Abstract
BackgroundIncreasing numbers of programs are addressing the specific needs of homeless people with schizophrenia in terms of access to housing, healthcare, basic human rights and other domains. Although quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. The aim of the present study was to validate the French version of the S-QoL a self-administered, subjective quality of life questionnaire specific to schizophrenia for people with schizophrenia who are homeless.MethodsIn a two-step process, the S-QoL was first administered to two independent convenience samples of long-term homeless people with schizophrenia in Marseille, France. The objective of the first step was to analyse the psychometric properties of the S-QoL. The objective of the second step was to examine, through qualitative interviews with members of the population in question, the relevance and acceptability of the principle quality of life indicators used in the S-QoL instrument.ResultsAlthough the psychometric characteristics of the S-QoL were found to be globally satisfactory, from the point of view of the people being interviewed, acceptability was poor. Respondents frequently interrupted participation complaining that questionnaire items did not take into account the specific context of life on the streets.ConclusionsLess intrusive questions, more readily understandable vocabulary and greater relevance to subjects’ living conditions are needed to improve the S-QoL questionnaire for this population. A modular questionnaire with context specific sections or specific quality of life instruments for socially excluded populations may well be the way forward.
Highlights
The Schizophrenia Quality of Life Questionnaire (S-QoL) questionnaire was completed in its entirety for all 55 participants, no single patient completed it entirely on their own
In Step 1 of the present study, a strong ceiling effect was found in the Psychological Well-being dimension (PsW), whereas the ceiling effect was low in the validation sample in the original S-QoL study [13]
Certain areas of quality of life explored in the S-QoL awaken painful memories and raise the question of the context in which this information is to be collected
Summary
Quality of life scales are being used to evaluate such programs, few instruments have been validated for people with schizophrenia and none for people with schizophrenia who experience major social problems such as homelessness. Homelessness among people living with schizophrenia is increasingly visible on the streets of major cities in developed countries [1]. In 2011, the European Community addressed the problem of long-term homelessness and its impact on those with severe psychiatric disorders [2]. This group has a high mortality rate [3] that is associated with length of time spent living on the streets [4]. Instruments currently used to assess quality of life in this population are either generic scales validated for the general population [7] or specific scales for people living with schizophrenia [8]
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