Quality-of-Life Measurement: Assessing the WHOQOL-BREF Scale in a Sample of High-HIV-Risk Transgender Women in San Francisco, California

We assess the psychometric properties of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) with a sample of 312 transgender women in San Francisco, California. In 2010, the San Francisco Department of Public Health conducted the Transfemales Empowering and Advancing Community Health (TEACH) study and administered a cross-sectional survey. Long-chain, peer-referral sampling generated a diverse sample, and this analysis uses confirmatory factor analysis, model-based reliability and construct validity to assess the WHOQOL-BREF instrument. The scale demonstrated acceptable internal consistency ranging from 0.77 to 0.78 with the exception of the one domain (0.65) consisting of three relatively heterogeneous items. The confirmatory factor analysis showed marginally good model fit (RMSEAD = 0.05, 90% CI [0.043, 0.058], CFID 0.89) for a four-factor structure. Higher quality of life (QOL) mean scores among HIV-positive respondents may indicate robust HIV care in San Francisco but also how discrimination may work to deprive HIV-negative respondents of key resources. Response shift may also explain these differences as well as the sample's higher domain mean scores vis-a-vis samples somewhat comparable samples of cisgender women. Cost-effective QOL measures are needed to better understand relationships between psychosocial factors and the social determinants of transgender health; additional transgender QOL research may consider more in-depth psychometric testing and scale development.