Validation of the factor structure of the WHOQOL-BREF using meta-analysis of exploration factor analysis and social network analysis.
Abstract
The brief version of the World Health Organization's Quality of Life Questionnaire, called WHOQOL-BREF, is an internationally applicable measurement for quality of life (QOL) and is widely used in medical and psychological research. Consistent factor structure across countries is essential for the WHOQOL-BREF. However, poor construct validity was found in Lin and Yao's systematic review study. Few studies have investigated this issue. To fill this gap, this study is the first to examine the factor structure of the WHOQOL-BREF using a meta-analysis approach through exploratory factor analysis (EFA) and social network analysis (SNA). Sixteen studies published from 1998 to April 2021 were selected from two well-known academic databases: PsycINFO and MEDLINE. The findings from EFA revealed that four- and five-factor models are acceptable. Because of the weak factor structure of the five-factor model, leading to difficulty in explaining the measurement outcome, the four-factor model was chosen. All 24 items, except Item 8, were loaded on the theoretically designed factors. The theory-based four-factor model proposed by the WHOQOL group was validated. Our results not only provide additional insight into the factor structure of the WHOQOL-BREF but also facilitate its international applicability and comparability. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Evidence from meta-analyses supports the structural validity and reliability of the four-dimensional model of the WHOQOL-BREF.
“Evidence from meta-analyses supports the structural validity and reliability of the four-dimensional model [47].”
From Psychometric validation and measurement invariance of the Health-Promoting Lifestyle Profile II in Honduran university students (2025) · cites this paper as [47]
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Best practices for your confirmatory factor analysis: A JASP and lavaan tutorial
Rogers, P. (2024) · Behavior Research Methods · doi:10.3758/s13428-024-02375-7 · Cited by 101 · see citing works
“These dynamic cutoffs are grounded in a population model proposition deduced from the meta-analysis conducted by Lin & Yao (2022) and using the R dynamic package .”
InfluentialΑντωνιάδου, Μ., Μangoulia, P., & Myrianthefs, P. M. (2023) · Healthcare · doi:10.3390/healthcare11202792 · Cited by 26 · see citing works
“In this study, we used a previously reliable study technique based on questionnaire data selection on QOL [52,55,56].”
BackgroundMethodZang, W., Liu, N., Wu, J., Wu, J., Guo, B., Xiao, N., Fang, M., Liu, Z., Zhang, Y., Wei, X., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.119679 · Cited by 16 · see citing works
Hattoh, K. A., Sienso, B. A., & Kuugbee, E. D. (2022) · Venereology · doi:10.3390/venereology2010001 · Cited by 13 · see citing works
“The domain scores were calculated by averaging the facet scores and multiplying them by 4 to make them comparable to the full version of the WHOQOL tool [22].”
MethodBest Practices for your Confirmatory Factor Analysis: A JASP and lavaan TutorialPreprint
Rogers, P. (2023) · doi:10.31219/osf.io/57efj · Cited by 7 · see citing works
Garbade, M., Kappler, S., Eglinsky, J., Kindler, H., Rosner, R., Sachser, C., & Pfeiffer, E. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-06975-1 · Cited by 5 · see citing works
Castillo-Díaz, M. A., & Periañez, C. A. H. (2025) · BMC Public Health · doi:10.1186/s12889-025-25899-9 · Cited by 4 · see citing works
Hang, X., Lü, W., Wu, Y., Kang, X., & Zhu, Y. C. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1626912 · Cited by 4 · see citing works
“The EFA was conducted using the maximum likelihood (ML) estimation method with Oblimin rotation to identify the underlying factor structure of the PE (Lin and Yao, 2022).”
Peng, Y., Xiong, E., Li, Y., Song, L., & Xi, J. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1200130 · Cited by 3 · see citing works
“In comparison and review studies (58, 59), WHOQOL-BREF has been shown to be a sound, cross-culturally valid assessment of QOL in various countries (including China).”
ResultKaplan‐Kahn, E. A., McQuaid, G. A., Lee, N., Wallace, G. L., & Yerys, B. E. (2024) · Autism in Adulthood · doi:10.1089/aut.2023.0101 · Cited by 4 · see citing works
“…reliability, criterion validity, and discriminant validity were strong across 50 reporting studies, only 41% of the studies examining the construct validity of the WHOQOL-BREF validated the four-factor model proposed by the WHO 62,63 consistent with the theoretical structure proposed by the WHO.”
