Quality of Life Scale – Brief (WHOQOL-BREF)

Abstract

The WHOQOL-BREF (Quality of Life Scale – Brief) is a globally recognized, 26-item self-report measure developed by the World Health Organisation (WHO) for the cross-cultural assessment of Quality of Life (QoL). It is an abbreviated version of the comprehensive WHOQOL-100 instrument.

Designed to be applicable across diverse cultural settings, the scale is particularly useful for measuring outcomes in adults, including those with a psychosocial disability. It evaluates the impact of disease and impairment on daily activities, perceived health status, disability, and overall functional capacity, yielding scores across four primary domains.

Keywords

WHOQOL-BREF, Quality of Life, WHO, self-report measure, health outcomes, psychosocial assessment, cross-cultural validation, functional capacity

Authors

The WHOQOL Group

Purpose

The primary purpose of the WHOQOL-BREF is to provide a concise and reliable instrument for measuring subjective Quality of Life that is suitable for large-scale epidemiological studies and clinical trials globally. By focusing on the individual’s subjective perception of their position in life, the scale allows researchers and clinicians to evaluate the effectiveness of health interventions and understand the burden of disease across various populations.

It aims to standardize the assessment of QoL across different cultures, ensuring that the concept of well-being is measured consistently, regardless of the socio-economic or health status of the respondent.

Construct

The WHOQOL-BREF measures the multidimensional construct of Quality of Life, defined by the World Health Organisation 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 scale operationalizes this construct across four distinct, yet interrelated, domains:

1. Physical Health (e.g., pain, energy, mobility).
2. Psychological Health (e.g., positive feelings, cognition, self-esteem, body image).
3. Social Relationships (e.g., personal relationships, social support, sexual activity).
4. Environment (e.g., financial resources, physical safety, access to health care, transport).

Validity

The WHOQOL-BREF serves as a validated, shorter alternative to the original WHOQOL-100 instrument. It has demonstrated strong concurrent and discriminant validity, having been successfully tested in both normative samples and specific groups, including individuals with disability. Validation studies, such as that by Shawver et al. (2016), have confirmed the underlying four-domain factor structure, supporting its conceptual framework.

Furthermore, the scale’s cross-cultural validity is a core strength, as it was intentionally developed through extensive international collaboration to ensure relevance and meaning across diverse linguistic and cultural backgrounds.

Reliability

Reliability analyses of the WHOQOL-BREF, including assessments of internal consistency, have consistently shown that the domain scales are cohesive and reliable measures of their respective constructs. Shawver et al. (2016) specifically evaluated the internal consistency and verified the robust psychometric properties of the scale across different data collection methods.

Normative data collected from representative samples, such as the Australian study by Hawthorne et al. (2006), provide benchmarks for interpreting domain scores. In this study, the mean Transformed Scores (and standard deviations) across the domains were reported as: Physical health: 73.5 (SD = 18.1); Psychological Health: 70.6 (SD = 14); Social relationships: 71.5 (SD = 18.2); and Environment: 75 (SD = 13).

Factor Analysis

The WHOQOL-BREF is structured according to a four-domain factor structure, which was confirmed during the scale’s development and subsequent independent validation studies. This structure captures the breadth of the Quality of Life construct:

• Physical Health: Focuses on daily functioning, pain, energy, and dependence on medical aid.
• Psychological Health: Covers mood, self-esteem, spirituality, memory, and concentration.
• Social Relationships: Addresses interpersonal relationships, social support, and sexual activity.
• Environment: Includes financial security, physical safety, home environment, access to information, and transport.

Interpretation of Scores

Scoring for the WHOQOL-BREF involves calculating both raw scores and transformed scores for the four domains, as well as an overall QoL score. The total raw score ranges from 26 to 156, where higher scores uniformly indicate a higher level of perceived Quality of Life.

Domain scoring details are as follows:

• Physical Health (Q 3, 4, 10, 15, 16, 17, 18): Raw scores range from 7 to 35.
• Psychological Health (Q 5, 6, 7, 11, 19, 26): Raw scores range from 6 to 30.
• Social Relationships (Q 20, 21, 22): Raw scores range from 3 to 15.
• Environment (Q 8, 9, 12, 13, 14, 23, 24, 25): Raw scores range from 8 to 40.

To facilitate comparison across domains and populations, raw scores are converted into a Transformed Score scaled from 0 to 100, following the methodology detailed in the WHOQOL-BREF manual. Higher transformed scores correspond to better QoL. Scores can also be presented as a percentile rank relative to normative data, such as the Australian population norms, where a percentile rank of 50 represents the average level of Quality of Life.

Instrument

Test Type: Self-report questionnaire, Psychological assessment of Quality of Life

Format: 26 items utilizing 5-point Likert scales, administered via paper or digitally.

