WHOQOL-BREF

INTRODUCTION, ADMINISTRATION, SCORING

AND GENERIC VERSION OF THE

ASSESSMENT

Field Trial Version

December 1996

PROGRAMME ON MENTAL HEALTH

WORLD HEALTH
ORGANIZATION GENEVA
 This manual was drafted by Alison Harper on behalf of the WHOQOL group. The
WHOQOL group comprises a coordinating group, collaborating investigators in each of the
field centres and a panel of consultants. Dr J. Orley directs the project. He has been assisted
in this by Professor M. Power, Dr W. Kuyken, Professor N. Sartorius, Dr M. Bullinger
and Dr A. Harper. The field centres involved in initial piloting of the WHOQOL were:
Professor H. Herrman, Dr H. Schofield and Ms B. Murphy, University of Melbourne,
Australia; Professor Z. Metelko, Professor S. Szabo and Mrs M. Pibernik-Okanovic,
Institute of Diabetes, Endocrinology and Metabolic Diseases and Department of Psychology,
Faculty of Philosophy, University of Zagreb, Croatia; Dr N. Quemada and Dr A. Caria,
INSERM, Paris, France; Dr S. Rajkumar and Mrs Shuba Kumar, Madras Medical College,
India; Dr S. Saxena and Dr K. Chandiramani, All India Institute of Medical Sciences, New
Delhi, India; Dr M. Amir and Dr D. Bar-On, Ben-Gurion University of the Negev, Beer-
Sheeva, Israel; Dr Miyako Tazaki, Department of Science, Science University of Tokyo,
Japan and Dr Ariko Noji, Department of Community Health Nursing, St Luke's College of
Nursing, Japan; Dr G. van Heck and Mrs J. De Vries, Tilburg University, The Netherlands;
Professor J. Arroyo Sucre and Professor L. Picard- Ami, University of Panama, Panama;
Professor M. Kabanov, Dr A. Lomachenkov and Dr G. Burkovsky, Bekhterev
Psychoneurological Research Institute, St. Petersburg, Russia; Dr R. Lucas Carrasco,
University of Barcelona, Spain; Dr Yooth Bodharamik and Mr Kitikorn Meesapya,
Institute of Mental Health, Bangkok, Thailand; Dr S. Skevington, University of Bath, United
Kingdom; Professor D. Patrick, Ms M. Martinand, Ms D. Wild, University of
Washington, Seattle, USA and; Professor W. Acuda and Dr J. Mutambirwa, University of
Zimbabwe, Harare, Zimbabwe.
New centres using the field version of the WHOQOL-100 are: Dr S. Bonicato,
FUNDONAR, Fundacion Oncologica Argentina, Argentina; Dr A.E. Molzahn, University of
Victoria, Canada; Dr G. Yongping, St Vincent!s Hospital, Victoria, Australia; Dr G. Page,
University of Quebec at Rimouski, Canada; Professor J. Fang, Sun Yat-Sen University of
Medical Sciences, People!s Republic of China; Dr M. Fleck, University of the State of Rio
Grande do Sul, Brazil; Professor M.C. Angermeyer, Dr R. Kilian, Universitätsklinikum Klinik
und Poliklinik für Psychiatrie, Leipzig, Germany; Mr Kwok Fai Leung, Hospital Authority,
Hong Kong; Dr B.R. Hanestad, University of Bergen, Norway; Dr M.H. Mubbashar,
Rawalpindi General Hospital, Pakistan; Dr J. Harangozo, Semelweis University of Medicine,
Budapest & Dr L. Kullman, National Institute of Mental Rehabilitation, Budapest, Hungary;
Professor I. Wiklund, Health Economics & Quality of Life, Astra Hässle AB, Sweden; Dr C.
Fidaner, Dr Behçet Uz Paediatric Hospital, Balçova/Izmir, Turkey; Dr G. de Girolamo,
Servizio Salute Mentale USL 27, Italy; Professor P. Bech, Frederiksborg General Hospital,
Denmark; Dr
R.S. Pippalla, Howard University, College of Pharmacy and Pharmaceutical Sciences,
Washington, DC, USA and Dr H. Che Ismail, School of Medical Sciences, Kelantan, Malaysia.

