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
Abstract
Quality of life (QOL) assessments that are easily administered and which do not impose a great burden on the respondent are needed for use in large epidemiological surveys, clinical settings and clinical trials. Using data from the WHOQOL-BREF field trials, the objectives of this work are to examine the performance of the WHOQOL-BREF as an integrated instrument, and to test its main psychometric properties. The WHOQOL-BREF is a 26-item version of the WHOQOL-100 assessment. Its psychometric properties were analysed using cross-sectional data obtained from a survey of adults carried out in 23 countries (n = 11,830). Sick and well respondents were sampled from the general population, as well as from hospital, rehabilitation and primary care settings, serving patients with physical and mental disorders and with respect to quotas of important socio-demographic variables. The WHOQOL-BREF self-assessment was completed, together with socio-demographic and health status questions. Analyses of internal consistency, item-total correlations, discriminant validity and construct validity through confirmatory factor analysis, indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and performs well in preliminary tests of validity. These results indicate that overall, the WHOQOL-BREF is a sound, cross-culturally valid assessment of QOL, as reflected by its four domains: physical, psychological, social and environment.
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PF/PI measures yielded significant relationships with global quality of life, with higher PF and lower PI related to higher QoL.
“PF/PI measures yielded significant relationships with global QoL measures (i.e., higher PF and lower PI related to higher QoL), which represent a broad overview of biopsychosocial health (Skevington et al., 2004).”
From Psychological flexibility in older adulthood: a scoping review. (2023) · cites this paper as Skevington et al., 2004
The WHOQOL-BREF consists of 26 items rated on a five-point Likert scale, with two general items and 24 items grouped into four domains: physical (7 items), psychological (6 items), social (3 items), and environmental (8 items).
“This scale was developed by the World Health Organization (WHO) and consists of 26 items rated on a five-point Likert scale [45, 46].”
From Psychometric validation and measurement invariance of the Health-Promoting Lifestyle Profile II in Honduran university students (2025) · cites this paper as [45]
The WHOQOL-BREF internal consistency is acceptable (α = 0.7).
“The internal consistency of the questionnaire is acceptable (α = 0.7 [43]).”
The WHOQOL-BREF has adequate psychometric properties, with Cronbach's coefficient alpha values ranging from .68 to .82.
“The scale has been shown to have adequate psychometric properties, with Cronbach’s coefficient alpha values ranging from.68 to.82 (68).”
From Ayahuasca-assisted meaning reconstruction therapy for grief: a non-randomized clinical trial protocol (2025) · cites this paper as [68]
The WHOQOL-BREF is a valid and reliable instrument for assessing quality of life.
“The WHOQOL-BREF [86], a 26-item short form of the WHOQOL-100, is a valid and reliable instrument for assessing quality of life [87].”
From Metacognitive Training for Obsessive-Compulsive Disorder: A study protocol for a randomized controlled trial (2020) · cites this paper as [87]
The WHOQOL-BREF has good to excellent psychometric properties of reliability and validity.
“Analyses indicate that the WHOQOL-BREF has good to excellent psychometric properties of reliability and validity [29].”
From CareACT - internet-based intervention for enhancing the psychological well-being of elderly caregivers - a study protocol of a controlled trial (2019) · cites this paper as [29]
The QOL_BR23 questionnaire has acceptable internal consistency (Cronbach's alpha 0.73-0.89) based on WHO field trials.
“Koroonbakh Alfa Coefficient has been reported between %73 to %89 for quadruple subscales and whole scale (Skevington, Lotfy, &O , Connel, 2004).”
From The effectiveness of group psychotherapy based on acceptance and commitment on increasing of mental health and the quality of women's life with breast cancer (2015) · cites this paper as Skevington, Lotfy, &O , Connel, 2004
The short version of the WHO Quality of Life Questionnaire consists of 26 items and has demonstrated good reliability and validity.
“The short version of the WHO Quality of Life Questionnaire will be used to measure the CSO’s quality of life; it consists of 26 items and has demonstrated good reliability and validity.53”
The WHOQOL-BREF psychological quality of life component has good to excellent internal consistency, discriminant validity, and construct validity.
“The entire measure and its psychological QoL component have good to excellent internal consistency, discriminant validity, and construct validity (Skevington et al., 2004).”
From The feasibility and preliminary effects of a pilot randomized controlled trial: Videoconferencing acceptance and commitment therapy in distressed family caregivers of people with dementia. (2023) · cites this paper as Skevington et al., 2004
The WHOQOL-BREF shows good to excellent psychometric properties.
“The WHOQOL-BREF shows good to excellent psychometric properties (Skevington et al., 2004).”
From Supported Web-Based Acceptance and Commitment Therapy for Older Family Caregivers (CareACT) Compared to Usual Care. (2022) · cites this paper as Skevington et al., 2004
The psychoeducational studies used either the 12-Item Short Form Health Survey or the WHOQOL-BREF to assess QoL of carers.
“However, these studies used either the 12-Item Short Form Health Survey (Ware et al. , 1996) or the WHOQOL-BREF (Skevington et al. , 2004) to assess QoL of carers.”
From Which interventions work for dementia family carers?: an updated systematic review of randomized controlled trials of carer interventions. (2018) · cites this paper as Skevington et al., 2004
The WHOQoL-BREF has good psychometric properties.
“The WHOQoL-BREF has good psychometric properties (Skevington et al., 2004).”
From Feasibility, Acceptability and Preliminary Efficacy of Dialectical Behavior Therapy for Autistic Adults without Intellectual Disability: A Mixed Methods Study (2022) · cites this paper as Skevington et al., 2004
The WHO-QOL-BREF has good to excellent psychometric properties.
“The WHO-WOL-BREF has been shown to have good to excellent psychometric properties.42”
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“In addition, we will use three items of the WHOQOLBREF [49] to measure satisfaction with oneself and life in general: “How much do you enjoy life?"; “To what extent do you feel your life to be meaningful?"; “How satisfied are you with yourself?”.”
MethodSexual functioning in military personnel: preliminary estimates and predictors
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- Authors
- Skevington, S. M., Lotfy, M., & O'Connell, K. A.
- Affiliations
- University of Bath (GB)
- World Health Organization (CH)
- Corresponding author
- Skevington, S.M.
- ORCID
- Skevington, S.M.
- Venue
- Quality of Life Research
- Published
- 2004-03
- Volume
- 13
- Issue
- 2
- Pages
- 299-310
- ISSN
- 0962-9343 (ISSN-L)
- 1573-2649
- OpenAlex
- W2109935313
- Cited by
- 4,686
- References
- 15
- Citations by year
- 2026: 318 · 2025: 339 · 2024: 326 · 2023: 316 · 2022: 337 · 2021: 376 · 2020: 346 · 2019: 304 · 2018: 256 · 2017: 254 · 2016: 220 · 2015: 255 · 2014: 218 · 2013: 187 · 2012: 164
- FWCI
- 93.17
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Quality of Life Research (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Economic and Social Research Council (M569255001)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Education › Health Education and Validation
- Keywords
- WHOQOL-BREF, quality of life assessment, psychometric properties, cross-cultural validity, internal consistency, construct validity, discriminant validity, WHOQOL-100, self-report questionnaire, physical health, mental health, social health, environmental health
- MeSH terms
- Adolescent, Adult, Aged, Aged, 80 and over, Child, Cross-Sectional Studies, Cross-Cultural Comparison, Female, Humans, Male, Middle Aged, Psychometrics, Quality of Life, World Health Organization, Sickness Impact Profile
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