Study area and population
The study was carried out in August 2010 among 120 patients with confirmed malaria, diagnosed at the Madonna University Teaching Hospital in Elele, in South Nigeria, in the state of Rivers.
47% of subjects were women, and 53% men. Young (age below 30) and middle-aged (age below 50) people prevailed among the surveyed patients. The ratio of adolescents and elderly people was much lower, below 20% in each of those categories.
Quantitative research methods
A method of diagnostic survey using two standardized scales: AIS and SWLS and a standardized survey questionnaire: WHOQoL-BREF were used for the achievement of objectives of the study.
The standardized AIS, exploring the patient’s acceptance of the disease, consists of eight questions describing the consequences of poor health condition. The questions relate to the limitations imposed by the disease, the lack of self-sufficiency, the sense of being dependent on others and the reduced sense of self-value. Each question contained a five-grade scale, and a surveyed participant determined his/her current health condition by marking one of the numbers: 1 – strongly agree, 2 – agree, 3 – do not know, 4 – disagree, 5 – strongly disagree.
A strong agreement means poor adaptation to the disease, and no agreement – acceptance of the disease. The sum of all the points, ranging between 8 and 40, is a measure of the level of acceptance. Three point ranges were created for the description of the level of acceptance. A score ranging from 8 to 18 stood for no acceptance to the disease, from 19 to 29 – a medium acceptance, and from 30 to 40 – a good acceptance.
The standardized SWLS is a measure of life satisfaction. Satisfaction with life is one factor in the more general construct of subjective well-being. Satisfaction with life can be assessed specific to a particular domain of life (e.g., work, family) or globally. The SWLS is a global measure of satisfaction with life. The SWLS consists of five items that are completed by the individual whose satisfaction of life is being measured. A surveyed participant “agrees” or “disagrees” with statements using a seven-grade scale of answers (“totally agree”, “agree”, “rather agree”, “neither agree nor disagree”, “rather disagree”, “disagree”, “totally disagree”). Answers are positively scored which means that the higher the score, the higher the satisfaction with life.
The standardized survey questionnaire WHOQoL-BREF brief version contains 26 questions. The instrument allows for the determination of the quality of life profile in four domains: physical domain, psychological domain, social relations and environment. Scores for those domains reflect the individual perception of the quality of life within the domains. The domain score is positive, which means that the higher score, the better the quality of life.
Moreover, the study used a patient survey questionnaire prepared especially for it, which was not validated, containing in its introductory part: information about the purpose of the study, the voluntary character and the anonymity of answers, information on the patient’s right to withdraw from the study at any stage and in any moment, and information on the method of filling in the questionnaire and of the scales. In the first part the survey questionnaire also contained five questions on the demographic data of the respondent (gender age, place of living, marital status, profession), and in the second part – 14 open questions regarding the health situation of the patient (medical history).
Survey questionnaires and scales were prepared in English, which is the official language in Nigeria. The filling in of questionnaires was performed in the presence of the Project Manager and of a student of the last year of the medical faculty at the Madonna University, who was trained in objectives and the assumptions of the study and who knew the local language. The study objectives and methods were also explained to each of the respondents before the start of the study.
Statistical analysis
Statistical elaboration was performed using the STATISTICA software in the form of the following descriptive statistics: arithmetic mean, median, maximum and minimum value, standard deviation (s), centile 25 and 75. Information on the distribution of the summary values of scores associated with the acceptance of the disease (AIS) and the quality of life (WHOQoL-BREF), and life satisfaction (SWLS) was presented. For scales AIS and SWLS the distribution of responses following the categorization of score values to the adjective scale was also presented. The distribution of answers was presented in the form of histograms.
An analysis of correlation was used for the determination of the correlation between the acceptance of illness, satisfaction with life and quality of life. Spearman’s non-parametric rank correlation coefficient was used, because of, among others, some asymmetry of the distribution of some scales (especially AIS). To evaluate if the results of the analysis allow the generalization of conclusions regarding the existence of a correlation beyond the study sample, an appropriate statistical test was employed for evaluation if the correlations observed within the sample are an effect of a more general rule for the whole population, or just an accidental result. Statistical tests give the so-called test probability (p). Low values of that parameter confirm the statistical significance of the discussed correlation. Selected correlations were illustrated in dispersion graphs.
Evaluation of significance of differences between the compared groups of respondents was completed using the Mann–Whitney test for two groups for the factor of gender, and using the Kruskal-Wallis test for age groups.
Results of analyses of selected traits were illustrated in a box graph including mean values, the typical range of variability and a 95% confidence interval for measuring scales in compared groups. The distribution of all the performed observations was also presented in the form of a dispersion graph superimposed on the box graph.