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Factorial structure of WHOQoL-Bref quality of life questionnaire

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Qual Life Res (2014) 23:2205–2212
DOI 10.1007/s11136-014-0663-2
Factorial structural analysis of the Spanish version of WHOQOL-
BREF: an exploratory structural equation model study
Sonia Benitez-Borrego • Joan Guàrdia-Olmos •
Alfonso Urzúa-Morales
Accepted: 26 February 2014 / Published online: 8 March 2014
Ó Springer International Publishing Switzerland 2014
Abstract
Purpose The purpose of this study was to analyze the
factor structure of the abbreviated Spanish version of the
World Health Organization Quality of Life (WHOQOL-
BREF; WHOQOL Group in Psychol Med 28(3): 551–558,
1998b) questionnaire in a sample of individuals from
several Spanish-speaking countries.
Method The data were based on a sample of 1,972
undergraduates from nine Spanish-speaking countries.
Within the framework of a somewhat wider research pro-
tocol, they were administered the WHOQOL-BREF.
Results The data were initially analyzed using a confir-
matory factor analysis, which yielded a poor fit to the four-
factor theoretical model. Based on these results, the best
solution was estimated assuming structural invariance
across countries. The data showed a four-factor structure
that differed slightly from the model proposed. This four-
factor model was subsequently analyzed using exploratory
structural equation modeling (ESEM; Asparouhov and
Muthén in Struct Equ Model 16(3): 397–438, 2009) to
obtain the invariant structure across countries and an esti-
mation of the relation between the four latent factors. The
results obtained allowed us to establish that the factor
S. Benitez-Borrego (&)
J. Guàrdia-Olmos
Department of Methodology of Behavioral Sciences, Faculty of
Psychology, University of Barcelona, Barcelona, Spain
e-mail: sbenitez@ub.edu
J. Guàrdia-Olmos
Institute for Research on the Brain, Cognition and Behavior
(IR3C), University of Barcelona, Barcelona, Spain
A. Urzúa-Morales
Universidad Católica del Norte, Antofagasta, Chile
structure of WHOQOL-BREF maintains the four-factor
solution hypothesized for a Spanish-speaking population,
although the solution has a different and more complex
configuration than the original one with a clear tendency
toward non-orthogonality of the latent factors.
Conclusions As has been suggested by some studies on
the application of ESEM, it is reasonable to think that the
ESEM approximation is a useful approach for conducting
the factor analysis of instruments measuring complex
psychological phenomena.
Keywords Quality of life scale
Structural equation
modeling (SEM)
Exploratory structural equation
modeling (ESEM)
Confirmatory factor analysis (CFA)
Introduction
The World Health Organization (WHO) workgroup on
quality of life (QOL) defined QOL as an individual’s
perception 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 [1].
This definition reflects the view that QOL refers to a sub-
jective assessment within a cultural, social, and environ-
mental context. The importance lies, then, in how satisfied
or upset people feel about the relevant aspects of their
lives.
Within this context, the WHOQOL group [2] developed,
in collaboration with 15 international centers, the World
Health Organization Quality of Life (WHOQOL-100) as an
instrument to assess QOL that would be applicable cross-
culturally. It was operationalized through 100 items rep-
resenting 25 facets organized into 6 domains, thus attaining
acceptable psychometric properties [2, 3].
123
2206
Based on the previous assessment instrument, the same
WHOQOL group designed a short version of the ques-
tionnaire for use in limited-time situations. Using the data
collected by the 15 international centers for the WHOQOL-
100 [2], the items for the abbreviated version (WHOQOL-
BREF) were selected based on three criteria: their capacity
to explain a significant portion of the variance within their
facet and domain; their relation to the general WHOQOL
model; and their discriminant validity [4, 5]. Psychometric
studies provided sufficient evidence of the instrument’s
cross-cultural validity both in its first validations [4–6] and
in its validations in other languages and countries [7–11],
as well as in its applications to specific populations [10,
12–19].
