The psychometric properties of the WHOQOL-BREF in Japanese couples

Modern psychometric evaluation of Thai WHOQOL-BREF and its shorter versions in patients undergoing warfarin in Thailand: Rasch analysis

Rasch analysis was employed to investigate the psychometric properties of the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its shorter versions (EUROHIS-QOL-8 and WHOQOL-5) within the context of patients undergoing warfarin in Thailand. A group of 260 patients were recruited from three public hospitals and tasked with completing the WHOQOL-BREF questionnaire. Rasch analysis showed that the WHOQOL-BREF, structured into four-domain subtests, achieved a commendable fit to the Rasch model (χ2[16] = 12.26, p = 0.73), met the criterion of unidimensionality (7.31% significant t-tests; lower bound confidence interval, 4.66), and demonstrated satisfactory reliability (PSI = 0.87). The adoption of a subtest approach facilitated an acceptable fit to the Rasch model for each domain of the WHOQOL-BREF, except for the social domain. However, the presence of local dependency of the three-item social domain was detected, so the reliability was not reported. The WHOQOL-5 proved to be unidimensional, fitting the Rasch model acceptably, and had satisfactory reliability. Conversely, the EUROHIS-QOL-8 presented local dependency; thus, reliability was not reported. Consequently, the WHOQOL-BREF in its four-domain subtests is recommended for pre- and post-HRQoL measurements, whereas the WHOQOL-5 can effectively measure HRQoL levels in between-group analyses.

Psychometric evaluation of the WHOQOL-BREF and its shorter versions for general Thai population: confirmatory factor analysis and Rasch analysis

PURPOSE

Rasch analysis was employed to validate the World Health Organization Quality of Life-BREF (WHOQOL-BREF) and its existing shorter versions in the general Thai population.

METHODS

1200 respondents were randomly selected to complete the questionnaire. Confirmatory factor analysis (CFA) was employed to test the structure of the WHOQOL-BREF and its shorter versions with the random sub-sample of 900 respondents, while Rasch analysis was performed with a random sub-sample of 300 respondents.

RESULTS

The CFA confirmed the factor structure of WHOQOL-BREF and its shorter versions. The Rasch analysis revealed that the WHOQOL-BREF, when a four-domain structure was tested using a subtest approach, achieved acceptable model fit to the Rasch model and met the expectations of unidimensionality with high reliability (PSI = 0.87). Individual domain models were also unidimensional, but reliability of the 3-item social domain was inadequate. While the 8-item EUROHIS-QOL-8 and 5-item WHOQOL-5 achieved an overall acceptable fit and met the expectations of unidimensionality, the reliability of the WHOQOL-5 was below the acceptable threshold (PSI = 0.66). Reliability of the EUROHIS-QOL-8 was satisfactory (PSI = 0.79).

CONCLUSIONS

The WHOQOL-BREF is a valid instrument for use in the Thai general population, both as a total score as well as individual subscales. Rasch analysis also supports the use of EUROHIS-QOL-8, but the WHOQOL-5 lacks good reliability. While the reliability of the EUROHIS-QOL-8 is sufficiently high for between-group analysis, the Thai WHOQOL-BREF total score can also be used for within-participant analyses. Rasch investigation with a more varied health conditions of general Thai samples or patient groups is encouraged for future studies.

Effects of real-time remote cardiac rehabilitation on exercise capacity and quality of life: a quasi-randomised controlled trial

BACKGROUND

The impact of real-time remote cardiac rehabilitation (CR) on health and disability-related outcomes and its correlation with physical function are unknown. We compared the effectiveness of real-time remote CR with that of hospital-based CR on physical function improvement and physical functions of improvement (Δ) to clarify the relationship between health and disability at baseline.

METHODS

Patients with cardiovascular diseases (CVDs) were enrolled (n = 38) in this quasi-randomised controlled trial and underwent 4 weeks of hospital-based CR, followed by 12 weeks of remote or hospital-based CR based on quasi-randomised allocation. Patients were assessed at baseline and after 12 weeks of remote or hospital-based CR using the shortened version of the World Health Organization (WHO) Quality of Life scale (WHOQOL-BREF) for subjective satisfaction, WHO Disability Assessment Schedule (WHODAS2.0-J) for objective performance, and cardiopulmonary exercise test for physical function and peak oxygen uptake (peak VO2). The trends in measured variables from baseline to the post-CR stage were analysed.

