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Quality of life assessment instruments for adults: a systematic review of population-based studies
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Background: Against a backdrop of population aging and improving survival rates for chronic noncommunicable diseases (CNCD), researchers are placing growing emphasis on health-related quality of life (HRQoL). The aim of this study was to identify the QoL assessment instruments used in population-based studies with adults conducted around the world. Methods: A systematic review of original research published in all languages between 2008 and 2018 was conducted. Systematic reviews and meta-analyses were excluded. Results: Sixty-three articles (38.1% conducted in the Americas) fitted the eligibility criteria. Based on the AHRQ checklist for cross-sectional studies and the Newcastle-Ottawa scale for cohort studies, methodological quality was shown to be fair in the majority of studies (55.6%) and good in 44.4%. The country with the highest number of publications was Brazil (20.6%). Twelve types of generic instruments and 11 specific instruments were identified. The generic instrument SF-36 was the most frequently used measure (33.3% of studies). In-home interviewing was exclusively used by 47.6% of the studies, while 39 studies (61.9%) reported the use of self-administered questionnaires. Over two-thirds of the studies (34.9%) used questionnaires to investigate the association between chronic diseases and/or associated factors. Conclusions: It was concluded that the wide range of instruments and modes of questionnaire administration used by the studies may hinder comparisons between population groups with the same characteristics or needs. There is a lack of research on QoL and the factors affecting productive capacity. Studies of QoL in older persons should focus not only on the effects of disease and treatment, but also on the determinants of active aging and actions designed to promote it. Further research is recommended to determine which QoL instruments are best suited for population-based studies.
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![Fig. 2 Methodological quality and study characteristics. References: a. Fair quality: [8–42]. Good quality: [43–70]. b [28]. and [57]. c. Americas [8–16, 28–34, 43–49, 58], Europe [17–23, 35–38, 50–52, 57, 59–63], Asia [24–26, 39–41, 53–55, 64–69], Oceania [27, 56, 70] and Africa [42]. d. Brazil [8, 11, 13–16, 29, 33, 34, 43–45, 49], United States [9, 10, 12, 30–32, 46, 47, 58], Korea [26, 40, 41, 55, 64–68], Japan [24, 25, 53, 69], France [18, 61–63], England [19–21, 35], Germany [17, 23, 59], Denmark [37, 52, 60], Australia [27, 56, 70], Thailand [39, 54], United Kingdom [22, 57], Nigeria [42], Canada [28], Mexico [48], Laos [39], Spain [38], Sweden [36], and Switzerland [51]](/paper-figures/60253f0e0882431dac883ac3624682a1/quality-of-life-assessment-instruments-for-adults-a-systematic-review-of-figure-2.jpg)
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“Measures of quality of life are praised to be multi-dimensional and broadly applicable, but are often criticized for not being sensitive to specific aspects of quality of life for different health conditions (Pequeno et al., 2020).”
From A Systematic Review and Meta-Analysis Exploring Effects of Third-Wave Psychological Therapies on Hearing-Related Distress, Depression, Anxiety, and Quality of Life in People With Audiological Problems. (2022) · cites this paper as Pequeno et al., 2020
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“Another systematic review of 63 studies using generic measurement tools to assess quality of life among adults in the general population pointed out that 33.3% of the research had used the SF-36 (Pequeno et al. 2020).”
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“3% of the 63 articles included in the analysis were using SF-36 for QoL assessment [30].”
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BackgroundImpact of epilepsy surgery on quality of life: Systematic review and meta‐analysis
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“The number of NOS stars was then converted to the trichotomised standard (good, fair, and poor) developed by the Agency for Healthcare Research and Quality (AHRQ) as follows [21]:”
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Wen, H., Yang, Z.-F., Zhu, Z., Han, S., Zhang, L., & Hu, Y. (2022) · Health and Quality of Life Outcomes · doi:10.1186/s12955-021-01910-w · Cited by 27
“Nonetheless, they are not conducive to use in comparisons across populations [88, 89].”
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“Each assessed study is then graded out of a total score of 9 and further categorized into high (fewer than 4), moderate (4 to 6), and low (7 to 9) risk of bias [11].”
