Quality of Well-Being Scale

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Abstract

The Quality of Well-Being Scale (QWB) is a widely recognized, preference-based instrument designed to measure health-related quality of life (HRQOL) and derive a single, standardized utility index score. Developed by Kaplan, Bush, and Berry, the QWB quantifies an individual’s health status on a scale where 1.0 represents optimal health and 0.0 represents death. The scale achieves this by combining assessments of functional limitations across three domains—Mobility (MOB), Physical Activity (PAC), and Social Activity (SAC)—with the presence of specific Symptom/Problem Complexes (CPX).

The QWB is a valuable tool in clinical research, health policy analysis, and economic evaluations, such as calculating Quality-Adjusted Life Years (QALYs), due to its ability to provide a comprehensive and weighted summary of an individual’s overall well-being. The self-administered version (QWB-SA) further enhances efficiency in data collection.

Keywords

Quality of Well-Being Scale, QWB, Health Status, Health-Related Quality of Life, HRQOL, Utility Index, Health Services Research, Function Assessment, Symptom Complex, Mobility, Physical Activity, Social Activity.

Authors

Robert M. Kaplan, J.W. Bush, C.C. Berry, J.P. Anderson, T.G. Ganiats.

Purpose

The primary purpose of the Quality of Well-Being Scale is to provide a quantitative, interval-level measure of an individual’s overall health status. This scale transforms complex health profiles into a single numeric score, which is critical for comparative studies of health outcomes and interventions.

The QWB is uniquely designed for use in economic evaluation and policy analysis, allowing researchers to measure the benefits of medical treatments or public health programs in terms of improved quality of life years, specifically through the calculation of QALYs.

Construct

The QWB Scale measures health-related quality of life (HRQOL) based on a multi-attribute utility theory framework. The core construct posits that well-being is determined by an individual’s ability to function physically and socially, modified by the presence and severity of symptoms or health problems.

The scale is structured around four main components: three functional dimensions (Mobility, Physical Activity, Social Activity) and a comprehensive list of Symptom/Problem Complexes (CPX). Each state defined by these components is assigned a preference weight, or utility value, derived from population ratings, ensuring the resulting score reflects societal valuations of different health states.

Validity

The QWB Scale has demonstrated strong psychometric properties, particularly regarding validity. Early studies established its construct and criterion validity, showing that the scale effectively discriminates among individuals with varying levels of disease severity and overall health.

Research has confirmed the scale’s applicability across diverse patient populations, including those with chronic conditions such as Chronic Obstructive Pulmonary Disease (COPD), AIDS, cystic fibrosis, and arthritis. Furthermore, comparative analyses, such as those contrasting the QWB with the SF-36, highlight its ability to capture unique aspects of health status while maintaining conceptual consistency with other established measures.

Reliability

The reliability of the QWB, particularly the interviewer-administered version, has been extensively documented. Studies focusing on interday reliability confirm the scale’s consistency in function assessment when administered over short intervals.

The structured format and established weighting system contribute to the scale’s reliable measurement across different administrators and settings, providing confidence in its use as a stable outcome measure in longitudinal studies.

Factor Analysis

The QWB operates under a predefined conceptual model based on utility theory, rather than relying solely on traditional exploratory factor analysis to define its structure. The scale’s components (MOB, PAC, SAC, and CPX) are theoretically distinct domains of health function.

However, the preference weights applied to each health state are derived empirically, reflecting the implicit factor structure of how the general population values different combinations of functional limitation and symptoms.

Instrument

Test Type: Health Status Index / Multi-Attribute Utility Measure

Format: Interviewer-Administered (QWB) and Self-Administered Questionnaire (QWB-SA)

Language Available: English (Source documentation is in English)

Population Group: General population and various clinical populations (e.g., chronic illness patients)

Age Group: Applicable across a wide age range (Source content mentions considerations for ages younger than 15 years)

Population Details: Used extensively in studies involving chronic disease management, health policy modeling, and large-scale public health surveys.

Test Methodology: The scale uses weighted scores applied to different levels of functional limitation (MOB, PAC, SAC) combined with weights for specific symptoms (CPX) experienced by the respondent, resulting in a utility score between 0.0 (death) and 1.0 (optimal health).