RESULTS

Sixteen patients (mean age, 72.2 ± 10.4 years) completed remote CR, and 15 patients (mean age, 77.3 ± 4.8 years) completed hospital-based CR. The post-CR physical function differed significantly between the groups (Δpeak VO2, 2.8 ± 3.0 versus 0.84 ± 1.8 mL·min-1·kg-1; p < 0.05). The differences in post-CR changes in the WHOQOL-BREF scores between the groups were insignificant. The post-CR changes in the WHODAS2.0-J scores were significantly lower in the remote CR group than in the hospital-based CR group (ΔWHODAS2.0-J score, -8.56 ± 14.2 versus 2.14 ± 7.6; p < 0.01). Forward multiple stepwise regression analysis using overall data showed that the intervention method (β = 0.339, p < 0.05), baseline cognition (β =  - 0.424, p < 0.05), and social interaction level (β = 0.658, p < 0.01; WHODAS2.0-J) were significant independent contributors to Δpeak VO2 (r2 = 0.48, F = 8.13, p < 0.01).

CONCLUSIONS

Remote CR considerably improved physical function and objective performance in patients with CVDs. Remote CR can be used to effectively treat stable patients who cannot visit hospitals.

TRIAL REGISTRATION

This interventional trial was registered at the UMIN-CTR registry (trial title: Development of remote programme for cardiac rehabilitation using wearable electrocardiograph; trial ID: UMIN000041746; trial URL: https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000046564 ; registration date: 2020/09/09).

Validation of the abbreviated version of the World Health Organization Quality of Life in Mongolia: a population-based cross-sectional study among adults in Ulaanbaatar

There is currently no validated tool to measure the quality of life (QOL) in the Mongolian language. This study aimed to validate the Mongolian version of the World Health Organization Quality of Life - Brief (WHOQOL-BREF) questionnaire for the general population of Mongolia. The subjects were 301 adults aged 18-65 years selected randomly by a computer from 30 centers in 8 districts of Ulaanbaatar, Mongolia, in 2020. Reliability was measured using Cronbach's α and intraclass correlation coefficients. Convergent, discriminant, and construct validities were examined using exploratory and confirmatory factor analyses for a four-domain factor structure. Among the participants, 56.1% were women, 32.9% held a bachelor's degree or higher, 48.8% were employed, and 61.8% were married. The overall Cronbach's α coefficient of the WHOQOL-BREF questionnaire was 0.804. Correlations between the component scores of the WHOQOL-BREF ranged from 0.581-0.822. All items showed higher item-total correlations with their corresponding domains than with other domains, except the mobility item from the physical domain. Discriminative validity was evident in physical and psychological domains. Exploratory and confirmatory factor analyses revealed a four-factorial structure consisting of 24 items that provided an acceptable fit to the data (RMSEA=0.084; CFI=0.860). In conclusion, the Mongolian version of the WHOQOL-BREF demonstrated evidence of good reliability and validity for assessing QOL in the general population of Mongolia. These findings indicate that it allows the comparison of QOL of adults in Mongolia with those in other countries.

HIV Status Disclosure and Quality of Life of People Living with HIV/AIDS in the Ho Municipality, Ghana

Background. Quality of life (QoL) and HIV/AIDS serostatus disclosure are vital HIV outcome indicators. This study examined factors associated with QoL, HIV status disclosure, and the relationship between QoL and disclosure among people living with HIV (PLWHIV) at the Ho Teaching Hospital. Methods. We conducted a hospital-based cross-sectional survey among 311 PLWHIV. The World Health Organization WHOQOL-HIV BREF questionnaire was used to measure QoL. A semistructured questionnaire was used to gather information on socio-demographics and HIV serostatus disclosure. Multivariate logistic and multiple linear regressions were used to determine predictors of HIV serostatus disclosure and QoL in six domains, respectively. Results. Overall, 88.7% of participants disclosed their HIV status to a significant relation. The majority (98.1%) presented with good QoL, high (83.3%) among participants who disclosed their HIV seropositive status. Patients on antiretroviral therapy (ART) for more than a year were 8.64 times more likely to disclose their HIV status as compared to those on ART for less than a year (AOR = 8.64 (95% CI: 2.00–37.27), $p=0.004$ ). Increasing years on ART (β = 0.37) and being employed (β = 1.31) positively predicted good QoL in the physical domain, whereas higher educational level positively predicted good QoL in the social domain (β = 0.66). QoL was not associated with HIV serostatus disclosure. Conclusion. HIV status disclosure was high. Increasing years on ART increased the odds of disclosure. Although there was no significant relationship between QoL and disclosure, good QoL was high among those who disclosed their HIV status. Increasing years on ART, higher education, and being employed predicted good QoL.