The Impact of Cardiac Devices on Patients’ Quality of Life—A Systematic Review and Meta-Analysis
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“Individuals’ goals, expectations, standards, and desires significantly affect their physical and psychological condition, level of independence, social relationships, and beliefs [21, 22].”
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Changes in metabolic syndrome affect the health-related quality of life of community-dwelling adults
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“The most commonly used questionnaires to calculate QALYs are Health Utility Index mark 3 (HUI3), Euroqol-5D (EQ-5D), and Short-Form 6D (based upon SF36) [29–32].”
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“social relations, beliefs, and the relationship with the outstanding characteristics of the environment [21].”
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“The WHOQOL has been used widely in many different settings and conditions (often in its abbreviated version) [4, 5].”
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“However, based on the search of literature, a wide range of instruments were used for QOL assessment in older adults with MCI 66 .”
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Vederhus, J., Timko, C., Birkeland, B., Haugland, S. H., & Gabrielsen, K. B. (2024) · PLoS ONE · doi:10.1371/journal.pone.0307539 · Cited by 8
Exploring the Quality of Life (QOL) of medical students in Karachi, Pakistan
Bilawal, M., Shafique, R., Ansari, R. S., Bashir, M. A., Nadeem, M., Qayyum, S. N., Shah, H. H., Tehseen, A., Alnemr, L., & Noori, S. (2024) · BMC Medical Education · doi:10.1186/s12909-024-05481-4 · Cited by 8
“The QoL can be evaluated with a wide variety of instruments including the WHO-QOL (World Health Organization Quality of life), the EuroQol Group’s EQ-5D, the Short Form health surveys (SF-36 & SF-12) and Q-LES-Q (Quality of life Enjoy-ment and Satisfaction Questionnaire) [3].”
MethodAlthomali, O. W., Amin, J., Shaik, D. H., Alghamdi, W., Ibrahim, A. A., Hussein, H. M., & Kanwal, R. (2024) · Journal of Multidisciplinary Healthcare · doi:10.2147/jmdh.s449152 · Cited by 8
“15 19 Only a small number of studies have examined the long-term effect of COVID-19 on HRQoL within 12 months and beyond.”
Chiaranai, C., Chularee, S., Prawatwong, W., & Srithongluang, S. (2023) · Pacific Rim International Journal of Nursing Research · doi:10.60099/prijnr.2023.262244 · Cited by 6
Wickramasinghe, N. D., Ratnayake, H. E., Perera, R. A., & Agampodi, S. B. (2022) · Quality of Life Research · doi:10.1007/s11136-022-03230-y · Cited by 11
“The global evidence on QoL has steadily increased over the recent years with the cross-cultural adaptation and validation of assessment instruments in different languages [3].”
BackgroundBushey, M. A., Kroenke, K., Baye, F. M., & Lourens, S. G. (2021) · General Hospital Psychiatry · doi:10.1016/j.genhosppsych.2021.06.003 · Cited by 9
“the most widely used assessment of health-related quality of life [14, 15] Another multidimensional measure, the Patient-Reported Outcomes Measurement Information System (PROMIS) was developed by the National Institute of Health to provide a well-validated,”
MethodHongoro, D. J., Kengne, A. P., & Alaba, O. A. (2025) · SSM - Health Systems · doi:10.1016/j.ssmhs.2025.100076 · Cited by 10
Grim, S., Kotz, A., Kotz, G., Halliwell, C., Thomas, J. F., & Kessler, R. S. (2024) · Scientific Reports · doi:10.1038/s41598-024-80064-3 · Cited by 6
Wiehn, J., Kurth, T., Ravens‐Sieberer, U., Prugger, C., Piccininni, M., & Reiß, F. (2024) · Frontiers in Pediatrics · doi:10.3389/fped.2024.1252964 · Cited by 8
Hajilo, P., Imani, B., Zandi, S., Mehrafshan, A., & Khazaei, S. (2024) · Heliyon · doi:10.1016/j.heliyon.2024.e35435 · Cited by 7
“This questionnaire was completed before surgery and in the first and sixth months after surgery [19].”