Further information can be obtained from:

Dr John Orley
Programme on Mental Health
World Health Organization
CH-1211 Geneva 27, Switzerland
 This document is not issued to the general public, and all rights are reserved by the World
Health Organization (WHO). This document may not be reviewed, abstracted, quoted,
reproduced, translated, referred to in bibliographical matter or cited, in part or in whole,
without the prior written permission of WHO. No part of this document may be stored in a
retrieval system or transmitted in any form by any means - electronic, mechanical or other -
without the prior written permission of WHO. The WHOQOL Group, Programme on Mental
Health, WHO, CH-1211 Geneva 27, Switzerland.
WHOQOL-BREF - INSTRUCTIONS
Page 4
 WHOQOL-BREF
Introduction, Administration, Scoring and
Generic Version of the Assessment
Introduction
The WHOQOL-100 quality of life assessment was developed by the WHOQOL Group with
fifteen international field centres, simultaneously, in an attempt to develop a quality of life assessment that
would be applicable cross-culturally. The development of the WHOQOL-100, has been detailed
elsewhere (i.e. Orley & Kuyken, 1994; Szabo, 1996; WHOQOL Group 1994a, 1994b, 1995). This
document gives a conceptual background to the WHOQOL definition of quality of life and describes the
development of the WHOQOL-BREF, an abbreviated version of the WHOQOL-100. It also includes a
generic English language version of the WHOQOL-BREF, instructions for administering and scoring, and
proposed uses for this short form of the WHOQOL.

Rationale for the development of the WHOQOL-100

WHO's initiative to develop a quality of life assessment arose for a number of reasons. In
recent years there has been a broadening in focus in the measurement of health, beyond traditional
health indicators such as mortality and morbidity (e.g. World Bank, 1993; WHO, 1991), to include
measures of the impact of disease and impairment on daily activities and behaviour (e.g. Sickness
Impact Profile; Bergner, Bobbitt, Carter et al, 1981), perceived health measures (e.g. Nottingham
Health Profile; Hunt, McKenna and McEwan, 1989) and disability / functional status measures (e.g.
the MOS SF-36, Ware et al, 1993). These measures, whilst beginning to provide a measure of the
impact of disease, do not assess quality of life per se, which has been aptly described as "the missing
measurement in health" (Fallowfield, 1990). Second, most measures of health status have been
developed in North America and the UK, and the translation of these measures for use in other
settings is time-consuming, and unsatisfactory for a number of reasons (Sartorius and Kuyken, 1994;
Kuyken, Orley, Hudelson and Sartorius, 1994). Third, the increasingly mechanistic model of
medicine, concerned only with the eradication of disease and symptoms, reinforces the need for the
introduction of a humanistic element into health care. By calling for quality of life assessments in
health care, attention is focused on this aspect of health, and resulting interventions will pay increased
attention to this aspect of patients' well-being. WHO's initiative to develop a quality of life assessment
arises from a need for a genuinely international measure of quality of life and a commitment to the
continued promotion of an holistic approach to health and health care.

Steps in the development of the WHOQOL-100

The WHOQOL-100 development process consisted of several stages. These are explained in
brief within this document. For a detailed description, the reader is referred to the WHOQOL Group
(1994a, 1994b, in preparation). In the first stage, concept clarification involved establishing an
agreed upon definition of quality of life and an approach to international quality of life assessment.

Quality of life is defined as individuals' perceptions of their position in life in the context of the culture
and value systems in which they live and in relation to their goals, expectations, standards and
concerns.

This definition reflects the view that quality of life refers to a subjective evaluation which is
embedded in a cultural, social and environmental context. Because this definition of quality of life
focuses upon respondents' "perceived" quality of life, it is not expected to provide a means of
measuring in any
WHOQOL-BREF - INSTRUCTIONS
Page 6

detailed fashion symptoms, diseases or conditions, but rather the effects of disease and health interventions
on quality of life. As such, quality of life cannot be equated simply with the terms "health status", "life
style", "life satisfaction", "mental state" or "well-being". The recognition of the multi-dimensional
nature of quality of life is reflected in the WHOQOL-100 structure.

