WHO Quality of Life Scale (WHOQOL-100)

Abstract

The WHO Quality of Life Scale (WHOQOL-100) is the comprehensive, 100-item instrument developed through the collaborative efforts of the World Health Organization (WHO). This scale is designed to provide a broad, cross-culturally validated assessment of an individual’s subjective perception of their position in life, considering their cultural context, value systems, personal goals, expectations, standards, and concerns. As a foundational tool for measuring Quality of Life (QOL), the WHOQOL-100 is structured into six major domains and 24 specific facets, making it suitable for extensive research across diverse health and non-clinical populations globally.

Keywords

Quality of Life, QOL, WHOQOL, Cross-cultural assessment, Psychological scale, Health outcomes, Multidimensional assessment, WHO, Psychometrics, Well-being.

Authors

WHOQOL Group, World Health Organization.

Purpose

The primary purpose of the WHOQOL-100 is to provide a standardized, culturally sensitive measurement tool for subjective Quality of Life that can be applied consistently across different international settings. The instrument was created to overcome the limitations of existing scales which often failed to adequately capture the complexity and cultural relativity of QOL, especially outside of Western nations.

The scale allows researchers and clinicians to assess changes in QOL resulting from interventions, treatments, and environmental shifts. Furthermore, by including 32 companion “importance” questions, the WHOQOL-100 uniquely gauges how important each domain is to the respondent, providing personalized weighting for QOL assessment.

Construct

The WHOQOL-100 operationalizes the construct of Quality of Life as a multi-faceted concept encompassing physical, psychological, social, and environmental components. The scale is structured around six core domains, which are further divided into 24 distinct facets:

• Domain 1: Physical Health: Pain and discomfort, energy and fatigue, sleep and rest.
• Domain 2: Psychological: Positive feelings, thinking/learning/memory/concentration, self-esteem, bodily image and appearance, negative feelings.
• Domain 3: Level of Independence: Mobility, activities of daily living, dependence on medication or treatment, working capacity.
• Domain 4: Social Relations: Personal relationships, social support, sexual activity.
• Domain 5: Environment: Physical safety and security, home environment, financial resources, health and social care, opportunities for acquiring new information/skills, participation in leisure, physical environment, transport.
• Domain 6: Spirituality/Religion/Personal Beliefs: Spiritual life, meaning in life, strength from beliefs.

This comprehensive domain structure ensures that the assessment of QOL is holistic, reflecting the WHO‘s commitment to measuring health beyond merely the absence of disease.

Validity

The validation process for the WHOQOL-100 was rigorous and multinational, providing strong evidence for its validity across diverse cultures. **Content validity** was maximized through the collaborative international design process, ensuring that item selection and domain structure were culturally relevant and globally applicable, as detailed in the initial study protocols (WHOQOL Group, 1993).

**Construct validity** is supported by the consistent findings from confirmatory Factor Analysis, which confirms the theoretical grouping of items into the six proposed domains. Furthermore, the scale demonstrates high **criterion validity**, showing appropriate correlations with other established health and quality of life measures, and effectively differentiating between groups known to have different levels of health status, such as patients with chronic conditions versus healthy populations (Bonomi et al., 2000).

Reliability

The reliability of the WHOQOL-100 has been extensively tested across numerous languages and clinical settings, confirming its stability and internal consistency. Across the six domains, internal consistency measures, typically quantified by Cronbach’s alpha, consistently fall within the acceptable to high range (generally exceeding 0.70), indicating strong homogeneity among items within each domain.

These strong psychometrics confirm that the instrument provides dependable measurement. The robust test-retest reliability further supports its utility in longitudinal studies, ensuring that observed changes over time genuinely reflect changes in the respondent’s perceived Quality of Life rather than measurement error.

Factor Analysis

Extensive Factor Analysis was central to the development and refinement of the WHOQOL-100. The primary goal was to confirm that the scale’s structure was universal, or nearly universal, across the initial 15 participating countries. The analysis supported the derivation of 24 distinct facets which aggregate into the six overarching domains.

While minor variations in the factor loadings of individual items were observed across cultures, the overarching six-domain structure proved robust, confirming the instrument’s utility as a cross-cultural measure. This structure provides a comprehensive framework for generating domain scores and an overall QOL score, making it flexible for use in broad epidemiological surveys and targeted clinical research.

Instrument

Test Type: Self-report questionnaire / Multidimensional Quality of Life Assessment

Format: 100 core items plus 32 importance questions. Items utilize various 5-point Likert scales (e.g., intensity, satisfaction, capacity, frequency).

Language Available: Developed for global use and available in over 40 languages.

Population Group: General healthy populations, various patient groups, and individuals with chronic diseases.

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

Population Details: Developed through an international field study involving 15 centers globally to ensure cultural relevance and linguistic equivalence.

Test Methodology: The scale is self-administered, typically requiring 20 to 30 minutes to complete. Scoring involves transforming raw item scores to produce domain scores (ranging from 4 to 20) which can be further standardized to a 0–100 scale for comparative purposes.

Keywords

WHOQOL-BREF, Health measurement, Subjective well-being, International health, Psychometrics, Domain scoring, Clinical trials, Cross-cultural research.

Authors

Author ORCID Identifier: N/A (Attributed to the WHOQOL Group)

Affiliation Email addresses: N/A (Contact the World Health Organization for official correspondence)

Correspondence Address: World Health Organization (WHO), Geneva, Switzerland

Permissions & Fee and Test Year

The development of the WHOQOL-100 instrument was initiated in the early 1990s, with the core protocol published in 1993. The scale and its shorter version (WHOQOL-BREF) are generally available for non-commercial research purposes free of charge, but formal permission must be obtained from the World Health Organization.

The original PDF detailing the instrument and its development can be found on the WHO website, or accessed via the following link: The original PDF can be downloaded here: www.a4ebm.org/sites/default/files/Measuring Health.pdf

Reference’s

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.

Skevington, S.M., Bradshaw, J., Saxena, S. (1999). Selecting national items for the WHOQOL: conceptual and psychometric considerations. Soc Sci Med, 48:473–487.

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.

Items of the WHO Quality of Life Scale (WHOQOL-100)

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