However, some studies called into question the factor
structure of the WHOQOL-BREF. Yao et al. [20] exam-
ined the content validity of the WHOQOL-BREF using
quantitative methods examining the respondents’ perspec-
tive, and they found that the structure of the WHOQOL-
BREF adapted for Taiwan was not completely consistent
with the original factor structure (12 out of the 24 items did
not yield acceptable content validity). Similarly, other
studies failed to replicate the original structure of the
WHOQOL-BREF in the version adapted for Brazil [18],
and other authors also found that some items did not dis-
criminate well between domains and that other items cor-
related more highly with a domain that differed from its
original one [5].
The few studies conducted with the Spanish version of
the WHOQOL-BREF [17, 21, 22] found it to have
acceptable psychometric properties. However, due to the
scarcity of the literature on the matter, the main purpose of
the present study was to analyze the factor structure of the
Spanish version of WHOQOL-BREF in a sample of indi-
viduals from different Spanish-speaking countries (i.e.,
Costa Rica, Peru, Mexico, Cuba, Paraguay, Argentina,
Colombia, Spain, and Chile) using sufficiently large sam-
ple size, to establish a systematic analytical approach that
can be used to clearly identify the instrument’s limitations
within a Spanish-speaking population, including cross-
cultural aspects.
Studies analyzing factor structure are generally based on
confirmatory factor analyses (CFA), a methodology that
utilizes algorithms from the measurement model of struc-
tural equation modeling (SEM). CFA has generally proved
efficient enough to estimate construct validity such that the
majority of analysis involving the psychometric structure
of psychological assessments revolves around this type of
technique and its several derivatives. As widely known,
statistical approximation technique SEM has been exten-
sively used for estimating factor structures and is prevalent
in psychometric studies of complex psychological phe-
nomena. One of the advantages of the use of CFA, as
123
Qual Life Res (2014) 23:2205–2212
Table 1 Distribution of the sample by country of origin (n = 1,972)
Country Frequency (%)
Costa Rica 285 (14.5)
Peru 140 (7.1)
Mexico 198 (10)
Cuba 170 (8.6)
Paraguay 191 (9.7)
Argentina 155 (7.9)
Colombia 187 (9.5)
Spain 226 (11.5)
Chile 420 (21.3)
indicated by Asparouhov and Muthén [23], is that it allows
the researcher to propose a simple structure for the mea-
surement model, given that he is incorporating the previous
substantive knowledge in the form of certain restrictions in
the measurement model, thus yielding a more parsimonious
model. Nevertheless, unlike in the classic exploratory
factor analysis (EFA), the CFA approach of fixing many or
all of the cross-loadings to zero (because every item only
loads onto one factor) can result in the researcher speci-
fying a model that is more parsimonious than is required by
the data and can lead to goodness-of-fit indexes that are not
completely adequate [23].
As indicated above, the use of CFA is an effective way
to estimate measurement structures [23]. However, a
modification of the CFA algorithm was recently proposed
to provide SEM with an exploratory quality that was
lacking in its original application. This exploratory struc-
tural equation modeling (ESEM) proposed by Asparouhov
and Muthén [23] is based on a new conceptualization of the
exploratory factor loading matrix, which uses of parts of
the model through EFA with rotated factor loading matri-
ces in addition to, or instead of, parts of the measurement
model through CFA. That is to say, unlike CFA, the
measurement model through EFA does not require strict
restrictions to the cross-factor loadings. Furthermore,
similarly to the classical SEM approach, it grants access to
the usual factor loading parameters that allow us to make
common interpretations in terms of the saturation of each
observable indicator in relation to the non-observable latent
factor.
Method
Participants
The data were based on a sample of 1,972 undergraduates
(63 % were women) with an age range between 17 and
34 years (mean = 21.21 years; SD = 3.403), from nine
Qual Life Res (2014) 23:2205–2212
Spanish-speaking countries. The distribution of the sample
by country is presented in Table 1.
All the participants who did not fully complete the
measure or did not understand the task were excluded from
the analysis. No statistically significant differences were
found between countries with respect to their age and sex
distributions or concerning their socio-demographic condi-
tions, which leads us to assume certain homogeneity across
the nine subsamples assessed.