In the second stage of development, exploration of the quality of life construct within 15
culturally diverse field centres was carried out to establish a list of areas/facets that participating centres
considered relevant to the assessment of quality of life. This involved a series in meetings of focus
groups which included health professionals, patients and well subjects. A maximum of six specific
items for exploring each proposed facet were generated by each centreZs focus group. To enable the
collaboration to be genuinely international the 15 field centres were selected world-wide to provide
differences in level of industrialisation, available health services, and other markers relevant to the
measurement of quality of life (e.g. role of the family, perception of time, perception of self, dominant
religion).

In the third stage of development, questions from each centre were assembled into a global
pool. After clustering semantically equivalent questions, 236 items covering 29 facets were included in
a final assessment. Pilot work involved administration of this standardised assessment to at least 300
respondents within each centre.

Following field testing in these 15 centres, 100 items were selected for inclusion in the
WHOQOL-100 Field Trial Version. These included four items for each of 24 facets of quality of life,
and four items relating to the [overall quality of life and general healthZ facet (see Table 1). The
method by which these 100 items were selected is fully documented elsewhere (The WHOQOL
Group, in preparation). The WHOQOL-100 Field Trial Version is currently being tested in new centres
world-wide (these centres are outlined on page 6 of this document). The initial conceptual
framework for the WHOQOL-100 proposed that the 24 facets relating to quality of life should be
grouped into 6 domains. Recent analysis of available data, using structural equation modelling, has
shown a four domain solution to be more appropriate. For a more detailed explanation of this, the
reader is referred to The WHOQOL Group (in preparation). The WHOQOL-BREF is therefore based
on a four domain structure (see Table 1).
Table 1 - WHOQOL-BREF domains

Domain Facets incorporated within domains

1. Physical health Activities of daily living

Dependence on medicinal substances and medical aids
Energy and fatigue
Mobility
Pain and discomfort
Sleep and rest
Work Capacity

2. Psychological Bodily image and appearance

Negative feelings
Positive feelings
Self-esteem
Spirituality / Religion / Personal beliefs
Thinking, learning, memory and concentration

3. Social relationships Personal relationships

Social support
Sexual activity

4. Environment Financial resources

Freedom, physical safety and security
Health and social care: accessibility and quality
Home environment
Opportunities for acquiring new information and skills
Participation in and opportunities for recreation / leisure activities
Physical environment (pollution / noise / traffic / climate)
Transport

Development of the WHOQOL-BREF

The WHOQOL-100 allows detailed assessment of each individual facet relating to quality of
life. In certain instances however, the WHOQOL-100 may be too lengthy for practical use. The
WHOQOL- BREF Field Trial Version has therefore been developed to provide a short form quality of
life assessment that looks at Domain level profiles, using data from the pilot WHOQOL assessment
and all available data from the Field Trial Version of the WHOQOL-100. Twenty field centres
situated within eighteen countries have included data for these purposes (see Table 2). The
WHOQOL-BREF contains a total of 26 questions. To provide a broad and comprehensive assessment,
one item from each of the 24 facets contained in the WHOQOL-100 has been included. In addition,
two items from the Overall quality of Life and General Health facet have been included.
WHOQOL-BREF - INSTRUCTIONS
Page 8

Table 2 - Centres included in development of the WHOQOL-BREF

Centres in the pilot version Centres in the field trial of

of the WHOQOL the WHOQOL-100

Bangkok, Thailand Bangkok, Thailand

Beer Sheva, Israel Beer Sheva, Israel
Madras, India Madras, India
Melbourne, Australia Melbourne, Australia
New Delhi, India New Delhi, India
Panama City, Panama City,
Panama Seattle, USA Panama Seattle, USA
Tilburg, The Netherlands Tilburg, The Netherlands
Zagreb, Croatia Zagreb, Croatia
Tokyo, Japan Tokyo, Japan
Harare, Zimbabwe Harare, Zimbabwe
Barcelona, Spain Barcelona, Spain
Bath, UK Bath, UK
St Petersburg, Russia Hong Kong
Paris, France Leipzig, Germany
Mannheim, Germany
La Plata, Argentina
Port Alegre, Brazil

