WHO Quality of Life Scale

Abstract

The WHO Quality of Life Scale (WHOQOL) is a comprehensive cross-cultural instrument developed by the World Health Organization (WHO) to assess an individual’s perception of their position in life in the context of their culture and value systems, and in relation to their goals, expectations, standards, and concerns. The version presented here, often resembling the WHOQOL-BREF structure but tailored for specific health populations (e.g., Persons Living with HIV/AIDS), typically consists of 31 items measured using 5-point Likert scales, assessing subjective Quality of life across six distinct domains: Physical, Psychological, Level of Independence, Social Relationships, Environment, and Spirituality/Religion/Personal Beliefs. Questions specifically target experiences and feelings over the last two weeks.

Keywords

WHOQOL, Quality of life, Health Assessment, Psychological Scale, Cross-cultural Measurement, HIV/AIDS, Spirituality, Domains.

Authors

The WHOQOL Group.

Purpose

The primary purpose of the WHOQOL instrument is to provide a standardized, internationally comparable measure of Quality of life for use in health research, clinical trials, and population health surveys. It was designed to overcome limitations of existing scales by incorporating cultural sensitivity and a holistic definition of QoL, ensuring its relevance across diverse global settings.

It is particularly useful for evaluating the impact of disease, treatment, and public health interventions. The specific version detailed in the source content allows for the assessment of QoL dimensions uniquely relevant to individuals managing chronic conditions, such as the inclusion of symptoms related to Persons Living with HIV/AIDS (PLWHA) and associated social stigma.

Construct

The scale measures the construct of Quality of Life, defined by the World Health Organization as an individual’s perception of their life circumstances. This construct is recognized as multidimensional, encompassing subjective evaluations across six key domains:

• Domain I: Physical (Pain and discomfort, Energy and fatigue, Sleep and rest, Symptoms of PLWHA).
• Domain II: Psychological (Positive feelings, Thinking, learning, memory and concentration, Self-esteem, Bodily image and appearance, Negative feelings).
• Domain III: Level of Independence (Mobility, Activities of daily living, Dependence on medication or treatments, Work capacity).
• Domain IV: Social Relationships (Personal relationships, Social support, Sexual activity, Social Inclusion).
• Domain V: Environment (Physical safety and security, Home environment, Financial resources, Health and social care: accessibility and quality, Opportunities for acquiring new information and skills, Participation in recreation/leisure activities, Physical environment, Transport).
• Domain VI: Spirituality/Religion/Personal Beliefs (SRPB, Forgiveness and Blame, Concerns about the Future, Death and Dying).

Validity

Extensive international research has established the strong conceptual and empirical Validity of the WHOQOL framework. Initial validation studies for both the longer (WHOQOL-100) and shorter (WHOQOL-BREF) versions, including the Bonomi et al. (2000) validation for the United States, demonstrated that the scale accurately measures the intended domains of QoL and possesses robust psychometric properties.

The scale exhibits high content Validity due to its comprehensive, cross-cultural development process, ensuring item relevance across diverse populations. Furthermore, the instrument supports acceptable discriminant and convergent Validity, successfully differentiating between groups with varying health statuses and correlating appropriately with other established health outcome measures.

Reliability

The WHOQOL instruments consistently demonstrate high levels of internal consistency across their domains in numerous international studies. This high internal Reliability, typically measured using Cronbach’s alpha, confirms that the items within each factor are coherent and consistently measure the same underlying dimension of well-being, such as psychological health or physical functioning.

Furthermore, test-retest Reliability has been established, indicating that the scale provides stable measures of subjective Quality of life over time, making it a dependable tool for longitudinal research and clinical monitoring.

Factor Analysis

Factor analysis performed during the development of the WHOQOL family of instruments consistently supported the hypothesized multidimensional structure. The analyses empirically confirmed the distinct nature of the six major domains (Physical, Psychological, Independence, Social, Environment, and SRPB), validating the conceptual model proposed by the WHOQOL Group.

This empirical confirmation ensures that the scoring methodology, which calculates separate domain scores, is statistically sound. The factor structure allows researchers not only to determine an overall quality of life score but also to analyze specific areas of function and satisfaction independently, providing granular data on patient outcomes.

Instrument

Test Type: Self-report questionnaire / Psychometrics rating scale.

Format: 31 items, primarily utilizing a 5-point Likert response scale. The recall period for all questions is the last two weeks.

Language Available: Available in over 40 languages globally, reflecting its mandate as a cross-cultural tool.

Population Group: General population, but frequently utilized in clinical populations for specific conditions (e.g., oncology, HIV/AIDS, chronic disease).

Age Group: Adults (typically 18 years and older).

Population Details: Used globally in healthy and patient populations, emphasizing subjective experience of well-being.