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Ruparel, N., Gahlawat, N., & Choubisa, R. (2026) · Acta Psychologica · doi:10.1016/j.actpsy.2025.106174 · Cited by 2 · see citing works
Caldeira, F. I. D., Dias, I. C. S., Zamariolli, J. T., et al. (2023) · REVISTA CIÊNCIAS EM SAÚDE · doi:10.21876/rcshci.v13i3.1387 · Cited by 2 · see citing works
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Gubert, G. P., Gava, H. V., & Scherer, C. (2026) · Research Society and Development · doi:10.33448/rsd-v15i8.51553 · Cited by 1 · see citing works
“(Lin & Yao, 2022) Contudo, o instrumento validado completo não foi aplicado; portanto, esses resultados devem ser interpretados como medidas de percepção de estilo de vida e bem-estar, e não como escores formais de qualidade de vida.”
Summart, U., Sangruangake, M., Charoensaen, J., et al. (2025) · F1000Research · doi:10.12688/f1000research.161251.2 · Cited by 1 · see citing works
Summart, U., Sangruangake, M., Charoensaen, J., et al. (2025) · F1000Research · doi:10.12688/f1000research.161251.1
Longitudinal Predictors of Quality of Life in Community-Dwelling Older Adults
Zaidem, M. C. D. C. F., Lucchetti, G., Souza, J. M. N., Ávila, M. P. W., Corrêa, J. C., Passos, M. V., Oliveira, M., Ezequiel, O. D. S., & Lucchetti, A. L. G. (2025) · Activities Adaptation & Aging · doi:10.1080/01924788.2025.2506945
“Since previous factorial analyses revealed a four-factor structure, separating the instrument in 4 different outcomes/dimensions is considered an appropriate approach for the analyses (Lin & Yao, 2022).”
Systematic review of the factor structure of WHOQOL-bref in adult population
Taipe, C. M. M., Amador, J. A., Krieger, V., Miasso, A. I., Molina, N. P. F. M., & dos Santos, P. L. (2025) · Quality of Life Research · doi:10.1007/s11136-025-04115-6
“Previous systematic reviews and meta-analyses have examined the psychometric properties of the WHOQOL-bref, including recent efforts to validate its factor struc - ture using exploratory factor analysis and social network analysis [44].”
Brien, A., Bilodeau, C., & Bellehumeur, C. R. (2025) · British Journal of Guidance and Counselling · doi:10.1080/03069885.2025.2587231
“Overall, the WHOQOL-BREF was found to be a reliable instrument with high mean reliabilities and showed strong discriminant and criterion-related validity (Lin & Yao, 2022).”
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Mansoor, Z., Mchunu, X., Mthembu, N., et al. (2026) · South African Journal of Communication Disorders · doi:10.4102/sajcd.v73i1.1134
Fong, T. C. T., & Ho, R. (2026) · Applied Research in Quality of Life · doi:10.1007/s11482-026-10574-x
“For instance, Lin and Yao (2022) provided insights into the 4-factor structure of the WHOQOL-BREF on the item level that are not possible via overall domain scores.”
Lieb, M., Laskowski, N. M., Müller, R., & Paslakis, G. (2026) · BMJ Open · doi:10.1136/bmjopen-2025-109926
Gubert, G. P., Gava, H. V., & Scherer, C. (2026) · Revista da Faculdade de Ciências Médicas de Sorocaba · doi:10.23925/1984-4840.2026v28a22
- Authors
- Lin, L.-C., & Yao, G.
- Venue
- Psychological Assessment
- Published
- 2022-07
- Volume
- 34
- Issue
- 7
- Pages
- 660-670
- ISSN
- 1040-3590 (ISSN-L)
- 1939-134X
- OpenAlex
- W4221067251
- Cited by
- 23
- References
- 0
- Citations by year
- 2026: 6 · 2025: 11 · 2024: 2 · 2023: 3 · 2022: 1
- FWCI
- 0.83
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Assessment (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Science and Technology (MOST109-2410-H-002-091 -SS2)
- Topics
- Social Sciences › Decision Sciences › Management Science and Operations Research › Psychometric Methodologies and Testing
- Social Sciences › Education › Health Education and Validation
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Keywords
- WHOQOL-BREF, quality of life, factor structure, construct validity, exploratory factor analysis, social network analysis, cross-cultural comparability, international applicability, Big Five personality traits, four-factor model
- MeSH terms
- Social Network Analysis, Factor Analysis, Statistical, Humans, Psychometrics, Quality of Life, Surveys and Questionnaires, World Health Organization, Reproducibility of Results
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