Validation of the sign and symptom check-list for persons with HIV disease (SSC-HIV)

William L. Holzemer, Suzanne B. Henry, Kathleen M. Nokes, Inge B. Corless, Marie Annette Brown, Gail M. Powell-Cope, Joan G. Turner, Jillian Inouye

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72 Scopus citations


Symptom management for persons living with HIV disease is recognized as an extremely important component of care management. This article reports the validation of a new sign and symptom assessment tool designed to assess the intensity of HIV-related symptoms using two samples (study 1: n = 247; study 2: n = 686) of people living with HIV disease. Study 1 data were collected between 1994 and 1996 before the initiation of highly active antiretroviral therapy (HAART). Study 2 data were collected between 1997 and 1998 after the wide adoption of HAART therapy. The initial version of the Sign and Symptom Check-List for Persons with HIV Disease (SSC-HIV) included 41 signs and symptoms. This scale was submitted to a principal components factor analysis with a varimax rotation. The final solution reports six factors explaining 68.9% of the variance. The six symptom clusters (factors), the number of items in the factor, and the Cronbach alpha reliability estimates were: malaise/weakness/ fatigue (six items, alpha = 0.90); confusion/distress (four items, alpha = 0.90); fever/chills (four items, alpha = 0-85); gastrointestinal discomfort (four items, alpha = 0.81); shortness of breath (three items, alpha = 0.79); and nausea/ vomiting (three items, alpha = 0.77). These six factors have strong reliability estimates and a stable factor structure that supports the construct validity of the 26-item instrument. Additional evidence supports the concurrent validity of the scale as well as its sensitivity to change over time. The final version of the SSC-HIV is a 26-item scale available for use by clinicians and researchers to measure the patient's self-report of HIV-related signs and symptoms.

Original languageEnglish (US)
Pages (from-to)1041-1049
Number of pages9
JournalJournal of Advanced Nursing
Issue number5
StatePublished - Nov 1999
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Nursing(all)


  • Nursing research
  • Scale development
  • Symptoms


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