Assessing quality of life in older people: psychometric properties of the WHOQOL-BREF.
ABSTRACT: The World Health Organization has developed a brief generic questionnaire to assess quality of life, the WHOQOL-BREF. It has been studied in diverse groups, but not specifically in older people. The purpose of this study was to analyze the psychometric properties of the French version of the WHOQOL-BREF questionnaire in healthy older people and to compare the mean profiles of participants with the mean profile obtained in the international validation study of the WHOQOL-BREF. Of the total sample of 262 Swiss French speaking older participants, 122 completed a retest after 2 weeks. The WHOQOL-BREF items demonstrated high test-retest reliability and validity. The WHOQOL-BREF items were differentially related to physical and mental health measures (SF-12 components, morbidity, and depression), thereby demonstrating convergent and discriminant validity. Compared to the international validation sample of the WHOQOL-BREF, participants of the present study reported higher QOL on 22 of the 26 items. A comparison of item profiles between male and female participants revealed gender differences for two items only (social support and negative feelings). We conclude that the psychometric properties of the WHOQOL-BREF items in older adults are good. To consider the 24 specific facets that are assessed by the WHOQOL-BREF appropriately, we recommend using item profiles on the individual and the sample level.
Project description:There is no disease-specific instrument to describe health-related quality of life (HRQoL) in Indian patients with asthma. However, an abbreviated World Health Organization Quality of Life questionnaire (WHOQOL-Bref), a generic Hindi HRQoL measure, has been developed and validated in India.To evaluate the WHOQOL-Bref in adult patients with asthma and to test possible modifications to the instrument to improve its psychometric adequacy.Sixty-seven patients with asthma completed the WHOQOL-Bref. Rasch analysis was used to explore the psychometric performance of the four domains (physical, psychological, social relationships and environment) of the scale. Overall fit of data to model expectations, appropriate category ordering, presence of differential item functioning, individual item fit and targeting of item difficulty to patient ability were explored for each domain. Item deletion and rescoring were applied to misfitting items to improve overall performance.The overall fit of the WHOQOL-Bref data was adequate. Item 3 (pain prevents doing work) displayed a large positive fit residual value (indicating violation of unidimensionality), resulting in poor construct validity for the physical domain. No item exhibited differential item functioning. Ten items had disordered thresholds. The WHOQOL-Bref was modified by dropping item 3 and rescoring category structures of 16 items. The modified scale had good construct validity for all domains, ordered thresholds for all items and good targeting of items to persons.The WHOQOL-Bref performed inadequately in describing HRQoL in the asthma patients studied. However, when modified by Rasch analysis, the scale proved better than the original scale.
Project description:OBJECTIVES:This study aims to assess the psychometric properties of the Chinese version of the WHOQOL-HIV BREF. DESIGN:Cross-sectional study. SETTING:Centers for Disease Control and Prevention and infectious disease hospitals in three Chinese provinces. PARTICIPANTS:Sample of 1100 people living with HIV/AIDS (PLWHA). INTERVENTIONS:We recruited 1100 PLWHA to evaluate their quality of life (QOL) using the WHOQOL-HIV BREF. Of these participants, 57 were randomly selected to repeat the QOL evaluation 2 weeks later. MAIN OUTCOME MEASURES:The reliability of the WHOQOL-HIV BREF was assessed in terms of its internal consistency and test-retest reliability. The construct, concurrent, convergent, discriminant and known-group validity were also analysed. In addition, the factorial invariance across genders was assessed. RESULTS:Cronbach's ? coefficient for the overall scale was 0.93. Except for the spirituality domain, which had an ? below 0.70 (0.66), the other five domains showed adequate internal consistency. The test-retest reliability revealed a statistically significant intraclass correlation coefficient of 0.72-0.82 (p<0.001). Confirmatory factor analysis found that the six-domain structure produced an acceptable fit to the data. The instrument showed factorial invariance across gender groups. All domains were significantly correlated with the general items and the SF-36 (p<0.01). The correlation coefficients were >0.40 (r=0.40-0.67), except for the association between the spirituality domain and two general items (QOL: r=0.33; health status: r=0.36). Subjects with lower CD4 counts had lower scores for all domains (p<0.05). Symptomatic participants had significantly lower scores than asymptomatic participants on the physical, psychological and independence domains (p<0.05). CONCLUSIONS:The WHOQOL-HIV BREF revealed good psychometric characteristics among Chinese PLWHA. These findings offer promising support for the use of the WHOQOL-HIV BREF as a measure of QOL among Chinese PLWHA and in cross-cultural comparative studies on QOL.
