Qua&y ofLife Research, 2, pp.

153-159

Special Report

Study protocol for the World Health

Organization project to develop a Quality of Life
assessment instrument (WHOQOL)

WHOQOL Groupt
Division of Mental Health, World Health Organization, 1211 Geneva 27, Switzerland

The World Health Organization (WHO) has undertaken This paper outlines the characteristics of the
a project to develop an instrument (the WHOQOL) for planned instrument and the study protocol governing
measuring quality of life. Quality of life is defined as work on its development. To date steps 1 through 5
an individual’s perception of their position in life in have been completed and work Is progressing on step
the context of the culture and value systems in which 6. It is anticipated that the instrument will be available
they live and in relation to their goals, expectations, for piloting in July 1993 and a final version available
standards and concerns. It is a broad ranging concept for use in June 1994.
affected in a complex way by the person’s physical
health, psychological state, level of independence, Key words: WHO, Quality of Life assessment instrument
social relationships, and their relationship to salient
features of their environment.
The instrument will be developed in the framework Assumptions
of a collaborative project involving numerous centres
in different cultural settings. In addition, it will have
proven psychometric properties of validity, respons- It is assumed that:
iveness and reliability and will be sensitive to the
cultural setting in which it is applied, whilst maintain- (4 there is a broad entity encompassed by the
ing comparability of scores across different cultural term ‘quality of life’;
settings. 04 a quantative, reliable and valid measure of
quality of life can be constructed and
applied to various populations and;
t The study protocol for the WHO project to develop a Quality
of Life assessment instrument reported here is based on the (4 any factor affecting quality of life would
work and experience of a panel of consultants, as well as the influence a wide range of components
collaborating investigators in each of the field sites. The covered by the instrument and the instru-
collaborating investigators in this study are: Prof. H. Herrman,
University of Melbourne, Melbourne, Australia; Ass. Prof. Z. ment could, therefore, serve to measure
MeteIko and Prof. S. Szabo, Institute of Diabetes, Endocrin- the effect of specific health interventions
ology and Metabolic Diseases, University of Zagreb, Zagreb, on quality of life.
Croatia, Dr S. Rajkumar and Mrs Shuba Kumar, Madras
Medical College, Madras, India, Prof. Dr G. Van Heck, and Mrs
J. De Vries, Tilburg University, Tilburg, Netherlands, Prof.
Arroyo Sucre, University of Panama, Panama, Prof. Kabanov, Characteristics of the instrument
Dr Lomachenkov and Dr Burkovsky, Bekhterev Psychoneuro-
logical Research Institute, St. Petersburg, Russia, Prof Som-
patch Sukwatana and Mr Kitikorn Meesapya, Department of 1. The instrument will have a modular struc-
Medical Services, Bangkok, Thailand, Dr S. Skevington, Uni- ture. That is to say, the instrument will be
versity of Bath, Bath, United Kingdom; Dr D. Patrick and MS M.
Martin, University of Washington, Seattle, USA and; Dr J. organized into five broad domains. These are:
Mutambirwa, University of Zimbabwe, Harare, Zimbabwe. The
nroiect team at the Division of Mental Health, WHO, Geneva is - Physical health (bodily states and func-
Dr k. Sartorius, Dr J. Orley and Dr W. Kuyken. tions);
Technical support and funds for carrying out this study have - Psychological health;
been provided by the World Health Organization, by the
participating centres themselves and by grants from the Upjohn - Level of independence;
Company, Kalamazoo, USA, and the Carnegie Corporation, - Social relationships and;
New York, USA. - Environment.
’ Correspondence should be addressed to Dr J. Orley. Within each domain a series of facets of quality of

0 2993 Rupid Communications of Oxford Ltd Quality of Life Reseat& . VoZ 2 . 2993 153
WHOQOL Group

life summarizes that particular domain of quality
of life. For example, the domain physical health
includes the facets Pain and discomfort, Vitality
and fatigue and Sensory functions.
2. The WHOQOL instrument will be applicable
in different cultures, with broadly comparable
versions developed in a wide range of languages
and cultures. Field centres have been selected to
provide differences in their levels of industrializa-
tion, 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 religious denomination). It is anti-
cipated that these centres, including sites in North
America, Central America, Eastern Europe,
Central Europe, Southern Africa, South-East Asia
and Australia, will be involved not only in the
development and testing of the WHOQOL, but
also in further research and training on quality of
life and its assessment. *
3. The core module will have the same domains
and facets across cultures. However, the import-
ance of individual facets may vary across cultural
settings. In addition, it is likely that facets may
contain some different questions for different
cultural settings. The best questions for a given
culture will be selected on the basis of psychomet-
ric criteria following extensive field work with the
pilot instrument in each of the field centres. The
data from all field centres will also be analysed to
examine whether certain questions are valid in all
field centres.
4. The WHOQOL will focus upon respondents’
‘perceived’ quality of life. The instrument is not
expected to provide a means of measuring in any
detailed fashion symptoms, diseases or conditions
per se, but rather the effects of disease and health
interventions on quality of life.
5. The WHOQOL will contain questions organ-
ized according to the scheme summarized in
Table 1.
The ‘perceived objective’, ‘self-report subjective’
and ‘importance’ questions for each facet will be
written in general terms and are global, self-assess-
ments of a person’s quality of life. Rating scales
will be attached to each question. The instrument
will not include items based on objective measure-
ment of the individual’s health and functional
status, e.g. measuring the quantity of sleep,
although such data may be used in conjunction
with the WHOQOL.
6. The intention is to produce a quality of life
profile. It will be possible to compile scores for
each facet of quality of life, each domain and
overall quality of life for both self-reported object-
ive quality of life and self-reported subjective
quality of life. Questions about the importance of a
facet for the individual’s quality of life can be used
to weight scores for each facet.
7. The WHOQOL will be self-administered if
respondents have sufficient ability; otherwise,
interviewer assisted or interviewer administered
forms will be used. If respondents are unable to
communicate, proxy respondents will be used.

Table 1. Typology of questions for the WHOQOL

Perceived objective Self-report subjective Importance

Description A person’s global evaluations of
their behaviours states or capa-
cities. Questions at this level
assess how well or poorly a
person reports that he/she is
performing a desirable behavi-
our; e.g. restful sleep
Example question How do you sleep?
Example of rating Excellently/Very welll\Nell/
scale Fair/Poor
Perceived satisfaction/dissatis-
faction with behaviour, state or
capacity; i.e. How well are a
person’s needs and require-
ments met, and how much does
a problem or difficulty prevent
them from doing what he/she
wants to do?
(i) Are you satisfied with your
sleep?
(ii) How much do any difficulties
with your sleep interfere with
doing what you need to do and
would like to do?
(i) Very satisfied/Somewhat
satisfied/Neither satisfied nor
dissatisfied/Somewhat dis-
satisfied/Very dissatisfied
(ii) Not at all/A little/Somewhat/
Quite a bit/Extremely
Perceived importance; i.e. How
important is the facet to the
person’s quality of life? This
should be established even if
the person has had no difficul-
ties in this area within the time
frame of the instrument
How important to you is restful
sleep?
Most important/Very important/
Somewhat important/A little
important/Not at all important

154 Quality of Life Research . Vo12 . 7 993