BackgroundHarinath, G., Zalzala, S., Nyquist, A., Wouters, M. C. A., Isman, A., Moel, M., Verdin, E. M., Kaeberlein, M. R., Kennedy, B. K., & Bischof, E. Y. (2024) · Ageing Research Reviews · doi:10.1016/j.arr.2024.102293 · Cited by 9
“…Examination Survey (NHANES), the Medical Outcomes study, the National Health Interview Survey (NHIS), and the Medical Expenditure Panel Survey (MEPS) (CDC, 2015; Kaplan and Hays, 2022; Pequeno et al., 2020; Sonnega et al., 2014; Stanziano et al., 2010; Weng et al., 2020; Yin et al., 2016).”
MethodPrehabilitation for people undergoing cardiac surgery
Skorupska, N., Perry, R., Collis, P., Dawson, S., Taylor, R. S., Cleland, J. G., Akowuah, E., Gibbison, B., Murphy, G. J., Levett, D., et al. (2024) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015336 · Cited by 7
Low Correlation between Gait and Quality of Life in Advanced Knee Osteoarthritis
Freijo, V., Navarro, C., Molina, B., & Villalba, J. (2023) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk8020077 · Cited by 7
Song, J., Chen, J., & Lin, C.-C. (2022) · Evidence-Based Complementary and Alternative Medicine · doi:10.1155/2022/6813756 · Cited by 7
RetractedPequeno, N., Cabral, N. L. D. A., Oliveira, Â., Crispim, S., Rocha, C., Marchioni, D., Lima, S., & Lyra, C. D. O. (2022) · Frontiers in Public Health · doi:10.3389/fpubh.2022.893601 · Cited by 7
Self-citationBurkauskas, J., Podlipskytė, A., Kažukauskienė, N., Mickuvienė, N., & Taroza, S. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1284859 · Cited by 7
Jacobs, M., Evans, E., & Ellis, C. (2023) · Heart and Mind · doi:10.4103/hm.hm-d-23-00025 · Cited by 6
Bugarin, J. D., Šarić, L., Delić, N., Došenović, S., Ilić, D., Saric, I., Stipić, S. S., & Duplančić, B. (2023) · Journal of Intensive Care Medicine · doi:10.1177/08850666231158547 · Cited by 13
Lupus Erythematosus Quality of Life Questionnaire (LEQoL): Development and Psychometric Properties
Castellano-Rioja, E., Giménez‐Espert, M. D. C., & Soto-Rubio, A. L. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17228642 · Cited by 25
“In this way, we also minimize possible biases related to the use of different measuring instruments allowing the comparison between population groups with similar characteristics or needs [37].”
BackgroundHow Are You Doing… Really ? A Review of Whole Person Health Assessments
Gold, S. B., Costello, A., Gissen, M., Odman, S., Green, L. A., Stange, K. C., Rl, S., & Etz, R. (2025) · Milbank Quarterly · doi:10.1111/1468-0009.12727 · Cited by 5
Neelima, M., & Chivukula, S. K. (2023) · Journal of Family Medicine and Primary Care · doi:10.4103/jfmpc.jfmpc_739_23 · Cited by 8
Parra-Soto, S. L., Durán‐Agüero, S., Vargas-Silva, F., Vázquez-Morales, K., & Pizarro-Mena, R. A. (2023) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph20237096 · Cited by 5
“…in relation to their objectives, expectations, norms and concerns, which, in its multidimensional character, considers aspects of the physical health, psychological state, level of autonomy, social relationships, beliefs and the relationship with the salient characteristics of the environment [44].”
BackgroundQuality of Life of Patients With Inflammatory Bowel Disease in Bangladesh
Ghosh, C. K., Islam, S., Tabassum, N., Mohiuddin, S., Hossain, M. M., Sarkar, A., & Bari, A. (2023) · Cureus · doi:10.7759/cureus.39929 · Cited by 5
“Although EQ-5D-5L is not IBD-specific, it has been used in the general population and in a wide variety of chronic diseases across numerous countries for a long time and has been widely validated and refined over time [12,13,15].”