Project description:Quality of life (QOL) is an important outcome measure in the treatment of heroin addiction. The Taiwan version of the World Health Organization Quality of Life assessment (WHOQOL-BREF [TW]) has been developed and studied in various groups, but not specifically in a population of injection drug users. The aim of this study was to analyze the psychometric properties of the WHOQOL-BREF (TW) in a sample of injection drug users undergoing methadone maintenance treatment.A total of 553 participants were interviewed and completed the instrument. Item-response distributions, internal consistency, corrected item-domain correlation, criterion-related validity, and construct validity through confirmatory factor analysis were evaluated.The frequency distribution of the 4 domains of the WHOQOL-BREF (TW) showed no floor or ceiling effects. The instrument demonstrated adequate internal consistency (Cronbach's alpha coefficients were higher than 0.7 across the 4 domains) and all items had acceptable correlation with the corresponding domain scores (r?=?0.32-0.73). Correlations (p?<?0.01) of the 4 domains with the 2 benchmark items assessing overall QOL and general health were supportive of criterion-related validity. Confirmatory factor analysis yielded marginal goodness-of-fit between the 4-domain model and the sample data.The hypothesized WHOQOL-BREF measurement model was appropriate for the injection drug users after some adjustments. Despite different patterns found in the confirmatory factor analysis, the findings overall suggest that the WHOQOL-BREF (TW) is a reliable and valid measure of QOL among injection drug users and can be utilized in future treatment outcome studies. The factor structure provided by the study also helps to understand the QOL characteristics of the injection drug users in Taiwan. However, more research is needed to examine its test-retest reliability and sensitivity to changes due to treatment.
Project description:A healthy lifestyle includes health protective and health promoting behaviors. Health promoting lifestyle profiles have been developed, but measures of health protective behavior are still lacking. This study sought to develop a health protecting behavior scale.An initial item pool for the Health Protective Behavior Scale (HPBS) was generated based on read and referred literature and a single-item open-ended survey. An expert group screened this initial item pool using an item-level content validity index. Pilot testing was conducted. The degree of variation, the response rate, the item-total correlation coefficient, and the factor loading in factor analysis and item analysis were used to screen items using data of pilot testing. 454 subjects were recruited evaluate the psychometric properties of the HPBS. Analyses included internal consistency, test-retest reliability, factor analysis, parallel analysis, correlation analysis and criterion validity analysis.The final iteration of the HPBS was developed with 32 items and five dimensions: interpersonal support, general behavior, self-knowledge, nutrition behavior and health care. Cronbach's alpha coefficient, and test-retest reliability were 0.89 and 0.89 respectively. Correlation coefficients of the five dimensions ranged from 0.28 to 0.55. The Spearman correlation coefficient between the total scores on the WHOQOL-BREF and on the HPBS was 0.34.HPBS has sufficient validity and reliability to measure health protective behaviors in adults.
Project description:Accurate measurement of quality of life (QoL) is important for evaluation of autism services and trials of interventions. We undertook psychometric validation of the World Health Organisation measure-WHOQoL-BREF, examined construct validity of the WHO Disabilities module and developed nine additional autism-specific items (ASQoL) from extensive consultation with the autism community. The sample of 309 autistic people was recruited from the Adult Autism Spectrum Cohort-UK. The WHOQoL-BREF had good psychometric properties, including criterion, convergent, divergent and discriminant validity. The WHO Disabilities module showed adequate construct validity and reliability. The ASQoL items form a unitary factor of QoL, with one global item. Future studies can use the WHO measures alongside the ASQoL items to measure QoL of autistic people.