The WHOQOL-BREF is available in 19 different languages. The appropriate language

version, and permission for using it, can be obtained from The WHOQOL Group, Programme on
Mental Health, World Health Organisation, CH-1211 Geneva 27, Switzerland. Under no
circumstances should the WHOQOL-BREF be used without consultation with The WHOQOL
Group. A methodology has been developed for new centres wishing to develop a further language
version of the WHOQOL-100 or the WHOQOL-BREF. This can be obtained from The WHOQOL
Group, Programme on Mental Health, World Health Organisation, CH-1211, Geneva 27, Switzerland.

Questions should appear in the order in which they appear in the example WHOQOL-BREF
provided within this document, with instructions and headers unchanged. Questions are grouped by
response format. The equivalent numbering of questions between the WHOQOL-BREF and the
WHOQOL-100 is given in the example version of the WHOQOL-BREF to enable easy comparison
between responses to items on the two versions. The WHOQOL-100 field test permitted centres to
include national items or facets that were thought to be important in assessing quality of life. Where
centres wish to include additional national items or modules to the WHOQOL-BREF, these should be
included on a separate sheet of paper and not scattered amongst the existing 26 items. There are three
reasons for this:

1) To control for item order effects which could occur and change item meaning.
2) The WHOQOL-BREF represents an agreed upon core set of international items.
3) The WHOQOL-BREF is likely to be used where quality of life is amongst one of several
parameters being assessed. Therefore additional national information can be obtained by
including additional modules and measures

Administration of the WHOQOL-BREF

 For any new centre not previously involved in either the development or field testing of the
WHOQOL-100, the procedure being followed to field test the WHOQOL-BREF should be identical to
that used to field test the WHOQOL-100. The instrument should be piloted on at least 300 people. This
figure is based on the required numbers of respondents needed for analysis of pilot data. The
sample of respondents to whom the assessment should be administered ought to be adults, with
[adultZ being culturally defined. While stratified samples are not essential, a sampling quota should
apply with regard to:

> Age (50% = <45 years, 50% = 45+ years)

> Sex (50% = male, 50% = female)
> Health status (250 persons with disease or impairment; 50 well persons)

With respect to persons with disease or impairment, this group should contain a cross-section
of people with varied levels of quality of life. One way of attempting this would be to include some
people with quite severe and disabling chronic diseases, some people in contact with health facilities
for more transient conditions, possibly some attending a family practitioner, and others who are in
contact with the health service for reasons that are not likely to impinge upon their quality of life to
any great extent. By sampling patients from a cross-section of primary care settings, hospitals and
community care settings this could most likely be achieved.

The WHOQOL-BREF should be self-administered if respondents have sufficient ability:

otherwise, interviewer-assisted or interview-administered forms should be used. Standardised instructions,
given on the second page of the WHOQOL-BREF example assessment, should be read out to
respondents in instances where the assessment is interviewer-administered.

For centres who have already participated in the development and field testing of the
WHOQOL- 100, the above option of testing the WHOQOL-BREF is preferred, but not imperative
where specific studies of patient groups are planned.

Frame of reference and time frame

A time frame of two weeks is indicated in the assessment. It is recognised that different time
frames may be necessary for particular uses of the instrument in subsequent stages of work. For
example, in the assessment of quality of life in chronic conditions, such as arthritis, a longer time frame
such as four weeks may be preferable. Furthermore, the perception of time is different within different
cultural settings and therefore changing the time scale may be appropriate.

Proposed uses of the WHOQOL-100 and the WHOQOL-BREF

It is anticipated that the WHOQOL assessments will be used in broad-ranging ways. They will
be of considerable use in clinical trials, in establishing baseline scores in a range of areas, and looking
at changes in quality of life over the course of interventions. It is expected that the WHOQOL
assessments will also be of value where disease prognosis is likely to involve only partial recovery or
remission, and in which treatment may be more palliative than curative.

