Using PozQoL

Calculating PozQoL scores

Calculating PozQoL scores involves two parts:

1. Code items: Aligns all responses so higher numbers consistently indicate better quality of life
2. Calculate scores: Generates a score for overall quality of life (PozQoL score) and scores for each domain

Below, you’ll find step-by-step guidance for manual calculations, complete with examples.

✨ Prefer a faster approach? Use these tools to calculate scores:

• For individuals: ViiV Healthcare’s Digital Tool
• For groups: PozQoL Score Calculator for Groups and Comparisons (.xlsx download)

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Part 1: Coding PozQoL items

Coding means turning responses from the PozQoL scale into numbers you can use for calculations. It ensures that responses from the scale are ready for accurate scoring but ensuring that higher numbers always indicate better quality of life.

PozQoL items are either positively or negatively worded:

• Positive items reflect good quality of life (e.g., “I am enjoying life”)
• Negative items reflect challenges (e.g., “I worry about my health”)

To code responses:

• Positive items keep their original response numbers, as higher scores already indicate better quality of life
• Negative items are reversed so higher scores indicate better quality of life

The following steps illustrate how this is done

1. Start with a completed PozQoL scale
2. Code the positively worded items
3. Code the negatively worded items

1. Start with a completed PozQoL scale

2. Code the positively worded items

3. Code the negatively worded items

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Part 2: Calculating the PozQoL scores

Follow these steps to calculate PozQoL scores, including both overall quality of life and domain-specific scores.

1. Understand the scoring options
2. Calculate summary scores
3. Calculate average scores (recommended)
4. Calculate group scores (optional)

1: Understand the scoring options

Types of scores

• Overall score: Provides a comprehensive measure of quality of life by combining all 13 items on the scale
• Domain scores: Offer targeted insights into specific areas of life:
  • Psychological domain score: Reflects mental health, mood, and outlook
  • Social domain score: Captures belonging, support, and experiences of stigma
  • Health concerns domain score: Assesses health-related worries, energy, and management of HIV
  • Functional domain score: Evaluates independence, meaningful activities, and living standards

Methods of calculation

• Average scores (recommended): Calculated by finding the average of responses for all items in the scale or a specific domain. This method accommodates incomplete responses but requires most items to be completed for accuracy.
• Summary scores: Calculated by adding the responses for all items in the scale or a specific domain. This method is simpler for manual calculation but requires all items to be answered.

Step 2: Calculate summary scores

Add the response values for each item to get a total score.

‼️Important: Use these summary scores for quick assessments only if all items are answered. If any items are unanswered, proceed to calculate an average score instead.

Overall score

• Add up the response values for all 13 items on the scale
• Score range: 13-65
• ❗ Note: If fewer than 13 items are answered, you cannot use the summary score. Instead, calculate an average score

Psychological domain score

• Add the response values for these 4 items:
  • 1. I am enjoying life
  • 5. I feel good about myself as a person
  • 8. I feel in control of my life
  • 13. I am optimistic about my future
• Score range: 4 to 20
• ❗ Note: If fewer than 3 items are answered, you cannot calculate a PozQoL psychological domain score

Social domain score

• Add the response values for these 3 items:
  • 3. I lack a sense of belonging with people around me
  • 9. I am afraid that people may reject me when they learn I have HIV
  • 11. I feel that HIV limits my personal relationships
• Score range: 3 to 15
• ❗ Note: If fewer than 2 items are answered, you cannot calculate a PozQoL social domain score

Health concerns domain score

• Add the response values for these 3 items:
  • 2. I worry about my health
  • 7. I worry about the impact of HIV on my health
  • 12. I fear the health effects of HIV as I get older
• Score range: 3 to 15
• ❗ Note: If fewer than 2 items are answered, you cannot calculate a PozQoL health concerns domain score

Functional domain score

• Add the response values for these 3 items:
  • 4. I feel that HIV prevents me from doing as much as I would like
  • 6. Having HIV limits my opportunities in life
  • 10. Managing HIV wears me out
• Score range: 3 to 15
• ❗Note: If fewer than 2 items are answered, you cannot calculate a PozQoL functional domain score

Step 3: Calculate average scores

To calculate average scores, divide the summary score by the number of items for the overall scale or each domain.