Project description:BACKGROUND:The worries of next of kin about their older loved ones in nursing homes can be extensive and can adversely affect their subjective experiences of their own physical, mental and social well-being. It is thus of utmost importance to measure the quality of life of next of kin in a valid and reliable way. METHODS:The design is a cross-sectional study with psychometric evaluation based on classical test theory in preparation for a planned educational intervention study on palliative care. An abbreviated version of the World Health Organization's quality-of-life self-assessment instrument WHOQOL, the Swedish WHOQOL-BREF, was completed by 254 next of kin of older persons in 30 nursing homes. Data quality was assessed via the mean, median, item response, missing values, and floor and ceiling effects. Reliability was estimated using Cronbach's alpha and corrected item-total correlations. Construct validity was estimated by Spearman's rank correlation, and model fit was assessed using confirmatory factor analysis. RESULTS:The rate of missing data was low (less than 2%). Ceiling effects ranged from 11 to 43% and were above 20% for 21 of 24 items. The corrected item-total correlations varied between 0.35 and 0.68 and were thus well above the lower limit of 0.30. Cronbach's alpha was 0.83, indicating satisfactory internal consistency. The confirmatory factor analysis indicated a fair to close model fit (comparative fit index 0.93, root mean squared error of approximation 0.06). CONCLUSIONS:The findings suggest that the WHOQOL-BREF may constitute a reliable and valid measure of quality of life for use among next of kin to older persons in nursing homes. When interpreting the results, it is important to assess the ceiling effect, as it may restrict the ability of the WHOQOL-BREF to detect true positive changes in quality of life over time. TRIAL REGISTRATION:NCT02708498.
Project description:The aim of this study was to examine the validity and reliability of the WHOQOL-BREF, a generic quality of life scale, among older people in Canada and Norway. Very similar data from the Canadian and Norwegian Field Trial data (Canada n = 192; Norway, n = 469) were analyzed and compared. Higher negatively skewed mean scores were found for all WHOQOL-BREF domains in Canada. For both study samples, missing values were highest for the sex item from the social domain. Ceiling effects were found (Canada n = 21; Norway n = 11) primarily among items in the physical and environmental domains. In both study samples, a multitrait multimethod procedure indicated items correlated most strongly with their parent domains; however, equally appreciable correlations were observed between physical, psychological, and environmental items (r = 0.33-0.64; p < 0.01). The social domain had the lowest internal consistency (α = 0.67 Canada, α = 0.55 Norway). Confirmatory factor analyses (CFA) yielded marginal goodness-of-fit between the hypothesized WHOQOL-BREF measurement model and the sample data as well as differing patterns of domain misspecification. Patterns of correlations (p < 0.01) of WHOQOL-BREF domains with WHOQOL-OLD facets, a global QOL item, the SF-12, and the geriatric depression scale provided evidence of convergent and divergent validity. Domain scores also significantly discriminated between health and unhealthy populations and presence of morbidity. Empirical support was found, in part, for the construct validity of the WHOQOL-BREF in older adults. Despite some different patterns found in the CFA, possibly due to cultural or sampling differences, it appears that the instrument is reliable, valid, and facilitates cross-cultural comparisons.
Project description:BACKGROUND:This study aimed to validate the psychometric properties of the World Health Organization Quality of Life Instrument, Short Form (WHOQOL-BREF) questionnaire for use in a rural district of Bangladesh. METHODS:This cross-sectional study recruited a multi-stage cluster random sample of 2425 participants from the rural district Narail of Bangladesh in May-July 2017. Rasch analysis was carried out using the sampled participants, as well as multiple validation random sub-samples of 300 participants, to validate four domains of the WHOQOL-BREF questionnaire: physical, psychological, social and environmental. RESULTS:The original WHOQOL-BREF appeared to be a poor fit for both sampled and sub-sampled group of participants in Narail district in all underlying domains: physical, psychological, social and environmental. Two items (sleep and work capacity) from the physical domain, two items (personal belief and negative feelings) from the psychological domain and three items (home environment, health care and transport) from the environment domain were excluded for goodness of fit of the Rasch model. The social domain exhibited reasonably reliable fitness while fulfilling all the assumptions of the Rasch model. A modified version of the WHOQOL-BREF questionnaire using five-items for the physical ([Formula: see text] = 36.47, p = 0.013, Person Separation Index (PSI) = 0.773), four-items for the psychological ([Formula: see text] = 28.30, p = 0.029, PSI = 0.708) and five-items for the environmental ([Formula: see text] = 36.97, p = 0.011, PSI = 0.804) domain was applied, which showed adequate internal consistency, reliability, unidimensionality, and similar functioning for different age-sex distributions. CONCLUSIONS:The modified WHOQOL-BREF questionnaire translated into Bengali language appeared to be a valid tool for measuring quality of life in a typical rural district in Bangladesh. Despite some limitations of the modified WHOQOL-BREF questionnaire, further application of Rasch analysis using this version or an improved one in other representative rural areas of Bangladesh is recommended to assess the external validity of the outcomes of this study and to determine the efficacy of this tool to measure the quality of life at the national rural level.
