,9
61 4 8,2 8,2 55,1
63 2 4,1 4,1 59,2
64 2 4,1 4,1 63,3
65 2 4,1 4,1 67,3
67 4 8,2 8,2 75,5
68 3 6,1 6,1 81,6
69 2 4,1 4,1 85,7
74 2 4,1 4,1 89,8
76 1 2,0 2,0 91,8
78 2 4,1 4,1 95,9
80 1 2,0 2,0 98,0
92 1 2,0 2,0 100,0
Total 49 100, 100,0

With the SPSS-10, the EQVS scale shows for the answers of 49 topics, a high internal consistence (Cronbach alpha = 0.89; the good quality of life corresponds to 75% or more; the excellent to 100%. In the present case, only 5 patients, about 10% have a good quality of life; the majority has a bad quality of life (Tab. 2). When we search for the qualities psychométriques (Tab. 1, 3, 4), the time required is about 20 minutes. In relation to the other scales, the EQVS is somewhat similar as the qualities psychométriques. In relation to the domains of applied life (Tab. 4), the EQVS has 11 domains of life, such as the WHOQOL-100.

Table 3:    Psychometric qualities of Instruments.

scale Sqol SQL’s QL Lehman WHOQOL-100 EQVS
autoquestionnaire * * * * *
reliablity * * * * *
validity * * * * *
feasability * * * * *
Time required 45 min 22 min 20 min
satisfaction * * * * *
Concistency.alpha 0,85 0,94 0,89

Table 4: Domains of life applied

scale Sqol SQL’s QL Lehman WHOQOL-100 EQVS
Health * * * * *
Symptoms * * * * *
Situation financial * * * *
Conditions of life * * * *
Family Reports * * * *
social and in love * * * *
Leasure creativity * * * * *
Involvement in communal life * * * * *
Religion * * *
Esteem of oneself and well – being * * * * *
Autonomy * *

DISCUSSION:

The assessment of quality of life corresponds with the impact of the illness on the physical and psychosocial level.  It remains one of the main elements that must contribute to medical decisions. At the present time, it is becoming increasingly important to evaluate quality of life in mental pathology, especially regarding schizophrenia in public health.

Our research creates interest in the quality of life for schizophrenics-communities will look at them more as people and less as an object of science. It gives schizophrenics the opportunity to recover from their illness and improve their lives.  It encourages these individuals to pursue better lives and find happiness despite the challenge of adapting to society with stern and obstinate psychiatric troubles. Measuring quality of life can bring precious information to the intervention and to organizations dedicated to service. It is for this reason that we create a tool of assessment for quality of life that is adapted to our socio cultural context.

Here are the results from the answers of the 49 schizophrenic topics. The Questionnaire of assessment of the Quality of Life of the Schizophrenic (EQVS) understands 11 domains:

1. HEALTH (Items or facets based on the individual’s physical working: physical symptoms, state of health, physical activity, rest, sleep.),

2. PSYCHOLOGICALSYMPTOMS (Items or facets based on symptoms associated to a frame of mind or mental trouble),

3. SELF-ESTEEM / WELL-BEING (This item or facet examines how the person feels about him or herself. Items or scales based on the patient’s emotional, psychological, or subjective state, including their self-esteem; feeling of psychological well-being, contentment, optimism and life-view),

4. RELATIONSHIP WITH FAMILY (Items or facets concerning family members’ social support. Items based on the degree of domestic support emotionally and materially), D4.1 I am in good term with my family members (ever rarely sometimes often always),

5. SOCIAL AND IN LOVE REPORTS (Items or facets based on the relational plan and on emotional degree),

6. RECREATION/ CREATIVITY (Items or facets based on the quantity or the nature of activities of leisure or creative activities),

7. COMMUNITY INVOLVEMENT / PRODUCTIVITY (These items or facets are about the quantity, the degree, or the nature of involvement in communal life or to activities of employment. A lot of people suffering from chronic mental illnesses don’t work full-time, but can nevertheless participate in other activities that contribute to the good working of the collectivity),

8. RELIGION (Items or facets based on the formal or free practice of a religion, a cult, or a type of spirituality or beliefs),

9. FINANCIAL SITUATION (Items or facets based on the well-being or financial situation),

10. CONDITIONS OF LIFE (Items or facets based on the state or the character appropriate of mid-life),

11. AUTONOMY (Items or facets based on the capacity or ability to produce an action without the help of neither another person nor medicines).