Keywords

Robert M. Kaplan, J.W. Bush, Quality-Adjusted Life Years, HRQOL, Quality of Life, Health Measurement, Psychometrics, Chronic Disease Outcomes, Utility Measurement.

Authors

Author ORCID Identifier: N/A (Not provided in source content)

Affiliation Email addresses: N/A (Not provided in source content)

Correspondence Address: N/A (Not provided in source content)

Permissions & Fee and Test Year

The QWB Scale was initially developed in the mid-1970s (Kaplan, Bush, & Berry, 1976). The self-administered version (QWB-SA) was formalized and refined through subsequent research, with a comprehensive user manual published in 2008 by Sieber, Groessl, David, Ganiats, and Kaplan. Information regarding specific permissions and current licensing fees is not contained within the provided source material but generally requires contact with the authorized copyright holders or research institution (e.g., UC San Diego Health Services Research Center).

Reference’s

  • Anderson‚ J.P.‚ Kaplan‚ R.M.‚ Berry‚ C.C.‚ Bush‚ J.W.‚ & Rumbaut‚ R.G. (1989). Interday reliability of function assessment for a health status measure: The Quality of Well-being Scale. Medical Care‚ 27(11)‚ 1076-1084.
  • Bowling‚ A. (2005). Measuring Health: A review of quality of life measurement scales (3rd ed.). New York‚ NY: Open University Press
  • Kaplan‚ R.M. (1988). New health promotion indicators: the General Health Policy Model. Health Promot‚ 3:35–49.
  • Kaplan‚ R.M.‚ Anderson‚ J.P.‚ Wu‚ A.W.‚ Mathews‚ W.C.‚ Kozin‚ F.‚ & Orenstein‚ D. (1989). The Quality of Well-being Scale: Applications in AIDS‚ cystic fibrosis‚ and arthritis. Medical Care‚ 27(3)‚ S27-S43.
  • Kaplan‚ R.M.‚ Atkins‚ C.J.‚ and Timms‚ R. (1984). Validity of a quality of well-being scale as an outcome measure in chronic obstructive pulmonary disease. Journal of Chronic Diseases 37(2):85-95.
  • Kaplan‚ R.M.‚ and Bush‚ J. (1982). Health-related quality of life measurement for evaluation research and policy analysis. Health Psychology 1:61-80.
  • Kaplan‚ R.M.‚ Bush‚ J.W.‚ Berry‚ C.C. (1976). Health status: types of validity and the index of well-being. Health Serv Res: 11; 478-507.
  • Kaplan‚ R.M.‚ Bush‚ J.W.‚ Berry‚ C.C. (1979). Health status index. Category rating versus magnitude estimation for measuring levels of well-being. Med Care‚ 17;501-525.
  • Kaplan‚ R.M.‚ Ganiats‚ T.G.‚ Sieber‚ W.J.‚ et al. (1998). The Quality of Well-Being Scale: critical similarities and differences with SF-36. International Journal for Quality in Health Care‚ 10‚ 509-520.
  • Kaplan‚ R.M.‚ Sieber‚ W.J.‚ and Ganiats‚ T.G. (1997). The quality of well-being scale: Comparison of the interviewer- administered version with a self-administered questionnaire. Psych Health‚ 12:783-791
  • McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS
  • Sieber‚ William J.‚ Groessl‚ Erik J.‚ David‚ Kristin M.‚ Ganiats‚ Theodore G.‚ Kaplan‚ Robert M. (2008). Quality of Well Being Self-Administered (QWB-SA) Scale: User’s Manual. Health Services Research Center University of California‚ San Diego.

The original PDF documents related to this instrument can be downloaded here:

