Positive Outcomes: Validity, reliability and responsiveness of a novel person-centered outcome measure for people with HIV

HIV MedicineHarding R, Jones CI, Bremner S, et al. | January 13, 2022


Despite successful treatment, persistent and burdensome multidimensional problems are reported by people living with HIV. Researchers herein assessed the validity (structural, convergent and divergent, discriminant), reliability (internal consistency, test-retest) and responsiveness of Positive Outcomes, which is used as a patient-reported outcome measure in clinical practice.

  • At baseline and 12 months, a total of 1,392 outpatients in five European countries self-completed Positive Outcomes, PAM-13 (patient empowerment), PROQOL-HIV (quality of life) and FRAIL (frailty).

  • Overall findings demonstrate that the Positive Outcomes measure addresses the core domains of importance to people living with HIV: ‘Emotional wellbeing’ ‘Interpersonal and sexual wellbeing’ ‘Socioeconomic wellbeing’ and ‘Physical wellbeing’.

  • The Positive Outcomes measure was identified to have sound psychometric properties (validity, reliability and responsiveness) for determining the construct ‘symptoms and concerns’ among adults living with HIV.

  • Three subscales of Positive Outcomes and PROQOL had moderate to strong convergent validity.

  • Total scores had divergent validity.

  • Findings confirmed discriminant validity with worse Positive Outcomes score linked with increasing odds of worse FRAIL group (4.81-fold) and PAM-13 level (2.28-fold).

  • Total Positive Outcomes and its factors had internal consistency exceeding the conservative α threshold of 0.6.

  • This study established test-retest reliability: median Positive Outcomes change of 0 was also reported for those with stable PAM-13 and FRAIL scores.

  • Improved Positive Outcomes score was observed in correlation with improved PROQOL-HIV score baseline to 12 months.

  • Adherence to methodological guidance in development and validation of health outcome measures, and close involvement by the intended end-users (ie, people living with HIV, clinicians and commissioners) benefited the measure.

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