Terrence Steyer, M.D.
Chair, Department of Family Medicine
The WHO Quality of Life Group (1998)
The WHOQOL-100 was developed simultaneously in 15 international centers. Development was through the process of item creation, focus groups, pilot tests, and field tests. From an initial global pool of 100 questions, 236 were selected for pilot studies. The final 100 items were grouped into one facet examining overall quality of life and general health perceptions, and 24 quality of life facets which were originally grouped into six larger domains: Physical, Psychological, Level of Independence, Social Relationships, Environment, and Spirituality. Subsequently, the domains of Independence and Spirituality were folded into the Physical and Psychological domains. Most of the participants completed the survey themselves, although a small number with literacy problems were given the survey as a structured interview. Items are scored on a 5-point Likert scale with only the anchor points being specified (never-always, etc.).
Internal reliabilities of the 25 facets (as measured by Cronbach alpha) range from 0.65 to 0.93. The universality of the WHOQOL-100 was examined in several ways and was found to be remarkably adept at identifying facets of quality of life which are cross-culturally important (WHOQOL Group 1998, Power et al. 1999). Unpublished data show that test-retest reliability is very good (Power et al. 1999). Confirmatory factor analysis of the instrument showed that the 6-domain model was not as good a fit as the 4-domain model leading to the decision to fold two of the domains into the other four.
In a separate survey of the general population in Britain the WHOQOL-100 was shown to have excellent internal reliability (Skevington 1999). The scores discriminate well between sick and well people and concur with reported health status.
The original development (WHOQOL Group 1998) comparatively assessed data from young (18-44), middle-aged (45-64), and older (65+) populations. The survey protocol called for 50% of the individuals to be 45 years or older. Struttmann et al. (1999) used the WHOQOL-100 to assess QOL in patients with either dementia(average age 73) or cancer (average age 53). They concluded that the instrument is a powerful tool for assessing QOL in these diseases.
The WHOQOL was developed specifically to be a cross-cultural measurement tool. It has been tested extensively around the world in countries including the USA, several European countries, Russia, India, China, Japan, Australia, Panama, and Zimbabwe (among others).
Numerous followup studies have been conducted. Skevington et al. (2001a) report that the WHOQOL-100 is a reliable and valid measure of the effects of a pain management program in patients suffering from chronic pain. The WHOQOL is also an excellent instrument for measuring QOL in depressed patients (Skevington and Wright 2001b, Bonicatto et al. 2001). The WHOQOL-100 proved to be a more sensitive measure of change in quality of life following liver transplantation than the SF-36 (O'Carroll et al. 2000). Chinese (Wang et al. 2001), Danish (Norholm and Bech 2001), and Portuguese (Fleck et al. 2000) translations have subsequently been tested and show good reliability and validity.
The WHOQOL-100 has become one of the standard QOL measures in existence. Its international and multicultural aspects make it a very useful instrument. It demonstrates excellent reliability and validity. It has been used extensively in a variety of settings around the world.
M. Power, Royal Edinburgh Hospital, Department of Psychiatry
University of Edinburgh, Edinburgh, EH10 5HF UK
Bonnicatto, S.C., M. A. Dew, R. Zarateigui, L. Lorenzo, P. Pecina (2001) Adult outpatients with depression: Worse quality of life than in other chronic medical diseases in Argentina. Soc. Sci. Med., 52(6), 911-919.
Fleck, M.P.A., O.F. Leal, S. Louzada, M. Xavier, E. Chachamovich, G. Vieira, L. dos Santos, V. Pinzon (2000) Development of the Portuguese version of the WHO evaluation instrument of quality of life. Rev. Brazileira de Psiquiatria, 21(1) 19-28.
Norholm, V. and P. Bech (2001) The WHO Quality of Life (WHOQOL) questionnaire: Danish validation study. Nordic J. Psychiatry, 55(4), 229-235.
O'Carroll, R.E., J.A. Cossar, M.C. Couston, and P.C. Hayes (2000) Sensitivity to change following liver transplantation: A comparison of three instruments that measure quality of life. J. Health Psychol. 5(1), 69-74.
Power, M., A. Harper, M. Bullinger, The WHO Quality of Life Group (1999) The World Health Organization WHOQOL-100: Tests of the universality of quality of life in 15 different cultural groups worldwide. Health Psychol., 18(5), 495-505.
Skevington, S.M. (1999) Measuring quality of life in Britain: Introducing the WHOQOL-100. J. Psychosomatic Res., 47(5), 449-459.
Skevington, S.M., M.S. Carse, A. de C. Williams (2001a) Validation of the WHOQOL-100: Pain management improves quality of life for chronic pain patients. Clin. J. Pain, 17(3) 264-275.
Skevington, S.M. and A. Wright (200b1) Changes in the quality of life of patients receiving antidepressant medication in primary care: Validation of the WHOQOL-100. Br. J. Psychiatry, 178, 261-267.
Struttmann, T., M. Fabro, G. Romieu, G. de Roquefeuil, J. Touchon, T. Dandekar, and K. Ritchie (1999) Quality-of-life assessment in the old using the WHOQOL 100: Differences between patients with senile dementia and patients with cancer. Int. Psychogeriatrics, 11(3), 273-279.
Wang, G., Y. Huang, D. Zang (2001) Quality of life of nurses in a general hospital. Chinese Mental Health J., 15(5) 308-311.
The WHOQOL Group (1994) Development of the WHOQOL: Rationale and current status. Int. J. Mental Health. 23(3), 24-56.
The WHOQOL Group (1995) The World Health Organization Quality of Life Assessment (WHOQOL): Position paper from the World Health Organization. Soc. Sci. Med. 41, 1403-1409.
The WHOQOL Group (1998) The World Health Organization Quality of Life Assessment (WHOQOL): Development and general psychometric properties. Soc. Sci. Med. 46, 1569-1585.