For epidemiological research, the WHOQOL assessments will allow detailed quality of life
data to be gathered on a particular population, facilitating the understanding of diseases, and the
development
WHOQOL-BREF - INSTRUCTIONS
Page 10

of treatment methods. The international epidemiological studies that would be enabled by instruments
such as the WHOQOL-100 and the WHOQOL-BREF will make it possible to carry out multi-centre
quality of life research, and to compare results obtained in different centres. Such research has
important benefits, permitting questions to be addressed which would not be possible in single site
studies (Sartorius and Helmchen, 1981). For example, a comparative study in two or more countries
on the relationship between health care delivery and quality of life requires an assessment yielding cross-
culturally comparable scores. Sometimes accumulation of cases in quality of life studies,
particularly when studying rare disorders, is helped by gathering data in several settings. Multi-
centre collaborative studies can also provide simultaneous multiple replications of a finding, adding
considerably to the confidence with which findings can be accepted.

In clinical practice the WHOQOL assessments will assist clinicians in making judgements about
the areas in which a patient is most affected by disease, and in making treatment decisions. In some
developing countries, where resources for health care may be limited, treatments aimed at improving
quality of life through palliation, for example, can be both effective and inexpensive (Olweny, 1992).
Together with other measures, the WHOQOL-BREF will enable health professionals to assess changes
in quality of life over the course of treatment.

It is anticipated that in the future the WHOQOL-100 and the WHOQOL-BREF will prove
useful in health policy research and will make up an important aspect of the routine auditing of health
and social services. Because the instrument was developed cross-culturally, health care providers,
administrators and legislators in countries where no validated quality of life measures currently exist can
be confident that data yielded by work involving the WHOQOL assessments will be genuinely
sensitive to their setting.

Scoring the WHOQOL-BREF

The WHOQOL-BREF (Field Trial Version) produces a quality of life profile. It is possible to
derive four domain scores. There are also two items that are examined separately: question 1 asks
about an individualZs overall perception of quality of life and question 2 asks about an individualZs
overall perception of their health. The four domain scores denote an individualZs perception of
quality of life in each particular domain. Domain scores are scaled in a positive direction (i.e. higher
scores denote higher quality of life). The mean score of items within each domain is used to calculate
the domain score. Mean scores are then multiplied by 4 in order to make domain scores comparable
with the scores used in the WHOQOL-100. Explicit instructions for checking and cleaning data, and
for computing domain scores, are given in Table 3. A method for the manual calculation of individual
scores is given on page 1 of the WHOQOL-BREF assessment form. The method for converting raw
scores to transformed scores when using this method is given in Table 4, on page 11 of these
instructions. The first transformation method converts scores to range between 4-20, comparable with
the WHOQOL-100. The second transformation method converts domain scores to a 0-100 scale.

Where more than 20% of data is missing from a assessment, the assessment should be
discarded (see Step 4 in Table 3). Where an item is missing, the mean of other items in the domain is
substituted. Where more than two items are missing from the domain, the domain score should not be
calculated (with the exception of domain 3, where the domain should only be calculated if < 1 item is
missing).

Any national items should be scored separately from the core 26 item of the BREF. During
the analysis the performance of any national items will be examined for possible use in alter national
studies. At this stage of field testing national and core items must not be mixed in administration or
scoring of the BREF.
 An SPSS syntax file that automatically checks, recodes data and computes domain scores may
be obtained from Professor Mick Power, Department of Psychiatry, Royal Edinburgh Hospital,
Morningside Park, Edinburgh, EH10 5HF (email: mj@srv2.med.ed.ac.uk; fax: + 131 447 6860)
WHOQOL-BREF - INSTRUCTIONS
Page 12

Table 3 - Steps for checking and cleaning data and computing domain
scores

Steps SPSS syntax for carrying out data

checking, cleaning and computing total
scores
1. Check all 26 items from RECODE Q1 Q2 Q3 Q4 Q5 Q6 Q7 Q8 Q9 Q10 Q11 Q12 Q13 Q14
assessment have a range of 1-5 Q15 Q16 Q17 Q18 Q19 Q20 Q21 Q22 Q23 Q24 Q25 Q26 (1=1)
(2=2) (3=3) (4=4) (5=5) (ELSE=SYSMIS).
(This recodes all data outwith the range 1-5 to system missing).