BackgroundQuality of life of dental patients treated with laser surgery: A scoping review
Bandara, D. L., Kanmodi, K., Salami, A., Amzat, J., & Jayasinghe, R. (2023) · Health Science Reports · doi:10.1002/hsr2.1368 · Cited by 5
Ghahremani, L., Nazari, M., Bahadori, F., Yarelahi, M., Abbasi, F., & Karimi, M. (2023) · Gerontology and Geriatric Medicine · doi:10.1177/23337214231185915 · Cited by 4
Takahashi, M., Kinoshita, T., Maruyama, K., & Suzuki, T. (2022) · Nutrients · doi:10.3390/nu14132579 · Cited by 5
“Furthermore, compared to premenopausal women, postmenopausal women had higher stress and lower QOL scores with more plasma lipid peroxide levels [36].”
BackgroundInfluentialMello, J. D. A., Luo, H., Hirdes, A., Heikkilä, J., Umubyeyi, B., Gishoma, D., Saari, M., Hirdes, J. P., & Audenhove, C. V. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.719994 · Cited by 4
“In practice, many instruments are in place to identify mental health diagnoses and measure treatment outcomes, but there fewer standardized instruments routinely collect information about self-reported QoL, especially across different types of mental health settings (20).”
BackgroundBenazizi, I., Bernal-Soriano, M. C., Pardo, Y., Ribera, A., Peralta, A., Ferrer, M., Jaquete, A. A., Alonso, J., Lumbreras, B., & Parker, L. A. (2021) · Health and Quality of Life Outcomes · doi:10.1186/s12955-021-01818-5 · Cited by 6
“There are generic instruments to measure quality of life that can be used both in the general population and in all disease groups [12, 13].”
BackgroundEltaybani, S., Li, C., Fukui, C., Igarashi, A., Sakka, M., Noguchi‐Watanabe, M., & Yamamoto‐Mitani, N. (2025) · Geriatric Nursing · doi:10.1016/j.gerinurse.2025.03.058 · Cited by 3
Liem, A., Hui, J.-C., Velaithan, V., Norman, R., Reidpath, D. D., & Su, T. T. (2025) · Osong Public Health and Research Perspectives · doi:10.24171/j.phrp.2024.0076 · Cited by 4
“This finding supports a recent systematic review of population-based QoL assessments, which recommended active aging to prevent QoL decline due to sedentary lifestyles [4].”
Mestre, D., Orive, M., Gascón, M., Bilbao‐González, A., Erkoreka, L., González, N., & Quintana, J. M. (2025) · Current Psychology · doi:10.1007/s12144-025-07317-w · Cited by 3
“These illnesses are some of the most prevalent chronic pathologies in Spain (Soriano et al., 2018; WHO: Non Communicable Diseases , 2021 ), affect mental and physical integrity and are related to impaired HRQoL (Pequeno et al., 2020).”
Luquiens, A., Panjo, H., Bonnaire, C., & Pelletier‐Fleury, N. (2024) · Quality of Life Research · doi:10.1007/s11136-024-03835-5 · Cited by 4
“Such instruments can be used in clinical or population-based studies [6] or at the patient's bedside to assess changes in their clinical condition.”
Carvalho, A. V., Barroso, V. F. L., Baeta, C. C. L., Soares, A. N., & Drummond‐Lage, A. P. (2024) · Psychology Health & Medicine · doi:10.1080/13548506.2024.2422113 · Cited by 6
“The generic quality-of-life assessment tools provide a thorough evaluation of the impacts on health status, as stated by Pequeno et al. (2020).”
Sabău, D. T., Moca, A., Juncar, R., Bota, T., & Juncar, M. (2024) · Journal of Clinical Medicine · doi:10.3390/jcm13226865 · Cited by 4
Cancer patients’ satisfaction with day care unit services have impact on their quality of life
Vastardi, M., Govina, O., Kalokairinou, A., Tsamasiotis, G., & Kalemikerakis, I. (2024) · Medicine and Pharmacy Reports · doi:10.15386/mpr-2846 · Cited by 4
“Cancer patients’ quality of life is known to be diminished as it has been associated with disorders of mental, physical [4,5], emotional, social nature [6], role functioning [7-9] and global status of health/Qol [10].”
