Measuring adolescent HIV self-management: an instrument development study
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Adolescent HIV self-management is a complex phenomenon that has been poorly researched. A mixed-method explorative sequential research design was used to develop an instrument to measure adolescent HIV self-management in the context of the Western Cape, South Africa. The development and validation was undertaken in four phases: (i) individual interviews and focus groups with adolescents aged 13 to 18, their caregivers and healthcare workers (n=56); (ii) item identifcation; (iii) item refnement through cognitive interviewing (n=11), expert review (n=11) and pilot testing (n=33); and (iv) psychometric evaluation (n=385). The fnal scale consists of fve components with 35 items encompassing the construct of adolescent HIV self-management. The developed scale had acceptable reliability (0.84) and stability (0.76). Factor analysis indicated a good model-ft that support the structural validity (RMSEA=0.052, p=0.24; RMR=0.065; CFI=0.9). Higher self-management was associated with better HIV-related and general health outcomes, which supports the criterion- and convergent validity of the instrument.