World Health Organization Quality of Life (Brief Version)

Abstract

The World Health Organisation Quality of Life (Brief version), commonly known as the WHOQOL-BREF, is a cross-culturally comparable, self-administered Quality of Life (QoL) assessment instrument developed by the World Health Organisation (WHO) Group. It serves as a concise, 26-item short form derived from the original 100-item WHOQOL questionnaire. The scale assesses an individual’s perception of their QoL over the preceding two or four weeks, focusing on four primary domains: Physical Health, Psychological Health, Social Relationships, and Environment. The WHOQOL-BREF is widely utilized in clinical and research settings globally due to its robust psychometric properties and adaptability across diverse cultural contexts.

Keywords

WHOQOL-BREF, Quality of Life, WHO, Psychological Health, Physical Health, Social Relationships, Environmental Health, cross-cultural assessment, health outcomes

Authors

The WHOQOL Group (original developers); Murphy B, Herrman H, Hawthorne G, Pinzone T, Evert H (authors of the Australian Users Manual and Interpretation Guide cited in the source material)

Purpose

The primary purpose of the WHOQOL-BREF is to provide a standardized, yet culturally sensitive, measure of an individual’s subjective quality of life. It is designed to be used in broad health studies, clinical trials, and epidemiological research to measure changes in QoL resulting from disease, treatment, or public health interventions. The brevity of the instrument makes it highly practical for routine administration and large-scale data collection where time constraints are a factor.

Construct

The scale measures the construct of Quality of Life (QoL), which the World Health Organisation defines as an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. The WHOQOL-BREF structure covers four distinct domain scores, plus two stand-alone items (Q1 and Q2) assessing overall QoL and general satisfaction with health. The four domains are:

• Domain 1: Physical Health (e.g., pain, energy, mobility, sleep).
• Domain 2: Psychological Health (e.g., positive feelings, cognition, self-esteem, negative feelings).
• Domain 3: Social Relationships (e.g., personal relationships, social support, sexual activity).
• Domain 4: Environment (e.g., safety, physical environment, financial resources, access to information and health services).

Validity

The WHOQOL-BREF has demonstrated strong concurrent and discriminant validity across numerous international field trials. Its development involved extensive cross-cultural validation across 15 centers globally, ensuring that the concept of Quality of Life is measured consistently despite linguistic and cultural variations. Studies consistently show that the domain scores correlate appropriately with external measures of health status, disease severity, and functional capacity, confirming that the scale measures what it intends to measure within each specific domain.

Reliability

The instrument exhibits high internal consistency, generally yielding acceptable to excellent Cronbach’s alpha coefficients for all four domains across diverse populations. The scale’s test-retest reliability has also been confirmed, indicating that the scores remain stable over short periods when no significant life changes occur. The robust reliability supports its use in tracking individual changes and comparing group outcomes in research contexts.

Factor Analysis

Factor analysis conducted during the development and subsequent validation of the WHOQOL-BREF consistently supports the proposed four-domain structure. Although the scale is derived from the larger WHOQOL-100, the 26 items retained in the brief version successfully load onto the four distinct factors (Physical, Psychological, Social, and Environmental). This structure confirms the multidimensional nature of the QoL construct as conceptualized by the WHO Group, allowing for meaningful interpretation of scores in these separate areas.

Instrument

Test Type: Subjective, self-report psychological measure of Quality of Life

Format: 26 items, generally utilizing a 5-point Likert scale (ranging from ‘Not at all’ to ‘Completely’ or ‘Very poor’ to ‘Very good’).

Language Available: Available in numerous languages due to its international development by the World Health Organisation.

Population Group: General and clinical populations, including those with specific illnesses.

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

Population Details: The scale is designed for universal use, having been rigorously tested in varied cultural settings to ensure cross-cultural equivalence.

Test Methodology: Respondents are asked to reflect on their experiences and feelings over the last two or four weeks, circling the number that best represents their answer.

Keywords

WHO, brief QoL scale, cross-cultural validity, Physical Health domain, Psychological domain, Social Relationships, Environment domain, self-report, health assessment

Authors

Author ORCID Identifier: N/A (Information not provided in source material)

Affiliation Email addresses: N/A (Information not provided in source material)

Correspondence Address: Correspondence is typically directed through the Australian WHOQOL Field Study Centre or the global WHO headquarters for official inquiries.