Every domain consists of 4 items; for the EQVS there are 44 items on the whole. The topics focus on what happened within the past 7 days; we use a short period of reference because, in general, it is during this time that it is easiest to remember the most recent events. For the test – retest, the values are reasonably steady (to the tour of 0, 75). The time between the test and the retest is not long enough to influence the results and the patients don’t have the tendency to modify their appreciation of life quality in the second interview. The time to answer is about 20 minutes. The score according to the answer varies from 0 to 4, either 0% to 100%. With the answer, the score is never, 0, and of bad life quality; or excellent, 100%, when the answer is always (Tab.1, 2).

In literature, one meets a lot of clear models that are disparate of quality of life. So he or she sometimes leaves too many general and vague definitions of quality of life. It is about, in fact, the satisfaction in life. In any case, to measure the quality of life, researchers feel the need to agree. The gap between the quantities discerned of an experience or an event and the desired level of this event, we consider it an important indicator of life quality; he or she is quantifiable. This measure is subjective and is often constructed from auto – managed questionnaires that are relative to the multiple factors of health, perceptions, well-being, and daily habits of life as well as functional limitations (autonomy, sociability, inability).

Leaving these principles, our instrument is conceived to have our interviewer relaxed throughout the entire interview, which enables us to finish in a decent amount of time (36 minutes on average). Although several types of scales exist, we want ours to act like a conversation with the schizophrenic interviewee. We take in account human feelings and the sensitivity with respect, while avoiding questions that appear like cross-examination (as How? Why?). The cleaning of the questionnaire is done to the vertical as to the horizontal to the vertical. We stick to the coherent succession of the ideas while avoiding overwhelming the interviewee and causing him or her to stress or fear.

We aim for consistent answers; we ask questions in a way that avoids double or fuzzy interpretations, or an overlapping of ideas., Interviewees answer consistently on the ‘never’ to ‘always’ scale, with ‘never’ being synonymous with ‘poor’ and ‘always’ being synonymous with ‘excellence.’ Scoring, never is 0, always is 4. This way of scheduling, we recognize that several sources can possibly make mistakes. Because of this, we were very attentive to finding ways to increase the precision of the assessment and to discover all areas of potential mistakes during the conception of the test. We made an effort to avoid to reduce the consistency of the data as well as the level of reliability and to undermine the confidence that we could have in the results.

At all times, we wonder about the significance of the results: What do the results mean? Do the results apply to other people? This is why after several tests, we stop at 11 domains and 44 items. Indeed, we know that generally, the more the number of items on a scale is raised, the more reliable it is (internal consistency) (8). Also, with all other factors remaining equal, a relative questionnaire that studies quality of life. Also, with all other factors remaining equal, a relative questionnaire that studies quality of life which counts less items will be less coherent than a longer instrument.  A shorter instrument will have more fluctuations in patients’ scores, due to answers being at random. Beside the mathematical considerations, there are various other reasons why scales with multiple categories are more coherent than instruments with unique categories.

An interesting theory explains this phenomenon:  Instruments of multiple categories generally provoke topics to remember more effectively applicable experiences to better answer each question (9). It would seem that this research of applicable elements of information has the effect of reducing the impact of fast judgments and thoughts that is only bound to the reason of the first question (Poppy and Deiner, 1993). To evaluate the quality of life, we owe the measure Raymond TEMPIER, professor of psychiatry in Montreal, Canada, who though that when one calculates a global score, he is generally useful for research and not for the clinic. This information allows him to put the finger on the interviewee’s specific essential needs if he or she wants to undertake a gait of re-adaptation. In the EQVS, the scores received by the topics are not influenced by luck; the set of data are clear, there is not any systematic and unforeseen element that affects the observations and falsifies the findings.