Items of the Quality of Well-Being Scale

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

Mobility Scale (MOB)
5   No limitations for health reasons
4   Did not drive a car‚ health related; did not ride in a car as usual for age (younger than 15 yr)‚ health related‚ and/or did not use public transportation‚ health related; or had or would have used more help than usual for age to use public transportation‚ health related
2   In hospital‚ health related
Physical Activity Scale (PAC)
4   No limitations for health reasons
3   In wheelchair‚ moved or controlled movement of wheelchair without help from someone else; or had trouble or did not try to lift‚ stoop‚ bend over‚ or use stairs or inclines‚ health related; and/or had any other physical limitation in walking‚ or did not try to walk as far as or as fast as others the same age are able‚ health related
1   In wheelchair‚ did not move or control the movement of wheelchair without help from someone else‚ or in bed‚ chair‚ or couch for most or all of the day‚ health related
Social Activity Scale (SAC)
5   No limitations for health reasons
4   Limited in other (e.g. recreational) role activity‚ health related
3   Limited in major (primary) role activity‚ health related
2   Performed no major role activity‚ health related‚ but did perform self-care activities
1   Performed no major role activity‚ health related‚ and did not perform or had more help than usual in performance of one or more self-care activities‚ health related
CPX description
  1. Death [not on respondent’s card]
  2. Loss of consciousness such as seizure (fits)‚ fainting‚ or coma (out cold or knocked out)
  3. Burn over large areas of face‚ body‚ arms‚ or legs
  4. Pain‚ bleeding‚ itching‚ or disch‎arge (drainage) from sexual organs—does not include normal menstrual bleeding
  5. Trouble learning‚ remembering‚ or thinking clearly
  6. Any combination of one or more hands‚ feet‚ arms‚ or legs either missing‚ deformed (crooked)‚ paralyzed (unable to move)‚ or broken—includes wearing artificial limbs or braces
  7. Pain‚ stiffness‚ weakness‚ numbness‚ or other discomfort in chest‚ stomach (including hernia or rupture)‚ side‚ neck‚ back‚ hips‚ or any joints or hands‚ feet‚ arms‚ or legs
  8. Pain‚ burning‚ bleeding‚ itching‚ or other difficulty with rectum‚ bowel movements‚ or urination (passing water)
  9. Sick or upset stomach‚ vomiting or loose bowel movement‚ with or without chills‚ or aching all over
  10. General tiredness‚ weakness‚ or weight loss
  11. Cough‚ wheezing or shortness of breath‚ with or without fever‚ chills‚ or aching all over
  12. Spells of feeling upset‚ being depressed‚ or of crying
  13. Headache‚ or dizziness‚ or ringing in ears‚ or spells of feeling hot‚ nervous or shaky
  14. Burning or itching rash on large areas of face‚ body‚ arms‚ or legs
  15. Trouble talking‚ such as lisp‚ stuttering‚ hoarseness‚ or being unable to speak
  16. Pain or discomfort in one or both eyes (such as burning or itching) or any trouble seeing after correction
  17. Overweight for age and height or skin defect of face‚ body‚ arms‚ or legs‚ such as scars‚ pimples‚ warts‚ bruises or changes in color
  18. Pain in ear‚ tooth‚ jaw‚ throat‚ lips‚ tongue; several missing or crooked permanent teeth—includes wearing bridges or false teeth
  19. Took medication or stayed on a prescribed diet for health reasons
  20. Wore eyeglasses or contact lenses
  21. Breathing smog or unpleasant air
  22. No symptoms or problems [not on respondent’s card]
  23. Standard symptom/problem
  24. Trouble sleeping
  25. Intoxication
  26. Problems with sexual interest or performance
  27. Excessive worry or anxiety
Quality of Well Being Self-Administered (QWB-SA) Scale
Symptoms (CPX)