Instrument
We administered the Spanish version of the WHOQOL-
BREF, an abbreviated version of WHOQOL-100 devel-
oped simultaneously in 15 international centers [5, 22]. The
WHOQOL-BREF includes 26 items: one item measures
Overall QOL (item 1); one item measures satisfaction with
health (item 2); and the remaining 24 items (items 3–26)
assess four additional aspects of QOL, namely Physical
Health (7 items), Psychological Health (6 items), Social
Relationships (3 items), and Environmental Health (8
items). Study participants were asked to indicate how sat-
isfied they felt with each aspect during the previous
2 weeks using a Likert’s scale ranging from 1 to 5. The
scores for each domain were converted according to a
correction table due to the different number of items in
each domain [24]. Examination of the internal validity of
the Spanish WHOQOL-BREF [22, 31] revealed the fol-
lowing psychometric characteristics in relation to the
internal consistency estimated through Cronbach’s alpha:
.69 for Physical QOL, .74 for Psychological QOL, .77 for
Environmental QOL, and .70 for Social QOL. The Cron-
bach’s alpha values of all the domains were acceptable,
except that the value for Physical QOL was slightly low.
Procedure
In every country represented in our sample, a group of test
administrators was trained. They conducted the scale
administration, tabulation, and correction, and generated
each factor’s score, a total score, and the general scores for
the Overall QOL index and the satisfaction with health
index. These two index values were not the object of a
specific statistical analysis in this paper because the
objective was to study the factor structure of WHOQOL-
BREF regardless of the total value of each factor or scale.
Data analysis
We conducted a psychometric factor structural analysis of
the WHOQOL-BREF through a series of 3 approximations.
First, CFA was applied to the four factors (physical, psy-
chological, environmental, and social QOL) in accordance
2207
with the original structure, assuming the orthogonality
between factors and invariance of the structure across
countries. Second, and as consequence of the poor fit of the
CFA, we analyzed the possibility of a new factor structure
through both EFA and ESEM, fixing the invariance of the
factor matrix through the countries. All the analyses were
conducted with the whole sample to test the construct
validity of the questionnaire.
In recent study adopting ESEM, Marsh et al. [25]
demonstrated the power and flexibility of ESEM. Simi-
larly, Marsh, Muthén, Morin, Lüdtke, Asparouhov, Trau-
twein, and Nagengast [26] presented ESEM as a possible
alternative for the factor analysis of the Big Five person-
ality model.
To compare the models described above, the following
goodness-of-fit indexes were analyzed: comparative fit
index (CFI) and Tucker-Lewis index (TLI), obtained from a
free-distribution estimation due to the ordinal scale of the
observed variables, and in both cases, values greater than
.95 indicate a good fit of the model [27], although initially,
CFI values greater than .90 were considered to indicate of
good fit [28]; root mean square error of approximation
(RMSEA), where values smaller than .05 indicate a good
fit of the model and values up to .08 represent a reasonable
error of approximation to the population [29]; and stan-
dardized root mean square residual (SRMR), where values
smaller than .08 indicate a good fit of the model [27].
The data were analyzed using the IBM SPSS statistical
package (version 21.0) and Mplus software (version 5.1).
The routines applied in the latter case followed the scheme
proposed by Marsh, Muthén et al. [25] for estimating dif-
ferent invariance-of-models scenarios. The general idea is
to generate a factor loading matrix (K) for all the samples
(countries in our case) with all the parameters declared as
free and to test the statistical fit of each of the components
across the samples. The final result was an invariant factor
loading structure for all the samples, which assumed that
the majority of the original standardized variance came
from the observed variables.