2. Reverse 3 negatively phrased RECODE Q3 Q4 Q26 (1=5) (2=4) (3=3) (4=2) (5=1).
items (This transforms negatively framed questions to positively framed
questions)

3. Compute domain scores COMPUTE DOM1=MEAN.6(Q3,Q4,Q10,Q15,Q16,Q17,Q18)*4.

COMPUTE DOM2=MEAN.5(Q5,Q6,Q7,Q11,Q19,Q26)*4.
COMPUTE DOM3=MEAN.2(Q20,Q21,Q22)*4.
COMPUTE DOM4=MEAN.6(Q8,Q9,Q12,Q13,Q14,Q23,Q24,Q25)*4.
(These equations calculate the domain scores. All scores are
multiplied by 4 so as to be directly comparable with scores derived
from the WHOQOL-100. The [.6Z in [mean.6Z specifies that 6
items must be endorsed for the domain score to be calculated).

4. Delete cases with >20% COUNT TOTAL=Q1 TO Q26 (1 THRU 5).

missing data (This command creates a new column [totalZ. [TotalZ contains a
count of the WHOQOL-100 items with the values 1-5 that
have been endorsed by each subject. The [Q1 TO Q26Z means
that consecutive columns from [Q1Z, the first item, to [Q26Z, the
last item, are included in the count. It therefore assumes that data
is entered in the order given in the assessment).
FILTER OFF.
USE ALL.
SELECT IF (TOTAL>=21).
EXECUTE.
(This second command selects only those cases where [totalZ, the
total number of items completed, is greater or equal to 80%. It
deletes the remaining cases from the data set).

5. Check domain scores DESCRIPTIVES

VARIABLES=DOM1 DOM2 DOM3 DOM4
/STATISTICS=MEAN STDDEV MIN MAX.
(Running descriptives should display values of all domain scores
within the range 4-20).

6. Save data set Save data set with a new file name so that the original remains intact.
Table 4 - Method for converting raw scores to transformed scores

DOMAIN 1 DOMAIN 2 DOMAIN 3 DOMAIN 4

Raw
Trasnformed Raw Trasnformed Raw Transformed Raw Transformed
Score
scores score scores score scores score scores

4-20 0-100 4-20 0-100 4-20 0-100 4-20 0-100

7 4 0 6 4 0 3 4 0 8 4 0
8 5 6 7 5 6 4 5 6 9 5 6
9 5 6 8 5 6 5 7 19 10 5 6
10 6 13 9 6 13 6 8 25 11 6 13
11 6 13 10 7 19 7 9 31 12 6 13
12 7 19 11 7 19 8 11 44 13 7 19
13 7 19 12 8 25 9 12 50 14 7 19
14 8 25 13 9 31 10 13 56 15 8 25
15 9 31 14 9 31 11 15 69 16 8 25
16 9 31 15 10 38 12 16 75 17 9 31
17 10 38 16 11 44 13 17 81 18 9 31
18 10 38 17 11 44 14 19 94 19 10 38
19 11 44 18 12 50 15 20 100 20 10 38

20 11 44 19 13 56 21 11 44
21 12 50 20 13 56 22 11 44
22 13 56 21 14 63 23 12 50
23 13 56 22 15 69 24 12 50
24 14 63 23 15 69 25 13 56
25 14 63 24 16 75 26 13 56
26 15 69 25 17 81 27 14 63
27 15 69 26 17 81 28 14 63
28 16 75 27 18 88 29 15 69
29 17 81 28 19 94 30 15 69
30 17 81 29 19 94 31 16 75
31 18 88 30 20 100 32 16 75

32 18 88 33 17 81
33 19 94 34 17 81
34 19 94 35 18 88
35 20 100 36 18 88

37 19 94
38 19 94
39 20 100
40 20 100

References
Bergner, M., Bobbitt, R.A., Carter, W.B. et al. (1981). The Sickness Impact Profile: Development and final revision of
a health status measure. Medical Care, 19, 787-805.
MSA/MNH/PSF/97.6
Page 14

Fallowfield, L. (1990). The Quality of Life: The Missing Measurement in Health Care. Souvenir Press.

