Abstract
Although South Africa has made significant progress in reducing the risk associated with
developing noncommunicable diseases (NCDs), the country still faces health inequities and
inequalities. Low- and middle-income countries, such as South Africa, are called to expand
their health-care capacities to respond effectively to the increased burden of NCDs. An
integrated approach to the broad spectrum of chronic disease may provide the most costeffective
method for NCD treatment, with a focus on minimizing symptoms, and improving
functional status and quality of life in patients with hypertension, type 2 diabetes and
cardiovascular disease (CVD).
The aim of this study was to develop a toolkit aimed at assessing the health-related quality of
life (HRQoL) of patients with hypertension, type 2 diabetes and CVD; the first of its kind in
South Africa. The toolkit consists of a long form (37 items) and short form (25 items)
questionnaires. The long-term purpose thereof is to assist healthcare practitioners in
determining a starting point for treatment and aid in the prescription of individualised,
multifactorial treatment programmes tailored specifically to improve health related quality of
life, (HRQoL) and the progression towards healthier lifestyles.
This study utilised a sequential exploratory mixed method design. Qualitative data was
collected and analysed, in the form of focus groups and semi-structured interviews with an
expert panel (n=12), which informed a questionnaire composed of quantitative data. This
questionnaire was piloted with a sample (n=14) similar to that of the target sample.
Amendments were made based on feedback from the pilot group, and the final questionnaire
was administered to the target sample (n=257) during two-time intervals. Principal components
analysis was performed on all items and results were used to determine face and content
validity and reliability using the Pearson and Spearman correlation coefficients, the interclass
correlation coefficient (ICC) and the coefficient of repeatability (CR). Both the long and short
form yielded an excellent Pearson’s r (0.89*; 0.89*), Spearman’s rho (0.88*; 0.89*), and ICC
(0.94; 0.94). The CR for both the long and short form were considered acceptable, at ±12.04%
and ±12.50%, respectively.
Since the primary goal in the treatment of NCDs is not curative, the outcome of this study was
to develop a toolkit aimed at assessing HRQoL. Both questionnaires in the toolkit were highly
reliable. The results of this study encourages a disease management approach to healthcare,
improving the patients’ quality of life through the prevention and relief of suffering by means
of thorough assessment and prescription of specific treatment programmes.