Qom University of Medical Sciences Journal

Introduction
Coronavirus disease 2019 (COVID-19) have affected the quality of life (QoL) of patients and their families. Since patients are not immune from future infection, it may have a more negative impact on their QoL [1-4]. QoL reflects people’s perceptions of their physical and mental health, social relationships, and overall well-being [5-7]. The QoL of patients with COVID-19 has been examined in several studies. They have used the World Health Organization quality of life questionnaire– BREEF (WHOQoL-BREF). This tool has been validated for the normal population [3, 4, 7-11]. However, it does not have a total score to evaluate the overall QoL [12]. Considering the negative consequences of low quality of life in patients with COVID-19, it is necessary to determine their overall QoL [13, 14]. Therefore, this tool cannot accurately determine the QoL of infected patients and there is a need to use another tool to measure it [15]. In this regard, a reliable tool has been introduced by Hlubocky et al. to measure the health-related quality of life (HRQoL) [16]. Due to the non-validation of the electronic form of this questionnaire, and the many advantages of electronic forms during pandemic, this research aims to evaluate the factor structure and validate the electronic form of Persian version of HRQoL questionnaire of Hlubocky et al.
Methods
This is a psychometric study. The study population includes all patients with COVID-19 in Tehran, Iran in 2020. The HRQoL and WHOQoL-BREF questionnaires were used. The HRQoL has 15 items (Rated on a 5-point Likert scale) and 2 subscales: disease-related symptoms (items 1-10) and emotional and social functions (items 11-15). It has acceptable validity and reliability [17]. The WHOQoL-BREF is a 26-item questionnaire with 4 subscales (physical health, psychological health, social relationships, and environmental health). Its validity and reliability in Iran have been confirmed in different studies [19-22].
The cluster sampling method was used for sampling. In this method, 4 regions were randomly selected from 22 districts of Tehran (regions 4, 11, 7 and 18). Of 430 selected participants, 100 were used for determining the convergence validity based on the criteria of Senjari et al. [23] and 330 were used for exploratory factor analysis. The questionnaire link was sent to the samples via email, or on WhatsApp, and Instagram. To check the content validity, the content validity ratio (CVR) and content validity index (CVI) was calculated. To determine the convergent validity, Pearson’s correlation test was used to assess the relationship between the scores of HRQoL and WHOQoL-BREF questionnaires. To examine the construct validity and determine the factor structure of Persian HRQoL questionnaire, exploratory factor analysis (principal component analysis with varimax rotation) was performed. In this analysis, factors with eigenvalues greater than 1 were considered as main factors [24]. Confirmatory factor analysis was also used to check the fit of the model. Data analysis was done in SPSS Software, version 22 and LISREL Software, version 8 applications.
Results
The findings showed that the online Persian version of HRQoL questionnaire has acceptable content validity and convergent validity in relation to the WHOQoL-BREF questionnaire. The results of the exploratory factor analysis showed that the HRQoL questionnaire had a two-factor structure. The results of Cronbach’s alpha for the whole scale and for each dimension showed that the HRQoL questionnaire had fair internal consistency,
Discussion
The electronic Persian version of HRQoL questionnaire is a valid and reliable tool and can be used in for assessment of HRQoL in patients with COVID-19 in Iran. It is recommended this research should also be carried out in other cities and populations for greater generalizability.
Ethical Considerations
Compliance with ethical guidelines
This study was approved by the ethics committee of Islamic Azad University, Bandarabas Branch (Code:IR.IAU.BA.REC.1401.00).
Funding
This study was extracted from the PhD thesis of the first author. It was not funded by any organization.
Authors contributions
The authors contributed equally to preparing this article.
Conflicts of interest
The authors declare no conflict of interest.
Acknowledgements
The authors would like to thank the participants as well as Azizollah Mohammadi Soleimani, Hossein Azarshab, and Sana Lotfi for their cooperation and assistance.