Adaptation and validation of the STARx for Ugandan adolescents

Health Care Transitions Pub Date : 2025-01-01 DOI:10.1016/j.hctj.2025.100121

Melissa A. Saftner PhD, CNM, FACNM , Tom D. Ngabirano MSN , Scovia Nalugo Mbalinda PhD , Barbara McMorris PhD , Phionah Tukamushabe MS , Sara Hildreth MPH , Annie-Laurie McRee DrPh, FSAHM , Peter Kirabira MD

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Abstract

Purpose

Transitioning from pediatric to adult care is a significant challenge in Uganda, where over 170,000 young people living with HIV (YPLHIV) require continuous HIV care. Assessment of adolescents’ readiness to transition is a keystone of developmentally appropriate care. This study aimed to adapt and validate the Self-Management and Transition to Adulthood with Rx = Treatment (STARx) measurement tool for Ugandan YPLHIV.

Methods

The STARx tool was adapted for the Ugandan context through cognitive interviews with 10 YPLHIV (ages 15–20), leading to revisions in the tool's structure and language. The adapted STARx-Uganda tool was then validated with 154 YPLHIV. Data were collected using electronic tablets and analyzed through exploratory factor analysis and reliability testing.

The validation process included assessing the tool’s psychometric properties, including internal consistency, factor structure, and concurrent validity.

Results

The STARx-Uganda tool was found to have satisfactory internal consistency (Cronbach’s alpha = 0.73). Factor analysis revealed a five-factor model: Provider Communication, Disease Knowledge, Self-Management, Medication Management and Engagement during Appointments. The tool demonstrated concurrent validity, with higher readiness scores associated with better healthcare utilization, including fewer missed appointments and better adherence to antiretroviral therapy. Notably, the Self-Management subscale was consistently correlated with both healthcare utilization outcomes.

Discussion

The findings support the STARx-Uganda as a reliable and valid tool for assessing transition readiness among YPLHIV in Uganda. The tool’s modifications, including a simplified Likert-type scale and the inclusion of local healthcare terms, improved clarity and relevance. The STARx-Uganda can guide healthcare providers in improving the continuity of HIV care. Future research should evaluate the tool’s impact on long-term health outcomes and expand its application in diverse settings.

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乌干达青少年STARx的适应和验证

在乌干达，从儿科护理过渡到成人护理是一项重大挑战，在乌干达，超过17万感染艾滋病毒的年轻人需要持续的艾滋病毒护理。对青少年过渡准备程度的评估是适当发展照料的关键。本研究旨在适应和验证乌干达YPLHIV的自我管理和通过Rx = 治疗（STARx）向成年过渡的测量工具。方法通过对10名YPLHIV（15-20岁）的认知访谈，使STARx工具适应乌干达的环境，从而对工具的结构和语言进行了修订。改良的STARx-Uganda工具随后在154例YPLHIV中进行了验证。采用电子片剂采集数据，通过探索性因子分析和信度检验进行分析。验证过程包括评估工具的心理测量特性，包括内部一致性、因素结构和并发效度。结果STARx-Uganda工具具有满意的内部一致性（Cronbach’s alpha = 0.73）。因子分析揭示了一个五因素模型：提供者沟通、疾病知识、自我管理、药物管理和预约期间的参与。该工具显示了并发有效性，较高的准备得分与更好的医疗保健利用相关，包括更少的错过预约和更好的抗逆转录病毒治疗依从性。值得注意的是，自我管理子量表与两种医疗保健利用结果一致相关。研究结果支持STARx-Uganda作为评估乌干达艾滋病毒感染者过渡准备情况的可靠和有效的工具。该工具的修改，包括简化的李克特式量表和纳入当地医疗保健术语，提高了清晰度和相关性。starx -乌干达项目可以指导卫生保健提供者改善艾滋病毒护理的连续性。未来的研究应评估该工具对长期健康结果的影响，并扩大其在不同环境中的应用。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Health Care Transitions

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