Avoid calculating averages for specific domains if more than one item in that domain is unanswered.

‼️ Important:

• Do not calculate averages for a domain if more than one item is unanswered
• If fewer than the expected number of items are answered, divide by the number of items completed instead

Benefits of using average scores over summary scores:

• Handles incomplete responses: Average scores can still be used if some items are left blank
• Easy to interpret and compare: Average scores fall within a consistent range of 1 to 5, making them easier to compare across individuals, domains, or over time

Overall average score

• Divide the total summary score for all 13 items by 13
• If fewer than 13 items are answered, divide the total by the number of items answered
• Score range: 1 to 5

Psychological domain average score

• Divide the total summary score for the psychological domain by 4
• If only 3 items are answered, divide by 3 instead
• If fewer than 3 are answered, you cannot calculate a PozQoL score for this domain
• Score range: 1 to 5

Social domain average score

• Divide the total summary score for the social domain by 3
• If only 2 items are answered, divide by 2 instead
• If only 1 item is answered, you cannot calculate a PozQoL score for this domain
• Score range: 1 to 5

Health concerns domain average score

• Divide the total summary score for the health concerns domain by 3
• If only 2 items are answered, divide by 2 instead
• If only 1 item is answered, you cannot calculate a PozQoL score for this domain
• Score range: 1 to 5

Functional domain average score

• Divide the total summary score for the functional domain by 3
• If only 2 items are answered, divide by 2 instead
• If only 1 item is answered, you cannot calculate a PozQoL score for this domain
• Score range: 1 to 5

Step 4 (Optional): Calculate group scores

If you are working with a group of clients, you can calculate group scores to understand trends, compare cohorts, or evaluate program effectiveness.

To calculate group scores:

1. Calculate individual scores: First, calculate the average scores for each client, for overall QoL and for each domain (psychological, social, health concerns, and functional)
2. Find group averages:
   • Add the individual scores for all clients in the group
   • Divide the total by the number of clients

For example:

• All the psychological domain scores of a group of 25 clients sum to 75
• The group average is 75 ÷ 25 = 3.00
• You can repeat this process for the other domains or the overall QoL score

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Example calculations

This example builds on the coded scores we worked out earlier in the Coding PozQoL items section.

Calculating domain scores

Psychological domain scores

Social domain scores

Health concerns domain scores

Functional domain scores

Calculating the overall PozQoL score

Summary of results

PozQoL Score Type	Summary Score	Average Score
Psychological domain	16	4.00
Social domain	12	4.00
Health concerns domain	9	3.00
Functional domain	11	3.67
PozQoL score (overall)	48	3.69

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Next steps

🔍 Interpreting scores

Once you’ve calculated scores, it’s time to figure out what they are telling you.

Refer to the interpreting PozQoL scores section for guidance »

Interpreting PozQoL scores

PozQoL scores help assess the quality of life (QoL) of people living with HIV (PLHIV). These scores provide insight into overall wellbeing as well as specific areas, such as mental health, social connections, health concerns, and daily functioning.

When interpreting PozQoL scores, it’s helpful to consider two key approaches:

1. Reference thresholds: These are based on a study of over 400 Australians living with HIV. They use a bell curve to show how a person’s scores compare to a typical range of QoL scores within this group. Reference thresholds are available for average and summary PozQoL scores.
2. Simplified benchmark (3 = Moderate QoL): This approach focuses on whether a score of 3 or higher has been achieved, as this generally indicates moderate-to-good QoL. This applies to average PozQoL scores only.

Why two approaches?

• The reference thresholds provide more detailed insights but are based on a specific population (primarily Australian gay men) and may not fully reflect other groups
• The simplified benchmark is easier to use and aligns with broader goals to ensure good QoL for all PLHIV

What the scores are telling you

Overall score

• This combines all areas of QoL into one number, summarising a person’s overall wellbeing
• What to look for:
  • A score of 3 or higher suggests moderate-to-good overall QoL
  • Lower scores may indicate areas where additional support is needed

Domain scores

Each domain score focuses on a specific area of life.