There are more properties to respect. Indeed, the quality of an assessment scale is defined by its degree of validity, reliability, and degree of truth. A strong interrelationship existed between the domains of the WHOQOL-100 and the measurements of the general inventory of life quality (= 0, 72-0,82 between related domains). The scale showed high internal consistence (Cronbach alpha = 0.94). The Neuro-Psycho-Pathological-Center (NPPC) of KINSHASA converged on their views with the Department of Psychiatry between people perfectly familiarized with the topic on the content of the scale. A group of experts including Professor Haworth, in Lusaka, and Psychiatrist Tchkara, in Harare, examined the instrument and determined to what degree the questions of this scale serve to measure the studied features, and what contributed extensively to validate it (validity of content). Formed of closely linked non-disparate questions and not requiring any disconnected answers, the internal consistency of our scale returns to the structural cohesion of the items that composes it.  Its Alpha consistency indication, following the software SPSS 10.0 is equal to 0, 89 satisfactory because of the cover of what is generally known, the Alpha coefficient of Cronbach > 0, 80 (10). The EQVS is valid because a consistency of the scale exists with the data set that we possess inside the field, and also a consistency of these numbers with other numbers is raised on a same population. The EQVS takes 20 minutes on average to complete.  Its reliability is remarkable since it has a strong coefficient of homogeneity (= 0.80 to 0.94).

To improve the EQVS, we passed the test and retest, another means to evaluate the precision of the scale. We wanted to determine the interrelationship between results of two assessments with the same scale and topics. The interval of time, 15 days, was sufficiently brief so that we had the insurance that the measured features didn’t change between the two sessions of assessment, and it was sufficiently long to assure us that the topics don’t answer from memory either. In general, the indication of test-retest constancy is slightly lower than the indication of consistency interne; a coefficient of >0,75 indicates a constancy sufficient test-retest. To this test of test-retest for fifteen days, the coefficient of interrelationship of the EQVS is also raised (0.78 to 0.96). It is sensitive and confirms the poor quality of life of the schizophrenics.

The validity of instruments that measures quality of life is uncertain because of the abstract relative to the concept of quality of life; in the same way an instrument must be sensitive to detect important changes by the chronic patients.  It can help some clinicians to determine how the physical, psychological, and social interventions affect the quality of life of a patient. Our survey showed that the EQVS answers its requirements. The determination of the significance or the truth of a measure is a complex question that supposes that one analyzes the output of an instrument seriously in relation to the other instruments or duly tried criteria to establish which measure fills the function of the assessment activity.

We were anxious to make a comparison with other instruments, (Tab. 3, 4) and in the same gait, we also visited an instrument known to the life quality which is bound to health: the Sickness Impact Profiles Bergner in its version, modified by Awad (11), used for the patients affected by schizophrenia or serious psychiatric unrests. This instrument, in its modified version, includes 64 gathered items in 12 measurements: sleep, rest, food, work, management of the home, etc. Thirty minutes are sufficient to maximally pass it. With a strong coefficient of homogeneity (= 0.81 to 0.97), its reliability is remarkable (Raymond TEMPIER, Professor of psychiatry, Montreal, Canada). The coefficient of interrelationship turns around 0, 90 and with other instruments around 0, 5, acceptable validity. For the Sickness Impact Profiles, the test of test-retest to two weeks, the coefficient of interrelationship is also raised (r = 0.79 to 0.97).  Its validity is weaker since the interrelationship with other instruments is rather in the middle (r = 0.4 – 0.7).

CONCLUSION:

In this century, neuroscience explores a future where the concept of life quality can be researched and extensively studied. We have just constructed a tool to evaluate the quality of life of our patients. The EQVS is a questionnaire of auto assessment, sensitive to the changes of several weeks or months; which means that it is capable of discovering subtle changes in an individual’s working. It is adapted to our socio-cultural environment in RDC. It is designed to depend strongly on the patient’s understanding of the questions. The used criteria are evaluative and are answered by the respondent’s cognitive or emotional judgments-judgments that are sometimes as labeled as subjective. Its use is to assess the perception of the schizophrenic’s satisfaction with his or her own life, and the impact that treatment can have on his or her illness. Based around the view of the patient, the EQVS is multi-dimensional, applicable, and valid. It is meant to serve henceforth in our investigations.

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