Psychometric Properties of the EORTC QLQ-C30 in a Ugandan Context

Abstract

Abstract; Background Self-reported measures play a crucial role in research, clinical practice and health assessment. Instruments used to assess self-reported health-related quality of life (HRQoL) need validation to ensure that they measure what they are intended to, detect true changes over time and differentiate between subjects. A generic instrument measuring HRQoL adapted for use among people living with cancer in Uganda is lacking; therefore, this study aimed to evaluate the psychometric properties of the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30 when used in a Ugandan context. Methods Adult patients with various types of cancer (N=385) cared for at the Uganda Cancer Institute answered the Luganda or English version of the EORTC QLQ-C30. The two language versions were evaluated with regard to data quality (floor and ceiling effects and missing responses), reliability (internal consistency) and validity (construct, known-group and criterion). Construct validity was examined through confirmatory factor analysis (CFA). Mean scores were compared between groups differing in disease stage to assess known-group validity. Criterion validity was examined according to associations between two QLQ-C30 subscales (Global quality of life and Physical function) and the Karnofsky Performance Scale (KPS).Results Floor and ceiling effects were observed for several scales in the Luganda and English versions. All EORTC scales with the exception of Cognitive function (Luganda α=0.66, English α=0.50) had acceptable Cronbach’s alpha values (0.79–0.96). The CFA yielded good fit indices for both versions (RMSEA=0.076–0.081, SRMR=0.048 and CFI=0.928–0.932). Known-group validity was demonstrated with statistically significant better HRQoL reported by patients with disease stages I–II compared to those in stages III–IV. The Global quality of life and the Physical function scales correlated positively to KPS (r=0.65 and r=0.75), indicating criterion validity. Conclusion The Luganda and English versions of the EORTC QLQ-C30 appear to be valid and reliable measures and can be recommended for use in clinical research to assess HRQoL in adult Ugandans with cancer. However, the cognitive scale did not reach acceptable internal consistency and needs further evaluation.