Permissions & Fee and Test Year

The scale is generally available for non-commercial research use, though specific usage often requires registration with the designated WHOQOL Field Study Centre. The Australian WHOQOL Field Study Centre citation notes a registration number (2007/184), which entitles users to technical support, scoring algorithms, interpretation guidance, and population norms. The primary reference cited is dated 2000, reflecting the publication of the Australian Users Manual, although the scale itself was developed in the mid-1990s following extensive field trials.

The original PDF containing scoring instructions can be downloaded here: http://depts.washington.edu/seaqol/docs/WHOQOL-BREF%20with%20scoring%20instructions_up‎dated%2001-10-14.pdf

Another related PDF document from the WHO is available here: http://www.who.int/substance_abuse/research_tools/en/english_whoqol.pdf

Reference’s

• Murphy B, Herrman H, Hawthorne G, Pinzone T, Evert H (2000). Australian WHOQOL instruments: Users manual and interpretation guide. Australian WHOQOL Field Study Centre, Melbourne, Australia.

• Further resources and information regarding the instrument can be found at: http://depts.washington.edu/seaqol/WHOQOL-BREF

• The Australian WOQOL Field Study Centre is cited as: http://www.acpmh.unimelb.edu.au/whoqol_aqol.html

Items of the World Health Organisation Quality of Life (Brief version)

The following pre-assessment demographic and health questions are typically asked:

• What is your gender? Male Female

• What is your date of birth? ______ / ______ / ______ day month year

• What is the highest education you received? None at all‚ Primary school‚ Secondary school‚ Tertiary

• What is your marital status? Single‚ Separated‚ Married‚ Divorced‚ Widowed‚ Living as married Are you currently ill? Yes No

• If something is wrong with your health what do you think it is? ___________________________________ illness/problem.

Please read each question‚ assess your feelings‚ for the last two weeks‚ and circle the number on the scale for each question that gives the best answer for you.

• 1. How would you rate your quality of life? Very poor‚ Poor‚ Neither poor nor good‚ Good‚ Very good

• 2. How satisfied are you with your health? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

The following questions ask about how much you have experienced certain things in the last two weeks. Not at all‚ A little‚ A moderate amount‚ Very much‚ An extreme amount

• 3. To what extent do you feel that physical pain prevents you from doing what you need to do?

• 4. How much do you need any daily treatment to function in your daily life? . Not at all‚ A little‚ A moderate amount‚ Very much‚ An extreme amount

• 5. How much do you enjoy life? . Not at all‚ A little‚ A moderate amount‚ Very much‚ An extreme amount

• 6. To what extent do you feel your life to be meaningful? Not at all‚ A little‚ A moderate amount‚ Very much‚ An extreme amount

• 7. How well are you able to concentrate? Not at all‚ A little‚ A moderate amount‚ Very much‚ extremely

• 8. How safe do you feel in your daily life? Not at all‚ A little‚ A moderate amount‚ Very much‚ extremely

• 9. How healthy is your physical environment? Not at all‚ A little‚ A moderate amount‚ Very much‚ extremely

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

• 10. Do you have enough energy for everyday life? Not at all‚ A little‚ moderate‚ mostly‚ completely

• 11. Are you able to accept your bodily appearance? Not at all‚ A little‚ moderate‚ mostly‚ completely

• 12. Have you enough money to meet your needs? Not at all‚ A little‚ moderate‚ mostly‚ completely

• 13. How available to you is the information that you need in your day-to-day life? Not at all‚ A little‚ moderate‚ mostly‚ completely

• 14. To what extent do you have the opportunity for leisure activities? Not at all‚ A little‚ moderate‚ mostly‚ completely

• 15. How well are you able to get around? Very poor‚ Poor‚ Neither poor nor good‚ Good‚ Very good

• 16. How satisfied are you with your sleep? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 17. How satisfied are you with your ability to perform your daily living activities? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 18. How satisfied are you with your capacity for work? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 19. How satisfied are you with yourself? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 20. How satisfied are you with your personal relationships? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 21. How satisfied are you with your sex life? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 22. How satisfied are you with the support you get from your friends? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 23. How satisfied are you with the conditions of your living place? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 24. How satisfied are you with your access to health services? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

• 25. How satisfied are you with your transport? Very dissatisfied‚ Dissatisfied‚ Neither satisfied nor dissatisfied‚ Satisfied‚ Very satisfied

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

• 26. How often do you have negative feelings such as blue mood‚ despair‚ anxiety‚ depression? Never‚ Seldom‚ Quite often‚ Very often‚ Always

Do you have any comments about the assessment? …. …. …. …..