Suzanne M. Skevington

The World Health Organization's WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group.

Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item–total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.

Investigating the relationship between pain and discomfort and quality of life, using the WHOQOL

&NA; The aim of this study was to examine the impact of pain on quality of life and its components in a representative sample of 320 well people, and patients selected from all major categories of illness. Quality of life was assessed using a new, multidimensional, multilingual, generic profile designed for cross‐cultural use in health care, i.e. the WHOQOL. Within the WHOQOL, pain and discomfort is one of 29 areas or facets of quality of life, grouped into six domains. It was found that pain and discomfort made a significant impact on perceptions of general quality of life related to health. Furthermore, the presence of pain affected perceptions of five of the six domains of quality of life; the domain of spirituality, religion and personal beliefs being the exception. When quality of life is assessed, negative feelings are most closely associated with reports of pain and discomfort than any other facet. But quality of life surrounding pain and discomfort is more fully explained by the inclusion of six additional facets; the availability of social care, mobility, activities of daily living, positive mood and to a lesser extent, sleep and dependence on medication. Together, these seven facets represent criteria against which the success of pain treatments may be evaluated. As predicted, those who were pain‐free had significantly better quality of life than those in pain. A longer duration of pain is associated with increasingly poorer quality of life. Intense affective pain is particularly detrimental to a good quality of life. The psychometric properties of the pain and discomfort facet of the WHOQOL and WHOQOL‐100 were assessed. Internal consistency (reliability), discriminant and criterion/concurrent validity were found to be good to excellent, justifying the use of this instrument with a range of chronic and acute pain patients.

Advancing cross-cultural research on quality of life: Observations drawn from the WHOQOL development

This paper is concerned with methods and theory recently used in cross-cultural research. It begins by looking at why we need cross-cultural measures and why we need more of them. A discussion of the translation styles, and the issues underpinning their design is central to this discussion. Through a description of the World Health Organisation Quality of Life Assessment instruments and their development, the paper demonstrates how some of the earlier theoretical and methodological challenges have been addressed, together with a critique of its limitations.

On Subjective Well-being and Quality of Life

We integrate the multi-disciplinary fields of quality of life (QoL) and well-being (WB) and appraise the impacts of health factors. Theoretical and methodological limitations are discussed and new conceptual and technical advances identified, These are informed by cross-cultural and community perspectives. Following a definitional review, social inequalities, and links with happiness are examined. Demographic, experiential and personal factors are outlined. Implications for poverty research are addressed. As the concept of SWB recently converged with the longstanding international QoL definition (WHOQOL Group, 1995), we discuss the separate need for SWB. Future collaborative conceptual and pragmatic research is recommended.

Developing methods for assessing quality of life in different cultural settings. The history of the WHOQOL instruments.

Abstract.Background:This review traces the 12-year history of an international collaboration of researchers—the WHOQOL Group—who were brought together by the World Health Organisation to develop and produce a cross-cultural measure of quality of life for use in health and health care.Discussion:The theoretical and philosophical basis of the WHOQOL instrument is outlined as it evolved throughout the design and adjustment of a reflexive methodology that places an assessment of the users’ views at the centre of health care. The stages of research are further expanded and explained in recounting the scientific experience of this unique collaboration. The WHOQOL is available in 40 countries and most majority languages. Adaptations exist for assessing particular conditions, e. g. spirituality, religion and personal beliefs.

The effects of exercise interventions on quality of life in clinical and healthy populations; a meta-analysis.

The aim of the study was to provide an overview of the effect of exercise interventions on subjective quality of life (QoL) across adult clinical populations and well people, and to systematically investigate the impact of the exercise setting, intensity and type on these outcomes. From a systematic search of six electronic databases, 56 original studies were extracted, reporting on 7937 sick and well people. A meta-analysis was conducted on change in QoL from pre- to post-intervention compared with outcomes from a no-exercise control group, using weighted (by the studys sample size) pooled mean effect sizes and a fixed-effects model. Significant differences in outcome were found when treatment purpose was compared; prevention/promotion (well populations), rehabilitation, or disease management. Three to 6 months post-baseline, a moderate positive effect of exercise interventions was found for overall QoL in rehabilitation patients, but no significant effect for well or disease management groups. However, physical and psychological QoL domains improved significantly relative to controls in well participants. Psychological QoL was significantly poorer relative to controls in the disease management group. This pattern of results persisted over 1 year. With some exceptions, better overall QoL was reported for light intensity exercise undertaken in group settings, with greater improvement in physical QoL following moderate intensity exercise. The implications for future health care practice and research are discussed.

WHOQOL-HIV for quality of life assessment among people living with HIV and AIDS: results from the field test

Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial to research and evidence-based practice in this area. This paper describes the analysis of the WHOQOL HIV field test instrument, which was given to 1,334 PLWHA from seven culturally diverse centres (Australia, Brazil, Italy, Thailand, Ukraine and two centres in India: Bangalore and New Delhi). The instrument demonstrates good psychometric properties (α values for domains between 0.70 and 0.90) and good discriminant validity, with poorest QoL found for those who reported that they were least well. Men reported poorer physical well-being (F=13.1, p<0.001) and level of independence (F=16.1, p<0.001), while women reported poorer environment (F=25.8, p<0.001), social support (F=11.3, p<0.001) and spirituality (F=7.5, p<0.01). Older people (>34 years) demonstrated poorer QoL on physical (F=20.6, p<0.001) and levels of independence (F=18.3, p<0.001), while younger people showed poorer environmental (F=34.6, p<0.001) and spiritual (F=23.5, p<0.001) domains of well-being. The instrument provides a promising means for QoL assessment for HIV/AIDS in diverse cultural settings.Assessment of quality of life (QoL) in persons living with HIV/AIDS (PLWHA) is becoming crucial to research and evidence-based practice in this area. This paper describes the analysis of the WHOQOL HIV field test instrument, which was given to 1,334 PLWHA from seven culturally diverse centres (Australia, Brazil, Italy, Thailand, Ukraine and two centres in India: Bangalore and New Delhi). The instrument demonstrates good psychometric properties (alpha values for domains between 0.70 and 0.90) and good discriminant validity, with poorest QoL found for those who reported that they were least well. Men reported poorer physical well-being (F=13.1, p<0.001) and level of independence (F=16.1, p<0.001), while women reported poorer environment (F=25.8, p<0.001), social support (F=11.3, p<0.001) and spirituality (F=7.5, p<0.01). Older people (>34 years) demonstrated poorer QoL on physical (F=20.6, p<0.001) and levels of independence (F=18.3, p<0.001), while younger people showed poorer environmental (F=34.6, p<0.001) and spiritual (F=23.5, p<0.001) domains of well-being. The instrument provides a promising means for QoL assessment for HIV/AIDS in diverse cultural settings.

Preliminary development of the World Health Organisation's Quality of Life HIV instrument (WHOQOL-HIV):analysis of the pilot version

The assessment of quality of life (QoL) is central to understanding how peoples lives are affected by HIV infection. A reliable and valid measurement tool developed for cross-cultural use will be important in evaluating the global impact of the disease. This paper reports on the development and preliminary assessment of the WHOQOL-HIV pilot instrument that is designed for use with the WHOQOL-100 for persons living with HIV and AIDS (PLWHA). In this study, 900 people with a mean age of 32 from six culturally diverse sites completed the WHOQOL-100 along with 115 HIV specific items. Respondents were HIV asymptomatic (23%), HIV symptomatic (23%), had AIDS (20%) or were well (34%). Analyses to select the best items from the piloted instrument resulted in the inclusion of 33 items covering 12 new facets for a field trial version of the WHOQOL-HIV instrument; e.g. symptoms of HIV, body image, social inclusion, death and dying, and forgiveness. The results indicate excellent internal consistency for the scale (alpha=0.98) and its domains (alpha=0.87-0.94). For PLWHA, pain and discomfort, positive feelings, dependence on medication, sexual activity, financial resources and spiritual connection were particularly poor, indicating that the severest impact of HIV extends beyond physical well-being to the psycho-social-spiritual and environmental areas of QoL. Comparisons using ANOVA showed that persons who are at later stages of HIV infection, or are currently ill report poorer QoL than those that were well (p<0.01). Women report poorer QoL than men for almost every facet (p<0.01) and older persons (>30) reported lower negative feelings, and better social inclusion, spiritual connection, forgiveness and spiritual experience than younger persons. Finally, those with no education, or only primary education showed some of the poorest means. It is concluded that these new items and facets add value for measurement of QoL in PLWHA.

MEASURING QUALITY OF LIFE IN BRITAIN: INTRODUCING THE WHOQOL-100

Quality of life is an important outcome measure in the evaluation of treatments for a range of chronic physical and psychological disorders. The psychometric properties of a new British quality-of-life instrument-the WHOQOL-100--are presented, as part of an international project to create a multilingual, multidimensional profile for cross-cultural use. The WHOQOL was completed by an adult sample (N = 320) of well people and patients attending GP surgeries and out-patient clinics and from inpatient wards. The sick represented 16 disease categories and all were selected for age, gender, and disease severity. The levels of quality of life of different disease groups and sociodemographic categories are reported. The presence or absence of positive feelings provides the best single predictor of quality of life in Britain today, and this improves when supplemented by information about mobility and energy. The scores of the scale discriminate well between sick and well people and concur with reported health status. The concept of quality of life covering 25 facets (hierarchically organized within six domains) was largely confirmed by mapping intercorrelations. The WHOQOL-100 shows excellent overall internal consistency reliability and can be used with individuals. This level of reliability extends to all domains and patient subgroups. Seven UK national items were also assessed for inclusion. The results show that WHOQOL-100 promises to be a comprehensive profile for generic use in the evaluation of contemporary health care.

Validation of the WHOQOL-100: Pain Management Improves Quality of Life for Chronic Pain Patients

ObjectiveThe study aimed to validate a new, multidimensional, multilingual instrument (the WHOQOL-100) for assessing QOL in chronic pain patients. MethodsChronic pain patients (N = 106) who agreed to participate in an established pain management program (PMP) were assessed for quality of life (QOL) before and one month after the intervention. The WHOQOL-100 is a generic profile containing 25 facets of QOL organized in 6 domains. It was administered concurrently with the MOS Short Form-36, the Beck Depression Inventory, and measures of pain intensity, duration, disruption and distress. ResultsThe patients were outpatients and inpatients with a mean age of 44 years and mean pain duration of 8 years. The sample included 70 (66%) women. After the PMP, QOL had significantly improved generally, and in the physical, psychological and independence domains, as well as in 10 facets of QOL including pain and discomfort. Good QOL is consistently associated with low levels of pain severity and pain distress and little pain disruption. Overall internal consistency reliability was good and for most facets and domains but marginal for the pain facet. When compared with the SF-36, the WHOQOL-100 shows good concurrent validity, greater comprehensiveness and very good responsiveness to clinical change. DiscussionThe WHOQOL-100 indicates significant improvements to QOL for those entering a PMP and is validated for the clinical assessment of chronic pain patients and for use in multi-national clinical trials, clinical governance and audit.