Hunt, S.M., McKenna, S.P. and McEwan, J. (1989). The Nottingham Health Profile. Users Manual. Revised edition.

Kuyken, W., Orley, J., Hudelson, P. and Sartorius, N. (1994). Quality of life assessment across cultures. International
Journal of Mental Health, 23 (2), 5-27.

Olweny, C. L. M. (1992). Quality of life in developing countries. Journal of Palliative Care, 8, 25-30.

Sartorius, N. and Helmchen, H. (1981). Aims and implementation of multi-centre studies. Modern Problems of
Pharmacopsychiatry, 16, 1-8.

Sartorius, N. and Kuyken, W. (1994). Translation of health status instruments. In J. Orley and W. Kuyken (Eds).
Quality of Life Assessment: International Perspectives. Heidelberg: Springer Verlag.

Szabo, S. (1996). The World Health Organisation Quality of Life (WHOQOL) Assessment Instrument. In Quality of
Life and Pharmaeconomics in Clinical Trials (2nd edition, Edited by Spilker B.). Lippincott-Raven Publishers,
Philadelphia, New York.

The WHOQOL Group. The World Health Organization Quality of Life assessment (WHOQOL): position paper from
the World Health Organization. Soc. Sci. Med., 41, 1403, 1995.

Ware, J. E., Snow, K., K., Kosinski, M. and Gandek, B. (1993). SF-36 Health Survey: Manual and Interpretation Guide.
New England Medical Center, MA, USA.

World Bank. (1993). World Development Report: Investing in Health. New York: Oxford University Press.

World Health Organization. (1991). World Health Statistics Annual. Geneva: WHO.

The WHOQOL Group. (1994a). Development of the WHOQOL: Rationale and current status. International Journal
of Mental Health, 23 (3), 24-56.

The WHOQOL Group. (1994b). The development of the World Health Organization quality of life assessment
instrument (the WHOQOL). In J. Orley and W. Kuyken (Eds) Quality of Life Assessment: International Perspectives.
Heidelberg: Springer Verlag.

The WHOQOL Group. (In preparation). The World Health Organisation Quality of Life Assessment (WHOQOL):
Development and General Psychometric Properties.
m:\...miscel\whoqol\brefinst
 WHO/MSA/MNH/PSF/97.4
English only
Distr.: Limited

WHOQOL-BREF

PROGRAMME ON MENTAL HEALTH

WORLD HEALTH ORGANIZATION
GENEVA

For office use only

Equations for computing domain scores Raw score Transformed scores*

4-20 0-100
Domain 1 (6-Q3) + (6-Q4) + Q10 + Q15 + Q16 + Q17 + Q18
d + d + d+ d+ d+ d+ d =

Domain 2 Q5 + Q6 + Q7 + Q11 + Q19 + (6-Q26)

d + d+ d+ d+ d+ d =

Domain 3 Q20 + Q21 + Q22

d + d+ d =

Domain 4 Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25

d+ d+ d+ d+ d + d + d +d =

* Please see Table 4 on page 10 of the manual, for converting raw scores to transformed scores.

This document is not issued to the general public, and all rights are reserved by the World Health Organization (WHO). The
document may not be reviewed, abstracted, quoted, reproduced or translated, in part or in whole, without the prior written
permission of WHO. No part of this document may be stored in a retrieval system or transmitted in any form or by any means -
electronic, mechanical or other - without the prior written permission of WHO.
 I.D. number
MSA/MNH/PSF/97.6
Page 16
ABOUT YOU
Before you begin we
would like to ask
you to answer a few
general questions
about yourself: by
circling the correct
answer or by filling
in the space
provided.

What is your gender?

Female
W
hat /
is
yo
u
dat
e
of
bir
th?
Day
/ Mon

/ Year

What is the highest education

What is your marital

status?
Separated
Marrie

Divor
Living

Widow
Are you currently ill?

No
If something is wrong
with your health what
do you think it is?

