The World Health Organization Quality of Life Abbreviated Version (WHOQOL-BREF) is a quality of life (QoL) assessment whose creation was sponsored by the World Health Organization (WHO) in order to develop an instrument that would be applicable across many patient populations and more importantly, many cultures. The initiative arose in part because measures of health status that have been developed in western countries have been constrained by cultural expectations and developer bias, thus the goal was to create as broad an assessment as possible concerning QoL (Garcia-Rea & LePage, 2010; Harper, 1996). The WHOQOL–BREF, which has been translated into 50 languages, contains 26 items that encompass 4 domains: physical (7 items), psychological (6 items), social relationships (3 items), and environmental (8 items). There are also 2 global questions that address overall QoL and health satisfaction (Kalfoss, Low, &Molzahn, 2008). Derived from data compiled from the original 100-item assessment, 1 highly relevant item from each of its 24 dimensions were included in the creation of the new short version as well as 2 new items (Mas-Expósito, Amador-Campos, Gómez-Benito, & Lalucat-Jo, 2011). Administered as either a self-report or interview, each question is scored along a 5-point Likert scale with respect to the person’s QoL over the last 2 weeks. Scoring uses a weighted framework with higher scores indicating better QoL. The WHOQOL-BREF can be completed in less than 10 minutes.
• Pain and discomfort
• Sleep and rest
• Energy and fatigue
• Positive feelings
• Body image and appearance
• Negative feelings
• Personal relationships
• Social support
• Sexual activity
• Freedom, physical safety, and security
• Financial resources
• Opportunities for acquiring new information and skills
Adapted from Harper, A., & Power, M. (1998). Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychological Medicine, 28(3), 552.
Twenty-four data centers representing 23 countries with 11,830 respondents established the psychometric properties of the WHOQOL-BREF where factor analysis of the 4 domains found that internal consistency was highest for the 7-item physical domain at α = 0.82, followed by the psychological domain at 0.81, the environment domain at 0.80, and lowest for the social domain at 0.68 (Skevington, Lotfy, & O’Connell, 2004). The same cohort determined that the mean scores of the 4 domains were physical at 16.2, psychological at 15.0, environment at 13.5, and social at 14.3) (Skevington et al., 2004). Another study involving data sets of 300 people determined that domain scores produced by the WHOQOL-BREF correlated highly with the original WHOQOL-100 with a range of 0.89 to 0.95 (Harper & Power, 1998). A study among patients with schizophrenia showed excellent internal consistency of α = 0.88 at baseline and 0.89 at 1-year follow-up (Mas-Expósito et al., 2011). Internal consistencies and test–retest coefficients, in a homeless substance-dependent veteran population were above 0.70 for all domains (Garcia-Rea & LePage, 2010). Divergent validity of WHOQOL–BREF showed that domain scores were negatively correlated with the Global Deterioration Scale with coefficients ranging from –0.47 to –0.76 for a Canadian sample of 192 older adults, and –0.46 to –0.59 for a Norwegian sample of 469 older adults. The same study found correlations with the Short Form 12 (an instrument that measures health and functioning status) were also statistically significant with a range from r = 0.24 to 0.78 for the Canadian sample and r = 0.21 to 0.76 for the Norwegian (Kalfoss et al., 2008).
Adapted from Skevington, S., Lotfy, M., & & O’Connell, K. (2004). The World Health Organization’s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial: A Report from the WHOQOL Group. Quality of Life Research, 13, 299–310,