Quality of life in Vietnamese young adults: A validation analysis of the World Health Organization's quality of life (WHOQOL-BREF) instrument

BACKGROUND

The abbreviated version of the World Health Organization's Quality of Life (WHOQOL-BREF) instrument has been widely used to assess the quality of life (QOL) of different population groups.

AIMS

This study aimed to examine the validity and reliability of the Vietnamese version of WHOQOL-BREF in evaluating the QOL of Vietnamese young adults.

METHODS

The WHOQOL-BREF was validated in an online cross-sectional study among 445 young adults from 16 to 35 years in Vietnam. The exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to examine the factorial structure of the instrument. The reliability and validity of the new factorial model were evaluated.

RESULTS

The EFA and CFA suggested the 3-factor model had better fit models than the theoretical 4-factor model. The internal consistency of factor 1 "External life" and factor 2 "Internal life" were excellent (0.931) and good (0.864), respectively, while the internal consistency of factor 3 "Physical and mental health" was nearly acceptable (0.690). Results indicated that the 3-factor model had good convergent and divergent validity as well as moderate discriminant validity. Scores of factors "External life" and "Internal life" had significant predictive effects on general QOL, general health, and overall QOL (p < 0.05). Meanwhile, factor 3 "Physical and mental health" could only predict general health and overall QOL (p < 0.05).

CONCLUSION

This validation study improves understanding of the characteristics of QOL among young adults in Vietnam. While the theoretical model of WHO can be utilized for global comparisons, a new local model should be considered and cross-culturally adapted to successfully capture the progress of public health interventions for promoting young adults' QOL.

Psychometric properties of the World Health Organization Quality of Life Instrument-Abbreviated version in Portuguese-speaking adults from three different countries

OBJECTIVE

To evaluate the validity, reliability and invariance of the World Health Organization Quality of Life Instrument-Abbreviated version (WHOQOL-Bref) in Portuguese-speaking adults from three different countries.

METHODS

A total of 4,020 Brazilian, Portuguese, and Mozambican individuals participated in the study. The total sample was divided into four samples: Brazilian patients (n = 1,120), Brazilian students (n = 1,398), Portuguese students (n = 1,165) and Mozambican students (n = 337). Factorial validity of the WHOQOL-Bref was assessed by confirmatory factor analysis. The convergent and discriminant validities of the instrument were assessed using the average variance extracted (AVE) and the square of Pearson's correlational coefficient (r2), respectively. Composite reliability and ordinal alpha were used as measures of reliability. The metric, scalar, and strict invariance of WHOQOL-Bref was evaluated by multi-group analysis in independent subsamples (within each sample) and only between Brazil and Portugal (transnational invariance), because the configural model of Mozambique was different.

RESULTS

The original model of the WHOQOL-Bref did not show a good fit for the samples. Different items were excluded to fit the instrument in each sample (different models for WHOQOL-Bref among Brazilian, Portuguese, and Mozambican samples). AVE and r2 were not adequate; however, the reliability of the WHOQOL-Bref was good, except in the Mozambican sample. Invariance was observed only in independent subsamples.

CONCLUSION

The WHOQOL-Bref fitted models showed adequate factorial validity and invariance in independent subsamples. The transnational non-invariance of the WHOQOL-Bref shows the influence of culture on the operationalization of the quality of life construct.

Psychometric properties of the World Health Organization WHOQOL-BREF Quality of Life assessment in Singapore

PURPOSE

This study validated the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire with 3400 respondents living in Singapore.

METHODS

The ethnic composition was 76.1% Chinese, 12.3% Malay, 9.6% Indian, and 2% Others. The sample included adults with disabilities (28.9%), adults recovering from mental health issues (14%), and adults from the general population (57.1%). Questionnaires about health-related conditions, the effects of disability on everyday functioning (WHODAS 2.0), the WHOQOL-BREF, and add-on modules of QOL of people with disabilities (WHOQOL-DIS) and QOL of elders (WHOQOL-OLD) were administrated.