1. Psychological domain: Reflects mood, outlook on life, and self-esteem
   • Example: A low score here might indicate struggles with mental health or self-worth
2. Social domain: Captures feelings of belonging, support, and experiences of stigma
   • Example: A low score might highlight social isolation or fear of discrimination
3. Health concerns domain: Reflects worries about health and ability to manage HIV
   • Example: A low score might suggest anxiety about future health or challenges managing HIV
4. Functional domain: Measures independence and ability to maintain daily life activities
   • Example: A low score here might point to struggles with financial security or work

• What to look for:
  • As a rule of thumb, a score of 3 or higher suggests moderate-to-good domain QoL
  • Functional domain averages may trend slightly higher

How to interpret scores

Using the simplified benchmark:

• For average overall or domain scores:
  • Higher than 3: Suggests the person has good QoL in that area
  • 3: Suggests the person has moderate QoL in that area
  • Below 3: Highlights areas where additional support might be needed

Using reference thresholds:

These thresholds are based on data from over 400 Australians living with HIV and provide a reference for how scores align with typical ranges observed in this group.

Thresholds for average PozQoL scores

Score Range	Low QoL	Moderate QoL	High QoL	Very High QoL
PozQoL (overall QoL)	≤ 2.84	2.85 – 3.53	3.54 – 4.14	≥ 4.15
Psychological domain	≤ 2.74	2.75 – 3.49	3.50 – 3.99	≥ 4.00
Social domain	≤ 2.32	2.33 – 3.32	3.33 – 3.99	≥ 4.00
Health concerns domain	≤ 2.32	2.33 – 3.32	3.33 – 3.99	≥ 4.00
Functional domain	≤ 3.32	3.33 – 4.32	4.33 – 4.66	≥ 4.67

Thresholds for summary PozQoL scores

Score Range	Low QoL	Moderate QoL	High QoL	Very High QoL
PozQoL (overall QoL)	≤ 36	37 – 45	46 – 53	≥ 54
Psychological domain	≤ 10	11 – 13	14 – 16	≥ 17
Social domain	≤ 6	7 – 9	10 – 12	≥ 13
Health concerns domain	≤ 6	7 – 9	10 – 12	≥ 13
Functional domain	≤ 9	10 – 11	12 – 14	≥ 15

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Practical Tips:

1. If scores fall below the low QoL threshold, this indicates significant challenges
2. Even if scores are above the threshold, discussions can help identify how to maintain or improve QoL
3. For groups, consider common trends in scores to design targeted programs (e.g., addressing low functional QoL)

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Next steps

📊 Using PozQoL scores

PozQoL scores are not just numbers. They can guide meaningful conversations about wellbeing, highlight areas for intervention, and track improvements over time.

Refer to our using PozQoL scores information for more information »

Using PozQoL scores

PozQoL scores provide actionable insights into the quality of life (QoL) of people living with HIV (PLHIV). Whether you are supporting individuals or evaluating programs, these scores can help identify strengths, areas for improvement, and opportunities for targeted interventions.

The information below provides some general guidance for using PozQoL scores:

• With individuals
• With groups
• In ongoing care

You can also learn more about how to use PozQoL in specific contexts by exploring these related sections:

• Using PozQoL in clinical services
• Using PozQoL in peer and community services
• Using PozQoL in research

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General guidance for using PozQoL scores

Working with individuals living with HIV

Healthcare providers can use PozQoL scores to:

• Identify areas for discussion and start meaningful conversations with clients about their experiences and needs
• Tailor interventions and refer clients to appropriate services or resources based on their scores and input

The following table provides some recommendations for working with PLHIV with low scores in different domains. You can also download a printable version of the table for quick reference.