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

Population Group: General population, clinical populations, and individuals with chronic illness or disability.

Age Group: Adults.

Population Details: Specifically useful for adults with a psychosocial disability, but validated across diverse normative samples.

Test Methodology: Respondents are asked to reflect on their standards, hopes, pleasures, and concerns over the preceding two weeks when answering the questions.

Keywords

psychometrics, self-esteem, physical health, psychological health, social relationships, environment domain, transformed score, internal consistency

Authors

Author ORCID Identifier: Not specified for the WHOQOL Group

Affiliation Email addresses: Contact information available via the WHOQOL Group at the World Health Organisation.

Correspondence Address: World Health Organisation, Geneva, Switzerland.

Permissions & Fee and Test Year

The scale was developed by The WHOQOL Group in 1994, based on the findings published in their 1994 reference. Permissions and usage fees are managed by the World Health Organisation, which generally provides access to the instrument and manual for research and non-profit clinical use, often requiring formal request and licensing.

Reference’s

• The WHOQOL Group. (1994). The development of the World Health Organization quality of life assessment instrument (the WHOQOL). In J. Orley and W. Kuyken (Eds) Quality of Life Assessment: International Perspectives. Heidelberg: Springer Verlag.
• Shawver, Z., Griffith, J. D., Adams, L. T., Evans, J. V., Benchoff, B., & Sargent, R. (2016). An examination of the WHOQOL-BREF using four popular data collection methods. Computers in Human Behavior, 55, 446-454.
• Hawthorne, G., Herrman, H., & Murphy, B. (2006). Interpreting the WHOQOL-BREF: Preliminary population norms and effect sizes. Social Indicators Research, 77(1), 37-59.

Items of the Quality of Life Scale – Brief (WHOQOL-BREF)

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

Instructions:

This assessment asks how you feel about your quality of life, health, or other areas of your life. Please answer all the questions. If you are unsure about which response to give to a question, please choose the one that appears most appropriate. This can often be your first response.

Please keep in mind your standards, hopes, pleasures and concerns. We ask that you think about your life in the last two weeks.

	Very poor	Poor	Neither poor nor good	Good	Very good
How would you rate your quality of life?	1	2	3	4	5
	Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
How satisfied are you with your health?	1	2	3	4	5
	Not al all	A little	A moderate amount	Very much	An extreme amount
The following questions ask about how much you have experienced certain things in the last two weeks. To what extent do you feel that physical pain prevents you from doing what you need to do?	5	4	3	2	1
	Not at all	A little	A moderate amount	Very much	An extreme amount
How much do you need any medical treatment to function in your daily life?	5	4	3	2	1
How much do you enjoy life?	1	2	3	4	5
To what extent do you feel your life to be meaningful?	1	2	3	4	5
	Not at all	A little	A moderate amount	Very much	Extremely
How well are you able to concentrate?	1	2	3	4	5
How safe do you feel in your daily life?	1	2	3	4	5
How healthy is your physical environment?	1	2	3	4	5

	Not at all	A little	Moderately	Mostly	Completely
The following questions ask about how completely you experience or were able to do certain things in the last two weeks. Do you have enough energy for everyday life?	1	2	3	4	5
Are you able to accept your bodily appearance?	1	2	3	4	5
Have you enough money to meet your needs?	1	2	3	4	5
How available to you is the information that you need in your day-to-day life?	1	2	3	4	5
To what extent do you have the opportunity for leisure activities?	1	2	3	4	5
	Very poor	Poor	Neither poor nor good	Good	Very good
How well are you able to get around?	1	2	3	4	5
	Very dissatisfied	Dissatisfied	Neither satisfied nor dissatisfied	Satisfied	Very satisfied
The following questions ask you to say how good or satisfied you have felt about various aspects of your life over the last two weeks. How satisfied are you with your sleep?	1	2	3	4	5
How satisfied are you with your ability to perform your daily living activities?	1	2	3	4	5
How satisfied are you with your capacity for work?	1	2	3	4	5
How satisfied are you with yourself?	1	2	3	4	5
How satisfied are you with your personal relationships?	1	2	3	4	5
How satisfied are you with your sex life?	1	2	3	4	5
How satisfied are you with the support you get from your friends?	1	2	3	4	5
How satisfied are you with the conditions of your living place?	1	2	3	4	5
How satisfied are you with your access to health services?	1	2	3	4	5
How satisfied are you with your transport?	1	2	3	4	5
	Never	Seldom	Quite often	Very often	Always
The following question refers to how often you have felt or experienced certain things in the last two weeks. How often do you have negative feelings such as blue mood, despair, anxiety, depression?	5	4	3	2	1