RESULTS

Confirmatory factor analysis supported a construct of QOL made of four domains, revealing good construct validity. The four domains predicted overall QOL and health satisfaction. Good internal consistency was evidenced by high alpha coefficients for the physical (.79), psychological (.82), social relationships (.81), and environment (.83) domains. Convergent validity was shown by moderate correlations between the different questionnaires measuring QOL (WHOQOL-BREF, WHOQOL-DIS, and WHOQOL-OLD), and discriminant validity by a lower correlation between the WHOQOL-BREF and disability. Convergent and divergent validity were also indicated by higher correlations between similar constructs across the different measures, and lower correlations between dissimilar constructs across measures, respectively. Concurrent validity was supported by showing that individuals with chronic medical conditions had lower QOL than individuals without chronic medical conditions.

CONCLUSIONS

The results showed that the WHOQOL-BREF has sound psychometric properties and can be used to measure QOL in Singapore.

Impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students

The aim of this study was to assess the impact of inherent aspects of body image, eating behavior and perceived health competence on quality of life of university students. Participants completed the instruments Body Shape Questionnaire (reduced version, BSQ-8B), Male Body Dissatisfaction Scale (reduced version, MBDS-R), Three-Factor Eating Questionnaire (reduced version, TFEQ-18), Perceived Health Competence Scale (bifactorial version, PHCS-B), World Health Organization Quality of Life Questionnaire-Short Form (WHOQoL-bref) and a questionnaire for characterization of sample. Psychometric properties of instruments were previously evaluated by confirmatory factor analysis. A hypothetical model for each sex was developed and tested. In both model surveys the aspects of the body image (BSQ-8B: body shape concern; MBDS-R: musculature and general body appearance), of eating behavior (TFEQ-18: cognitive restriction, emotional eating, and uncontrolled eating) and of the perceived health competence (PHCS-B: expectations of achieving the desired health results and competence in health behaviors) were used as direct predictors on quality of life (WHOQoL-bref). The variables age, medication use for body change, food supplement use for body change, and body mass index (BMI) were inserted in the aspects of the body image. The variables course shift, initial expectation regarding the course, self-reported performance in the course, concomitant work activities to studies, and economic class were inserted into the quality of life. The model surveys were evaluated using structural equation modeling. A level of significance of 5% was used. A total of 2,198 university students (female = 63.5%), including 1,151 Brazilians and 1,047 Portuguese, participated of study (locally representative samples). The average age of women was 20.8 ± 2.4 years and of men was 21.3 ± 3.3 years. The psychometric properties of the instruments were adequate, except for the PHCS, which was adjusted for each sex. The models presented variance explained of 54% and 49% for women and men, respectively. In both sexes, the students' perceived health competence and academic variables contributed significantly to their quality of life, and age, BMI, and medication and supplement use were significant factors relating to how a student views his or her body image. Women's quality of life was associated with body shape concern and emotional eating aspects. Men's quality of life was associated with general body appearance and cognitive restriction aspects. These results can be used to create and implement educational programs to improve quality of life of university students.

Sociodemographic Factors and Health-Related Characteristics That Influence the Quality of Life of Grandparent Caregivers in Zimbabwe

Very few studies have examined quality of life (QOL) in elderly carers of orphaned children in African settings. This study explored sociodemographic factors and health-related characteristics that influence QOL of grandparent carers in Zimbabwe. A cross-sectional study stratified by district was done to collect information on socioeconomic factors, health-related characteristics, and QOL of grandparent carers (N = 327; age: M = 62.4, SD = 11.2). Data were collected on socioeconomic factors, self-perceived health, health care access, chronic disease condition, health insurance status, types of health care services, and medications taken using the World Health Organization Quality of Life Questionnaire (WHOQOL-BREF). Bivariate and multivariate analyses were used to investigate the associations between QOL and the predictor variables. Caregivers' level of education (odds ratio [OR] = 3.0; confidence interval [95% CI] = [1.0, 27]), fostering orphans only (OR = 0.4; 95% CI = [0.2, 0.7]), self-perceived health (OR = 10.2; 95% CI = [4.5, 25]), medical insurance (OR = 9.8; 95% CI = [1.9, 54]), and satisfaction with health care services (OR = 2.2; 95% CI = [1.2, 4.4]) were associated with QOL, after adjusting for all influencing factors. The results confirm that QOL is compromised by specific demographic and self-rated health characteristics. Thus, eradicating poverty and providing services and changing caregiver's perceptions about self-rated health may enhance QOL among grandparent caregivers.