BACKGROUND Hope or hopefulness enhances coping and improves quality of life in persons with chronic or incurable illnesses. Lack of hope is associated with depression and anxiety, which impact negatively on quality of life. In Tanzania, where HIV prevalence is high, the rates of depression and anxiety are over four times higher among people living with HIV (PLH) compared to persons not infected and contribute annual mortality among PLH. Tanzania has a shortage of human resources for mental health, limiting access to mental health care. Evidence-based psychosocial interventions can complement existing services and improve access to quality mental health services in the midst of human resource shortages. Facilitating hope can be a critical element of non-pharmacological interventions which are underutilized, partly due to limited awareness and lack of hope measures, adapted to accommodate cultural context and perspectives of PLH. To address this gap, we developed and validated a local hope measure among PLH in Tanzania. METHODS Two-phased mixed methods exploratory sequential study among PLH. Phase I was Hope-related items identification using deductive, inductive approaches and piloting. Phase II was an evaluation of psychometric properties at baseline and 24 months. Classical test theory, exploratory, confirmatory factor analysis (CFA) were used. RESULTS Among 722 PLH, 59% were women, mean age was 39.3 years, and majority had primary school level of education. A total of 40 hope items were reduced to 10 in a three-factor solution, explaining 69% of variance at baseline, and 93% at follow-up. Internal consistency Cronbach's alpha was 0.869 at baseline and 0.958 at follow-up. The three-factor solution depicted: positive affect; cognition of effectiveness of HIV care; and goals/plans/ future optimism. Test-retest reliability was good (r = 0.797) and a number of indices were positive for CFA model fit, including Comparative Fit Index of 0.984. CONCLUSION The developed local hope scale had good internal reliability, validity, and its dimensionality was confirmed against expectations. The fewer items for hope assessment argue well for its use in busy clinical settings to improve HIV care in Tanzania. Hope in this setting could be more than cognitive goal thinking, pathway and motivation warranting more research. TRIAL REGISTRATION The intervention was registered in USA ClinicalTrials.gov on September 26, 2012, Registration number: NCT01693458.

中文翻译：

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希望的价值：坦桑尼亚城市艾滋病毒感染者希望的背景衡量标准的制定和验证，一项混合方法探索性序贯研究。


背景技术希望或充满希望可以增强患有慢性或不治之症的人的应对能力并提高生活质量。缺乏希望与抑郁和焦虑有关，这会对生活质量产生负面影响。在艾滋病毒感染率很高的坦桑尼亚，艾滋病毒感染者 (PLH) 的抑郁和焦虑症发病率是未感染者的四倍多，并且导致了 PLH 的年死亡率。坦桑尼亚精神卫生人力资源短缺，限制了获得精神卫生保健的机会。循证心理社会干预措施可以补充现有服务，并在人力资源短缺的情况下改善获得优质心理健康服务的机会。促进希望可能是非药物干预措施的一个关键要素，但这些干预措施未得到充分利用，部分原因是认识有限和缺乏适应文化背景和艾滋病患者观点的希望措施。为了解决这一差距，我们在坦桑尼亚的 PLH 中制定并验证了当地的希望措施。方法 PLH 中的两阶段混合方法探索性序贯研究。第一阶段是使用演绎、归纳方法和试点来识别与希望相关的项目。第二阶段是对基线和 24 个月时的心理测量特性进行评估。使用了经典检验理论、探索性、验证性因素分析（CFA）。结果722名PLH中，59%为女性，平均年龄39.3岁，大多数具有小学文化水平。在三因素解决方案中，总共 40 个希望项目减少到 10 个，解释了基线时 69% 的方差和随访时 93% 的方差。内部一致性 Cronbach's alpha 在基线时为 0.869，在随访时为 0.958。 描述的三因素解决方案：积极的影响；对艾滋病毒护理有效性的认识；以及目标/计划/未来的乐观情绪。重测信度良好（r = 0.797），CFA 模型拟合的多项指标均为正值，其中比较拟合指数为 0.984。结论制定的地方希望量表具有良好的内部信度、效度，其维度符合预期。希望评估项目较少，有利于在繁忙的临床环境中使用它来改善坦桑尼亚的艾滋病毒护理。在这种情况下，希望不仅仅是认知目标思维、途径和动机，需要更多的研究。试验注册该干预措施于2012年9月26日在美国ClinicalTrials.gov注册，注册号：NCT01693458。