Domain	A person with a low score in this domain may be:	They might benefit from:	Suggested referrals:
Psychological*	Experiencing poor mental health, for example: Low mood Negative outlook about themself, their life, or their future	Further discussion about their mental health Assessment using diagnostic mental health tools	Counselling services Community rehabilitation and support services Care and support
Social	Experiencing some difficulties in relationships with other people Experiencing HIV-related discrimination Lacking a sense of belonging and support	Meeting PLHIV peers, who can assist in: Overcoming isolation due to fear of stigma Managing disclosure and confidence	Peer support Peer navigation Care and support
Health concerns	Currently experiencing some difficulties managing their health Concerned that their health will deteriorate due to HIV — even if they are enjoying good health at the moment	Discussing treatment options or revisions Speaking with PLHIV peers about managing HIV Information about maintaining good health with HIV	Medical services Health promotion Peer education Care and support Counselling
Functional	Experiencing some difficulties with incorporating HIV into their everyday life Lacking functional independence Experiencing some financial distress	Meeting PLHIV peers Community or financial support or advice	Community support Financial and housing assistance Personal development

Although this table is a helpful guide, it does not replace talking with clients. It is always important to ask clients (and listen to their) answers about:

• Why they think they scored the way they did in a particular domain
• What kind of kind of support they need or would like to have

For example:

• A low psychological domain score might provide an opportunity to start a conversation about how the client is feeling and what they believe would help them improve their wellbeing
• Challenges in the functional domain may not always be immediately visible. Low scores in this domain could be an opportunity to explore how HIV impacts their daily life and uncover areas where support may be needed.

For all domains, listening to the client’s perspective is key to tailoring support and referrals effectively.

❗ Important: PozQoL is not a diagnostic tool. If you are not a mental health worker but you are concerned about your patient or client’s mental health, it is important to refer them to a mental health service.

Using PozQol scores with groups of people living with HIV

PozQoL scores can provide valuable insights when working with groups, whether for program evaluation, research, or planning services. Aggregated scores help identify common needs and assess the impact of interventions over time. However, it’s important to approach group scores thoughtfully.

Examples of group use cases

• Evaluate program effectiveness: Compare group scores before and after a targeted intervention, such as a peer support workshop, to measure its impact; for example:
  • A peer navigation program might show consistent improvement in social domain scores as participants gain confidence in managing disclosure and stigma
• Identifying trends: Aggregated group scores can reveal patterns that guide service improvements; for example:
  • Consistently low health concerns domain scores across a cohort might suggest the need for a health promotion campaign addressing long-term HIV management
• Research and advocacy: Group scores can contribute to larger studies or inform advocacy efforts by highlighting systemic challenges; for example:
  • If older PLHIV consistently show lower functional domain scores, this could support advocating for age-specific programs, such as retirement planning or ageing with HIV workshops

Considerations for group scores

• Group size and diversity: When interpreting group averages, consider the diversity within the group. For example, individuals with vastly different QoL levels may skew averages, making it harder to identify meaningful trends.
• Outliers and representation: Outliers, such as extremely high or low scores, can impact group averages disproportionately. It may be helpful to calculate median scores alongside averages to get a clearer picture of the group’s overall QoL.
• Context matters: Differences in demographics, program goals, and group dynamics mean that group scores should always be interpreted within the specific context of the group or service.

Using PozQol scores to inform ongoing care

Re-administering PozQoL periodically allows you to track progress and address emerging challenges in a client’s quality of life over time. This can help create a dynamic, client-centred approach to care.

• Monitor changes over time: Compare scores from different points to evaluate progress and identify any new areas of concern. For example, a client’s functional QoL might improve after receiving housing support, but new or ongoing challenges may be highlighted in other domains.
• Adapt care plans: Use changes in domain scores to adjust care plans, ensuring they remain relevant to the client’s evolving needs. For example:
  • Improved psychological QoL might allow focus to shift toward functional independence
  • Declining social QoL might signal the need for peer support or community engagement initiatives
• Evaluate long-term impact: For services offering ongoing support, tracking scores can demonstrate the long-term impact of care on QoL, supporting evidence-based adjustments to interventions