Expecting a good quality of life in health: assessing people with diverse diseases and conditions using the WHOQOL-BREF

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Background and objectives

Fulfilling patient expectations is central to defining a good quality of life (QoL) in health. The WHOQOL-BREF was developed using novel, person-centred methods and is a generic patient-reported outcomes measure (PROM). However, without robust psychometric performance, PROMs cannot be relied upon to assess individuals. This study investigated the WHOQOL-BREF (UK), with this use in mind.


Cross sectional with nested repeated measures.

Setting and participants

Twenty-seven disease groups or health conditions and healthy people were recruited at 38 UK sites, in a wide range of settings (n = 4628).


‘Treatment as usual’; new and alternative interventions.

Outcome measures



Respondent burden was low, as acceptability and feasibility were high. Internal consistency was excellent (0.92) and test–retest reliability good. Distinctive QoL profiles were found for diverse conditions. Musculoskeletal, psychiatric and cardiovascular patients reported the poorest QoL and also improved most during treatment. Overall, QoL was good, and best for healthy groups, supporting discriminant validity. Compared with the SF-36, WHOQOL physical and psychological domains showed good concurrent validity, although social was weak. Small or moderate effect sizes confirmed responsiveness to change in specified domains for certain conditions and interventions. Age had a small impact on reporting QoL.

Discussion and conclusion

The WHOQOL-BREF is found to be a high quality patient-centred generic tool suited to individual assessment in clinics, for research, and audit.

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