Health-related quality of life among HIV/AIDS women patients in Korogocho slums and its significance in health care outcomes

Abstract

The concept of quality of life is understood and interpreted differently by people and even professionals. The constitution of the World Health Organization (WHO) defines health as a State of complete physical, mental and social well being and not merely the absence of disease. It follows that the measurement of health and the effects of healthcare must include not only an indication of changes in the frequency and severity of diseases but also an estimation of well being. This can be assessed by measuring the improvement in the quality of life related to health care. Other researchers have pointed out that a good quality of life can be said to exist when the hopes of an individual are matched and fulfilled by experience. As most chronic diseases often do not disappear in spite of the best biomedical treatments, it might be that the real change patients 'have for betterment is in understanding and living the noble path of personal development. The hidden potential for improving quality of life really lies in helping the patient to acknowledge that his or her lust for life, his or her needs and his or her wish to contribute, is really deep down in human existence. Quality of life then invariably focuses on the ability of an individual to function in occupational, social, domestic spheres and his/her capacity to involve himself / herself in activities of daily living and self care. Determining the impact of HIV/AIDS on the quality of life in HIV/AIDS patients is important for estimating the burden of the disease. It is also a gateway to improve understanding of the factors that contribute to HRQOL among HIV/AIDS patients so as to identify targets for improving quality of life for persons with existing HIV/AIDS infections. This study was a purposive one that examined the determinants of Health Related Quality of Life (HRQOL) among HIV/AIDS women patients in the Korogocho slums of Kenya, aged 18 - 55 years, the significance of HRQOL among HIV/AIDS patients in the Kenyan healthcare system and whether Spirituality, Religiosity, and Personal Beliefs play any role in the HRQOL in HIV/AIDS women patients. Respondents' participation was on volunteerism basis. Quality of Life was evaluated using 26 items. Each item used a Likert-type fivepoint scale. These items were distributed in four domains. The four domains of QOL covered (a) Physical health and level of independence (seven items assessed areas such as presence of pain and discomfort; energy and fatigue, mobility; sleep and rest; activities of daily living: perceived working capacity); (b) Psychological well being (eight items assessed areas such as affect, both positive and negative self concept, higher cognitive functions; body image and spirituality), (c) social relationships (three items assessed areas such as social contacts, family support and ability to look after family, sexual activity and (d) environment (eight items assessed areas such as freedom, quality of home environment; physical safety and security and financial status; involvement in recreational activity; health and social care: quality and accessibility). The domain on environment was considered necessary because it plays a major role in determining health status, mediating disease pathogenesis and limiting or facilitating access to health care. There were two items as well that were examined separately: one which asked about the individual's overall perception ofQOL and the other which asked about the individuals overa!l perception of his or her health. The domain scores were scaled in a positive direction - higher scores denoted higher quality of life. Spirituality, Religiosity and Personal Beliefs (SRPB) were also assessed especially for qualitative research. Findings: On the general quality of life the respondents reported experiencing low QOL. 53% reported this. Only 28% reported good quality of life. There is the element of family support and relationships that hasbeen rated very highly by the respondents. On Satisfaction with personal relationships, 67% reported that they are dissatisfied. 70% reported that they do not get enough support from friends. This is in consistent with other researches that affirm on the same (O'Boyle et al. 1992;) (Cattell 2001). There is dissatisfaction on healthcare system that needs great improvement in this country. On the element of access to health, 54% reported dissatisfaction with the Kenyan health system. Important information gathered from the respondents was that they do not get enough information on HIV and Aids. This puts NACC and those other nongovernmental organizations that are supporting PLWHA especially m slum areas on the spot. Limited information on this aspect derails efforts to mitigate the manifestations of HIV and AIDS. 57% reported the lack of information. Education is too low in the slums. Academically 69% of the respondents have only attained primary level of education. This is a huge number going by the disadvantages of low education levels in this country. In itself, this contributes a lot on the prevalence of HIV and Aids in slum areas due to lack of enough information to make major decisions or informed choices. On bodily appearance only 29.5% accept their bodily appearance and 59% do not accept at all. On environment 37% reported that the environment they live in is unhealthy while 34.7% reported that it is healthy. Conclusions: Policy makers and clinicians need to consider the implications of this study for health resource allocation, and recognize that small improvements in HRQOL may be of great significance for individuals with HIV manifestations. This will also help in identifying specific intervention programmes that are needed to improve the QOL of HIV patients. This therefore calls for a holistic, approach to health and health care. The patient's view, priorities and behaviour on quality of life are thus important for healthcare planning and management systems.