WHOQOL - World Health Organization

1 WHO/MSA/MNH/ English only Distr.: General PROGRAMME ON MENTAL Health . WHOQOL . DIVISION OF MENTAL Health AND. PREVENTION OF SUBSTANCE ABUSE. World Health Organization . U World Health Organization 1997. This document is not a formal publication of the World Health Organization (WHO), and all rights are reserved by the Organization . The document may, however, be freely reviewed, abstracted, reproduced or translated, in part or in whole, but not for sale or use in conjunction with commercial purposes. WHOQOL - MEASURING quality OF life > 1. MEASURING quality OF life . THE World Health Organization quality OF life . INSTRUMENTS. (THE WHOQOL -100 AND THE WHOQOL -BREF). Introducing the WHOQOL instruments from different populations and countries to be compared. These instruments have many The Constitution of the World Health uses, including use in medical practice, Organization (WHO) defines Health as "A research, audit, and in policy making. state of complete physical, mental, and social WHO defines quality of life as well-being not merely the absence of disease.

2 IndividualsZ perception of their position in life ..". It follows that the measurement of Health in the context of the culture and value systems and the effects of Health care must include not in which they live and in relation to their only an indication of changes in the frequency goals, expectations, standards and concerns. and severity of diseases but also an estimation It is a broad ranging concept affected in a of well being and this can be assessed by complex way by the person's physical Health , measuring the improvement in the quality of psychological state, level of independence, life related to Health care. Although there are social relationships, personal beliefs and their generally satisfactory ways of measuring the relationship to salient features of their frequency and severity of diseases this is not environment. the case in so far as the measurement of well being and quality of life are concerned. Strengths of the WHOQOL instruments WHO, with the aid of 15 collaborating centres around the World , has therefore developed The WHOQOL instruments were developed two instruments for measuring quality of life cross-culturally (the WHOQOL -100 and the WHOQOL - BREF), that can be used in a variety of cultural settings whilst allowing the results The WHOQOL -100 was developed currently being tested to assess responsiveness simultaneously in 15 field centres around the to change.

3 The WHOQOL -BREF, an World . The important aspects of quality of abbreviated 26 item version of the life and ways of asking about quality of life WHOQOL -100, was developed using data were drafted on the basis of statements made from the field-trial version of the WHOQOL - by patients with a range of diseases, by well 100. The WHOQOL instruments can be used people and by Health professionals in a in particular cultural settings, but at the same variety of cultures. The instrument was time results are comparable across cultures. rigorously tested to assess its validity and The WHOQOL is now available in over 20. reliability in each of the field centres and is different languages and its development in WHOQOL - MEASURING quality OF life > 2. further languages is progressing. HIV/AIDS. The WHOQOL instruments place primary Administration of the WHOQOL . importance on the perception of the individual instruments Most assessments in medicine are obtained The national versions of the WHOQOL .

4 By examinations by Health workers and laboratory tests. The WHOQOL instruments, The WHOQOL instruments are available in by focusing on individuals' own views of over 20 different languages. The appropriate their well being, provide a new perspective on language version, and permission for using it, disease. For example, that diabetes involves can be obtained from the appropriate poor body regulation of blood glucose is well national centre, as listed on pages 7-8. understood, but the effect of the illness on the Centres may request a copy of data collected perception that individuals have of their for collation in a national data set. A. social relationships, working capacity, and methodology has been developed for new financial status has received little systematic centres wishing to develop further language attention. The WHOQOL instruments are versions of the WHOQOL -100 or the tools that will enable this type of research to WHOQOL -BREF. This information can be be carried out.

5 They not only inquire about obtained from The WHOQOL Group, the functioning of people with diabetes, across Programme on Mental Health , World Health a range of areas but also how satisfied the Organisation, CH-1211, Geneva 27, patients are with their functioning and with Switzerland. The WHOQOL -BREF is self- effects of treatment. administered if respondents have sufficient ability: otherwise, interviewer-assisted or Systematic development of the WHOQOL -100 interview-administered forms should be used. The method used to develop the WHOQOL - Scoring the WHOQOL instruments 100 involved considerable research and checking over several years to ensure that it The WHOQOL -100 produces scores relating accurately measures the issues that are to particular facets of quality of life ( important to a person's quality of life , and positive feelings, social support, financial that it does so reliably. The institutions which resources), scores relating to larger domains participated in this research now serve as ( physical, psychological, social reference centres and can provide technical relationships) and a score relating to overall support to users in their cultural setting (see quality of life and general Health .)