Zhao, K., Xu, J., Zhao, J., Chen, R., Wang, Y., Ye, X., & Zhou, F. (2024) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-024-06870-9 · Cited by 3
“…the Visual Analog Scale for Self-rated General Health (GH-VAS) [66], EuroQol Five Dimension Questionnaire (EQ-5D) [67], Short-form Health Questionnaire version 2 (SF36v2) [68] and World Health Organization Quality of Life Scale-Brief Form Questionnaire (WHOQOL-BREF) [69] were used in the RCTs.”
MethodTimmerman, A., Totsika, V., Lye, V., Crane, L., Linden, A. H., & Pellicano, E. (2024) · Autism · doi:10.1177/13623613241287586 · Cited by 6
“A classification checklist was created based on the QoL measures identified in systematic reviews by Ayres et al. (2018), Haraldstad et al. (2019) and Pequeno et al. (2020) (see supplementary materials).”
Chen, Y.-J., Lau, J., Alhamdah, Y., Yan, E., Saripella, A., Englesakis, M., He, D., & Chung, F. (2024) · PLoS ONE · doi:10.1371/journal.pone.0308842 · Cited by 4
Quality of Life of deaf adolescents in high school: A systematic literature review.
Madhesh, A. (2024) · Research in Developmental Disabilities · doi:10.1016/j.ridd.2024.104764 · Cited by 4
van Doorn, T., Coolen, R., Groen, J., Scheepe, J., & Blok, B. (2024) · Therapeutic Advances in Urology · doi:10.1177/17562872241303447 · Cited by 4
Sianturi, E. I., Izzah, Z., Huda, K., Sada, E. M., Perwitasari, D. A., Mantiri, S. Y. Y., & Gunawan, E. (2023) · Pan African Medical Journal · doi:10.11604/pamj.2023.46.61.41521 · Cited by 3
“Similarly, a complete understanding of objective indicators and how to select them requires that we understand people´s values, and have knowledge about how objective indicators influence people´s experience of well-being [1].”
BackgroundVetrugno, L., Sala, A., Deana, C., Meroi, F., Grandesso, M., Maggiore, S. M., Isola, M., Martino, M. D., Restaino, S., Vizzielli, G., et al. (2023) · Frontiers in Medicine · doi:10.3389/fmed.2023.1225648 · Cited by 5
Metadata
- Authors
- Pequeno, N. P. F., Cabral, N. L. D. A., Marchioni, D. M., Lima, S. C. V. C., & Lyra, C. D. O.
- Affiliations
- Universidade Federal do Rio Grande do Norte (BR)
- Universidade de São Paulo (BR)
- Corresponding author
- Pequeno, Nila Patrícia Freire
- ORCID
- Venue
- Health and Quality of Life Outcomes
- Published
- 2020-06-30
- Volume
- 18
- Issue
- 1
- Pages
- 208-208
- ISSN
- 1477-7525 (ISSN-L)
- PMC
- PMC7329518
- OpenAlex
- W3039908902
- Cited by
- 252
- References
- 91
- Citations by year
- 2026: 30 · 2025: 43 · 2024: 60 · 2023: 50 · 2022: 44 · 2021: 23 · 2020: 2
- FWCI
- 4.84
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Health and Quality of Life Outcomes (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, cc-by)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (publishedVersion, other-oa)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Postgraduate Program in Public Health at Federal University of Rio Grande do Norte (23077.014305/2019-29)
- Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Finance Code 001)
- Topics
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Health Systems, Economic Evaluations, Quality of Life
- Health Sciences › Nursing › Research and Theory › Health Education and Validation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Aging, Health, and Disability
- Keywords
- health-related quality of life, quality of life instruments, population-based study, adults, SF-36, questionnaire administration mode, non-communicable diseases, active ageing, older adults, methodological quality
- MeSH terms
- Adult, Aged, Aged, 80 and over, Cross-Sectional Studies, Female, Humans, Male, Psychometrics, Quality of Life, Surveys and Questionnaires
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