Yes; No

  • blindness‚ or severely impaired vision in both eyes
  • blindness or severely impaired vision in only one eye
  • speech problems such as stuttering‚ or being unable to speak clearly
  • missing or paralyzed hands‚ feet‚ arms or legs
  • missing or paralyzed fingers or toes
  • any deformity of the face‚ fingers‚ hand/arm‚ foot /leg‚ or back
  • general fatigue‚ tiredness or weakness
  • a problem with unwanted weight gain or weight loss
  • a problem with being under or overweight
  • problems chewing your food adequately
  • any hearing loss or deafness
  • any noticeable skin problems (i.e.‚ bad acne‚ large burns or scars)
  • eczema or burning/itching rash
health aides used:
  • dentures
  • eye glasses or contact lenses
  • hearing aide
  • any problems with your vision not corrected with glasses or contact lenses
  • any eye pain‚ irritation‚ disch‎arge‚ or excessive sensitivity to light
  • a headache
  • dizziness‚ earache or ringing in your ears
  • difficulty hearing or disch‎arge or bleeding from an ear
  • stuffy or runny nose or bleeding from the nose
  • a sore throat‚ difficulty swallowing‚ or hoarse voice?
  • a tooth ache or jaw pain
  • sore or bleeding lips‚ tongue‚ or gums
  • coughing or wheezing
  • shortness of breath or difficulty breathing
  • chest pain‚ pressure‚ palpitations‚ fast or skipped heart beat or other discomfort in the chest
  • an upset stomach‚ abdominal pain‚ nausea‚ heart burn or vomiting
  • difficulty with bowel movements‚ diarrhea‚ constipation‚ rectal bleeding‚ black tar-like stools‚ or any pain or discomfort in the rectal area
  • pain‚ burning‚ or blood in urine
  • loss of bladder control‚ frequent night-time urination or difficulty with urination
  • genital pain‚ itching‚ burning‚ or abnormal disch‎arge‚ or pelvic cramping or abnormal bleeding (does not include normal menstruation).
  • broken arm‚ wrist‚ foot‚ leg‚ or other broken bone (other than in back)
  • pain‚ stiffness‚ cramps‚ weakness or numbness in the neck or back
  • pain‚ stiffness‚ cramps‚ weakness or numbness in the hips or sides
  • pain‚ stiffness‚ cramps‚ weakness or numbness in any of the joints or muscles of the hand‚ feet‚ arms or legs
  • swelling of ankles‚ hands‚ feet‚ or abdomen
  • fever‚ chills‚ or sweats
  • loss of consciousness‚ fainting‚ or seizures
  • difficulty with your balance‚ standing or walking
  • trouble falling asleep or staying asleep
  • spells of feeling nervous or shaky
  • spells of feeling upset‚ downhearted‚ or blue
  • excessive worry or anxiety
  • feelings that you had little or no control over events in your life
  • feelings of being lonely or isolated
  • feelings of frustration‚ irritation or close to losing your temper
  • a hangover
  • any decrease of sexual interest or performance
  • Confusion‚ difficulty understanding the written or spoken word‚ or significant memory loss
  • thoughts or images you could not get out of your mind
  • take any medication including over-the-counter remedies (aspirin/Tylenol‚ allergy medications‚ insulin‚ hormones‚ estrogen‚ thyroid‚ prednisone)
  • to stay on a medically prescribed diet for health reasons
  • a loss of appetite or over-eating
Mobility
  • spend any part of the day or night as a patient in a hospital‚ nursing home‚ or rehabilitation center
  • either not drive a motor vehicle or not use public transportation because of your health or need help from another person to use
Physical Activity
  • have trouble climbing stairs or inclines or walking off the curb
  • avoid or have trouble walking‚ or walk more slowly than other people your age
  • limp‚ use a cane‚ crutches or walker
  • avoid or have trouble bending over‚ stooping or kneeling
  • have any trouble lifting or carrying everyday objects such as books‚ a briefcase or groceries.
  • have any other limitations in physical movements
  • spend all or most of the day in a bed‚ chair or couch
  • spend all or most of the day in a wheelchair
  • If in wheelchair‚ someone else controlled its movement
Social & Self-care activity
  • need help with your personal care needs‚ such as eating‚ dressing‚ bathing‚ or getting around our home
  • avoid‚ need help with‚ or were limited in doing some of your usual activities‚ such as work‚ school‚ or housekeeping?

Cite this article

Mohammed looti (2025). Quality of Well-Being Scale. Psychological Scales & Instruments Database. Retrieved from https://db.arabpsychology.com/scales/quality-of-well-being-scale/

Mohammed looti. "Quality of Well-Being Scale." Psychological Scales & Instruments Database, 14 Oct. 2025, https://db.arabpsychology.com/scales/quality-of-well-being-scale/.

Mohammed looti. "Quality of Well-Being Scale." Psychological Scales & Instruments Database, 2025. https://db.arabpsychology.com/scales/quality-of-well-being-scale/.

Mohammed looti (2025) 'Quality of Well-Being Scale', Psychological Scales & Instruments Database. Available at: https://db.arabpsychology.com/scales/quality-of-well-being-scale/.

[1] Mohammed looti, "Quality of Well-Being Scale," Psychological Scales & Instruments Database, vol. X, no. Y, ص Z-Z, October, 2025.

Mohammed looti. Quality of Well-Being Scale. Psychological Scales & Instruments Database. 2025;vol(issue):pages.

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