Instructions
This You should circle
assessment the number that best
asks how you fits how much
feel about support you got
your quality from others over the
of life, health, last two weeks. So
or other areas you would circle
of your life. the number 4 if you
Please got a great deal of
answer all support from others
the as follows.
questions. If
you are
unsure about
Do you get the kind of su
which
from others that you need
response to
give to a
question, You would circle
number 1 if you did not
please get any of the support
choose the that you needed from
one that others in the last two
appears most weeks.
appropriate.
This can
often be your
first response.

Please keep
in mind your
standards,
hopes,
pleasures and
concerns. We
ask that you
think about
your life in
the last two
weeks. For
example,
thinking
about the last
two weeks, a
question
might ask:

Not at
Do you get the kind of support 1
from others that you need?
 MSA/MNH/PSF/97.6
Page 17

Please read each question, assess your feelings, and circle the number on the scale for each question
that gives the best answer for you.
Neither
Very poor Poor poor Good Very good
nor
good
1(G1) How would you rate your quality of life? 1 2 3 4 5

Very Dissatisfied Neither Satisfied Very

dissatisfie satisfied satisfied
d nor
dissatisfied
2 (G4) How satisfied are you with your health? 1 2 3 4 5

The following questions ask about how much you have experienced certain things in the last two weeks.
Not at all A little A Very much An extreme
moderate amount
3 (F1.4) To what extent do you feel that 1 2 amount
3 4 5
physical pain prevents you from doing
what you need to do?
4(F11.3) How much do you need any medical 1 2 3 4 5
treatment to function in your daily
5(F4.1) life?
How much do you enjoy life? 1 2 3 4 5
6(F24.2) To what extent do you feel your life 1 2 3 4 5
to be meaningful?

Not at all A little A Very much Extremely

moderate
7(F5.3) How well are you able to concentrate? 1 2 amount
3 4 5
8 (F16.1) How safe do you feel in your daily life? 1 2 3 4 5
9 (F22.1) How healthy is your 1 2 3 4 5
physical environment?

The following questions ask about how completely you experience or were able to do certain things in the last two weeks.
Not at all A little Moderately Mostly Completely
10 (F2.1) Do you have enough energy 1 2 3 4 5
for everyday life?
11 (F7.1) Are you able to accept your 1 2 3 4 5
bodily appearance?
12 (F18.1) Have you enough money to meet 1 2 3 4 5
your needs?
13 (F20.1) How available to you is the 1 2 3 4 5
information that you need in your day-
14 (F21.1) to-day
To whatlife?
extent do you have the 1 2 3 4 5
opportunity for leisure activities?

Very poor Poor Neither Good Very good

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poor
nor
15 (F9.1) How well are you able to get around? 1 2 good
3 4 5

The following questions ask you to say how good or satisfied you have felt about various aspects of your life over the last two
weeks.

Very Dissatisfied Neither Satisfied Very

dissatisfie satisfied satisfied
d nor
16 (F3.3) How satisfied are you with your sleep? 1 2 dissatisfied
3 4 5
17 (F10.3) How satisfied are you with your 1 2 3 4 5
ability to perform your daily living
18(F12.4) activities?
How satisfied are you with your 1 2 3 4 5
capacity for work?
19 (F6.3) How satisfied are you with yourself? 1 2 3 4 5
20(F13.3) How satisfied are you with 1 2 3 4 5
your personal relationships?
21(F15.3) How satisfied are you with your sex life? 1 2 3 4 5
22(F14.4) How satisfied are you with the 1 2 3 4 5
support you get from your friends?
23(F17.3) How satisfied are you with the 1 2 3 4 5
conditions of your living
24(F19.3) place?satisfied are you with your
How 1 2 3 4 5
access to health services?
25(F23.3) How satisfied are you with 1 2 3 4 5
your transport?

The following question refers to how often you have felt or experienced certain things in the last two weeks.

Never Seldom Quite often Very often Always

26 (F8.1) How often do you have negative 1 2 3 4 5
feelings such as blue mood, despair,
anxiety, depression?

Did someone help you to fill out this form?..............................................................................................................

How long did it take to fill this form
out?.................................................................................................................

Do you have any comments about the assessment?

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THANK YOU FOR YOUR HELP