Test Methodology: Scores are calculated by summing or averaging item scores within each domain, with specific items being reverse-scored (e.g., (6-Q3)) to ensure consistency where higher raw scores indicate better QoL. The domain scores are standardized to range from 4 to 20 or 0 to 100.

Keywords

WHOQOL-BREF, Health Status, Subjective Well-being, Multi-domain Assessment, Cross-cultural Psychometrics, Likert Scale.

Authors

Author ORCID Identifier: Not specified in source content (Developed by the WHOQOL Group).

Affiliation Email addresses: Contact the World Health Organization (WHO) for official correspondence regarding the instrument.

Correspondence Address: World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland.

Permissions & Fee and Test Year

The WHOQOL instruments are developed and managed by the World Health Organization. Permissions for use in non-commercial academic research or clinical settings should generally be sought from the WHOQOL Group, though the instrument is often provided free of charge for non-profit use. The initial study protocol for the WHOQOL was published in 1993, marking the official commencement of the scale’s development and validation period.

Reference’s

The original PDF document relating to the scoring and application of this instrument can be downloaded here: http://apps.who.int/iris/bitstream/10665/77775/1/WHO_MSD_MER_Rev.2012.02_eng.pdf?ua=1

• WHOQOL Group. (1993). Study protocol for the World Health Organization project to develop a quality of life assessment instrument (WHOQOL). Qual Life Res, 2:153–159.
• WHOQOL Group. (1994). The development of the World Health Organization quality of life assessment instrument (the WHOQOL). In: Orley J, Kuyken W, eds. Quality of life assessment: international perspectives. Berlin: Springer-Verlag, 1994:41–57.
• WHOQOL Group. (1998). Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med, 28:551–558.
• Skevington, S.M., Bradshaw, J., Saxena, S. (1999). Selecting national items for the WHOQOL: conceptual and psychometric considerations. Soc Sci Med, 48:473–487.
• Bonomi, A.E., Patrick, D.L., Bushnell, D.M., et al. (2000). Validation of the United States’ version of the World Health Organization Quality of Life (WHOQOL) instrument. J Clin Epidemiol 2000;53:1–12.
• McDowell, Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires, Third Edition. OXFORD UNIVERSITY PRESS.

Items of the WHO Quality of Life Scale

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

Questions refer to the last two weeks.

1. How would you rate your quality of life? (1) Very poor; (2) Poor; (3) Neither poor nor good; (4) Good; (5) Very good
2. How satisfied are you with your health? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied

The following questions ask about how much you have experienced certain things in the last two weeks.

3. To what extent do you feel that physical pain prevents you from doing what you need to do? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
4. How much are you bothered by any physical problems related to your HIV infection? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
5. How much do you need any medical treatment to function in your daily life? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
6. How much do you enjoy life? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
7. To what extent do you feel your life to be meaningful? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
8. To what extent are you bothered by people blaming you for your HIV status (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
9. How much do you fear the future? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
10. How much do you worry about death? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
11. How well are you able to concentrate? (1) Not at all‚ (2) A little‚ (3) A moderate amount‚ (4) Very much‚ (5) Extremely
12. How safe do you feel in your daily life? (1) Not at all‚ (2) A little‚ (3) A moderate amount‚ (4) Very much‚ (5) Extremely
13. How healthy is your physical environment? (1) Not at all‚ (2) A little‚ (3) A moderate amount‚ (4) Very much‚ (5) Extremely

The following questions ask about how completely you experience or were able to do certain things in the last two weeks.

14. Do you have enough energy for everyday life? (1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
15. Are you able to accept your bodily appearance? (1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
16. Have you enough money to meet your needs? (1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
17. To what extent do you feel accepted by the people you know? (1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
18. How available to you is the information that you need in your day-to-day life? (1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
19. To what extent do you have the opportunity for leisure activities? (1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
20. How well are you able to get around? (1) Very poor; (2) Poor; (3) Neither poor nor good; (4) Good; (5) Very good

The following questions ask you how good or satisfied you have felt about various aspects of your life over the last two weeks.

21. How satisfied are you with your sleep? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
22. How satisfied are you with your ability to perform your daily living activities? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
23. How satisfied are you with your capacity for work? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
24. How satisfied are you with yourself? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
25. How satisfied are you with your personal relationships? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
26. How satisfied are you with your sex life? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
27. How satisfied are you with the support you get from your friends? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
28. How satisfied are you with the conditions of your living place? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
29. How satisfied are you with your access to health services? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
30. How satisfied are you with your transport? (1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied

The following question refers to how often you have felt or experienced certain things in the last two weeks.

31. How often do you have negative feelings such as blue mood‚ despair‚ anxiety‚ depression? (1) Never; (2) Seldom; (3) Quite often‚ (4) Very often; (5)Always

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