6 The later section for contact information). In WHOQOL -BREF produces domain scores, return for this support, centres request a but not individual facet scores. Details on copy of data collected to be sent to them. scoring are included in manuals available from The WHOQOL Group, Programme on The Instruments have different forms for Mental Health , World Health Organisation, different uses CH-1211 Geneva 27, Switzerland. Syntax files for checking and cleaning data, and for The core WHOQOL instruments can assess computing facet and domain scores are also quality of life in a variety of situations and available from The WHOQOL Group. population groups. In addition, modules are being developed to allow more detailed Psychometric properties of the WHOQOL . assessments of specific populations ( instruments cancer patients, refugees, the elderly and those with certain diseases, such as Both the WHOQOL -100 and the WHOQOL - discriminant validity, content validity and BREF have been shown to display good test-retest reliability.

7 Their sensitivity to WHOQOL - MEASURING quality OF life > 3. change is currently being assessed. Domain In Health services evaluation scores produced by the WHOQOL -BREF. have been shown to correlate at around In the periodic review of the completeness with the WHOQOL -100 domain scores. and quality of medical services, the patients'. concerns are of importance. The instruments The Uses of the WHOQOL instruments provide an invaluable supplementary appraisal of Health care services, by yielding In medical practice a measure of the relationship between the Health care service and patients' quality of In clinical practice the WHOQOL life , and also by directly presenting a measure instruments may be used with other forms of of patients' perception of the quality and assessment, giving valuable information that availability of Health care. can indicate areas in which a person is most affected and help the practitioner in making In research the best choices in patient care.

8 In addition they may be used to measure change in The WHOQOL instruments provide new quality of life over the course of treatment. insights into the nature of disease by assessing how disease impairs the subjective well being Improving the doctor-patient relationship of a person across a whole range of areas. By increasing the physician's understanding In policy making of how disease affects a patient's quality of life , the interaction between patient and When Health providers implement new doctor will change and improve. This gives policies it is important that the effect of policy more meaning and fulfilment to the work of changes on the quality of life of people in the doctor and leads to the patient being contact with Health services is evaluated. The provided with more comprehensive Health WHOQOL instruments allow such care. Because a more complete form of monitoring of policy changes. assessment covering different aspects of The Structure of the WHOQOL -100.

9 Patients' functioning is being carried out, patients themselves may find their Health care The structure of the WHOQOL -100 reflects more meaningful. the issues that a group of scientific experts as well as lay people in each of the field centres In assessing the effectiveness and relative felt were important to quality of life . The six merits of different treatments broad domains of quality of life , and the twenty-four facets covered within each The WHOQOL instruments can form a part domain are shown below. Four items are of the evaluation of treatments. For example, included for each facet, as well as four chemotherapy for cancer may prolong a general items covering subjective overall person's life , but may only do so at QOL and Health , producing a total of 100. considerable cost to their quality of life . By items in the assessment. All items are rated using the WHOQOL instruments to look at on a five point scale (1-5). changes in the person's well being over the course of treatment, a much fuller picture can be gained.

10 Domain Facets incorporated within domains WHOQOL - MEASURING quality OF life > 4. Overall quality of life and General Health 1. Physical Health Energy and fatigue Pain and discomfort Sleep and rest 2. Psychological Bodily image and appearance Negative feelings Positive feelings Self-esteem Thinking, learning, memory and concentration 3. Level of Independence Mobility Activities of daily living Dependence on medicinal substances and medical aids Work Capacity 4. Social relationships Personal relationships Social support Sexual activity 5. Environment Financial resources Freedom, physical safety and security Health and social care: accessibility and quality Home environment Opportunities for acquiring new information and skills Participation in and opportunities for recreation/. leisure Physical environment (pollution/noise/. traffic/climate). Transport 6. Religion /Spirituality/Personal beliefs Spirituality/Religion/Personal beliefs Structure of the WHOQOL -BREF.