A conceptualisation and psychometric evaluation of positive psychological outcome measures used in adolescents and young adults living with HIV: a mixed scoping and systematic review

Introduction Sub-Saharan Africa bears the greatest burden of HIV/mental disorders combined. It is important to evaluate the mental health of adolescents and young adults living with HIV (AYALHIV) comprehensively by measuring both negative and positive psychological constructs. There has been a proliferation of interest in positive psychological outcome measures, but the evidence of their psychometric robustness is fragmented. This review sought to: Identify positive psychological outcomes and corresponding outcome measures used in AYALHIV in sub-Saharan Africa Critically appraise the psychometrics of the identified outcome measures Methods and analysis Independent and blinded reviewers searched articles in PubMed, Scopus, Africa-Wide Information, CINAHL, Psych INFO, and Google Scholar. Separate independent reviewers screened the retrieved articles. We applied a narrative synthesis to map the key constructs. The risk of bias across studies was evaluated using the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) checklist. The quality of the psychometric properties was rated using the COSMIN checklist and qualitatively synthesised using the modified Grading of Recommendations Assessment, Development and Evaluation checklist. Results We identified 15 positive psychological constructs: body appreciation, confidence, coping, flourishing, meaningfulness, personal control, positive outlook, resilience, self-management, self-compassion, self-concept, self-efficacy, self-esteem, self-worth and transcendence that had been used to assess ALHIV. Resilience, self-concept, self-esteem, coping and self-efficacy were the most measured constructs. Construct validity and internal consistency were the properties most frequently assessed, while content validity and structural validity were assessed less often. Conclusions Few studies performed complete validations; thus, evidence for psychometric robustness was fragmented. However, this review shows the initial evidence of the feasibility of using positive psychological outcomes in low-resource settings. Instead of creating new outcomes, researchers are recommended to leverage the existing measures, adapt them for use, and, if appropriate, strive to maintain the factorial structure to facilitate comparisons. Registration PROSPERO-CRD42022325172