Project description:BACKGROUND:Antiretroviral therapy has prolonged the lives of those with human immunodeficiency virus (HIV), but the effects of chronic infection on their health-related quality of life (HRQoL) remain a concern. Numerous instruments have been developed to measure HRQoL, yet evidence of their cross-cultural equivalence and continued applicability is limited. We adapted the WHOQOL-HIV BREF to French and assessed its psychometric properties in a sample of community-dwelling adults living with HIV who were mostly virally suppressed. METHODS:We conducted a cross-sectional study within the ANRS CO3 Aquitaine cohort from July 2018 to May 2019. Five hundred eighty-six participants were consecutively enrolled at their HIV-consultations and completed either a web-based (n?=?406) or paper self-administered assessment (n?=?180). The means and standard deviations for items and domains were computed and the presence of floor and ceiling effects assessed. We evaluated internal consistency by calculating Cronbach's alpha coefficients per domain. We assessed construct validity by performing a Confirmatory Factor Analysis (CFA). Concurrent, convergent and discriminant validity were assessed with Pearson's correlations and known-group validity was assessed according to CD4 cell count, viral load, Centers for Disease Control and Prevention clinical categories for HIV, and hospitalization of more than 48?h within 2 years of the most recent consultation using one-way analysis of variance and independent t-tests. RESULTS:Five hundred eighty-six PLWH were included in this analysis. Their median age was 55; 73% were male; 85% were of French descent; 99% were on ART and 93% were virally suppressed. We found floor effects for one and ceiling effects for 11 items. Four of the six domains showed good internal consistency (? range: 0.63-0.79). CFA showed that the WHOQOL-HIV BREF's six-domain structure produced an acceptable fit (SRMR?=?0.059; CFI?=?0.834; RMSEA?=?0.07; 90% CI: 0.06-0.08). It showed good concurrent, convergent and discriminant validity. There was some evidence of known-group validity. The personal beliefs domain had the highest score (15.04?±?3.35) and the psychological health domain had the lowest (13.70?±?2.78). CONCLUSIONS:The French WHOQOL-HIV BREF has acceptable measurement properties. Its broad conceptualisation of HRQoL, going beyond physical and mental health, may be of particular value in our older, treatment-experienced and virally suppressed population. TRIAL REGISTRATION:ClinicalTrials.gov NCT03296202 (Archived by WebCite at http://www.webcitation.org/6zgOBArps ).
Project description:Patient Reported Outcome Measures (PROMs) assess health status and health-related quality of life from the patient/service user perspective. Our study aimed to: i. develop a PROM for recovery from drug and alcohol dependence that has good face and content validity, acceptability and usability for people in recovery; ii. evaluate the psychometric properties and factorial structure of the new PROM ('SURE').Item development included Delphi groups, focus groups, and service user feedback on draft versions of the new measure. A 30-item beta version was completed by 575 service users (461 in person [IP] and 114 online [OL]). Analyses comprised rating scale evaluation, assessment of psychometric properties, factorial structure, and differential item functioning.The beta measure had good face and content validity. Nine items were removed due to low stability, low factor loading, low construct validity or high complexity. The remaining 21 items were re-scaled (Rasch model analyses). Exploratory and confirmatory factor analyses revealed 5 factors: substance use, material resources, outlook on life, self-care, and relationships. The MIMIC model indicated 95% metric invariance across the IP and OL samples, and 100% metric invariance for gender. Internal consistency and test-retest reliability were granted. The 5 factors correlated positively with the corresponding WHOQOL-BREF and ARC subscales and score differences between participant sub-groups confirmed discriminative validity.'SURE' is a psychometrically valid, quick and easy-to-complete outcome measure, developed with unprecedented input from people in recovery. It can be used alongside, or instead of, existing outcome tools.