Results
Confirmatory factor analysis
The factor structure proposed, as has been mentioned,
included four factors: Physical QOL (Items 3, 4, 10, 15, 16,
17, 18); Psychological QOL (Items 5, 6, 7, 11, 19, 26);
Social QOL (Items 20, 21, 22); and Environmental QOL
(Items 8, 9, 12, 13, 14, 23, 24, 25). This structure was
defined as orthogonal between factors. Therefore, it was
assumed that the matrix of correlations between factors
was equal to the identity matrix. Additionally, we chose to
123
2208 Qual Life Res (2014) 23:2205–2212

Table 2 Cronbach’s alpha values for each factor and sample converge in their values and Spearman’s correlations are
(n = 1,972) preferable with known parametric distribution models. In
Countries Physical Psychological Social Environmental addition, we made the following assumptions in specifying
QOL QOL QOL QOL the CFA model: independence between measurement
errors across the 24 items; a standardized metric for the
Costa .67 .71 .74 .70
Rica four latent factors; and a parameter estimation technique
Peru .71 .77 .72 .74 based on free distributions (asymptotically free distribution
Mexico .78 .82 .76 .71 estimation) given that sample sizes prevented more exact-
Cuba .67 .54 .63 .69 ing estimations. The results of the CFA including good-
Paraguay .73 .72 .69 .76
ness-of-fit indices and model estimations are shown in
Argentina .82 .88 .79 .83
Table 3.
The previous results allowed us to clearly establish that
Colombia .65 .68 .66 .74
the model derived from the CFA yielded a relatively poor
Spain .78 .79 .72 .77
fit, and the invariance of the factor structure formulated in
Chile .76 .72 .76 .75
the theoretical model is hardly assumable. Indeed, neither
Total .68 .71 .77 .75
sample the fit indices (in general having values less than .95 and
ratios up to 5 with very small p values (p \ .001 in all
cases)) nor the residual values (in general values up to .07
define the latent factors in a standardized way (defining the and .08 for all the models except for the global sample)
variance of each factor to be equal to 1 (one) to guarantee a allowed us to accept the factor structure proposed. Thus, it
homogeneous metric structure). Preliminary data analysis seemed necessary to devise an alternative structure to the
indicated that all the samples yielded values indicating one proposed theoretically. Along the same lines, the
internal consistency, as observed in Table 2. analysis of standard factor loadings estimated in each
Likewise, we conducted an inspection of the observed factorial model also proved that the assumption of invari-
distributions of all the items in every sample and noticed ance in the structure is clearly compromised. Table 4
that it would be difficult to assume the condition of mul- shows the range of values for the factor saturations when
tinormality (84 % of the Kolmogorov–Smirnov tests for estimated under the assumption of invariance.
normality yielded significant values (p \ .001). The values in Table 4 showed some saturations that
In view of the previous data, we chose to estimate were sufficiently high enough to be considered adequate
Spearman’s correlation coefficients to try to account for according to the theoretical model proposed. However, in
having ordinal response options and the limitation in some cases, the values of those saturations were particu-
assuming multinormality. We used Spearman’s correla- larly low, indicating inadequate fits between the observable
tions instead of polychoric correlations due to the sample indicator and the latent factor. Despite the fact that their
size; with large sample sizes, the correlation estimations use may be disputed from a methodological standpoint

Table 3 CFA goodness-of-fit indices applied to the factor structure of WHOQOL (df = 299 for every partial model)
Models v2 Ratio v2/df p v2BL Model CFI TLI RMSEA SRMR 90 % CI

Costa Rica 2,208.893 7.38 \.001 15,284.755 .868 .841 .066 .139 .11–.15
Peru 1,666.109 5.57 \.001 df = 276 .903 .871 .060 .106 .09–.12
Mexico 1,185.092 3.86 \.001 Ratio 55.379 .933 .901 .052 .081 .07–.09
Cuba 2,142.55 7.17 \.001 .921 .899 .061 .071 .06–.08
Paraguay 1,123.77 3.76 \.001 .911 .877 .071 .082 .07–.09
Argentina 1,978.53 6.61 \.001 .933 .876 .059 .071 .06–.08
Colombia 2,435.12 8.14 \.001 .899 .899 .066 .074 .06–.08
Spain 1,943.55 6.49 \.001 .901 .901 .082 .110 .10–.12
Chile 2,145.12 7.17 \.001 .915 .855 .068 .093 .08–.11
Total sample 1,124.66 3.75 \.05 .943 .922 .051 .045 .04–.05
v2 chi-square test, v2BL Model chi-square test of null model, CFI comparative fit index, TLI Tucker-Lewis index, RMSEA root mean square error of
approximation, SRMR standardized root mean square residual, CI confidence interval of SRMR

123
Qual Life Res (2014) 23:2205–2212 2209

Table 4 kij factor loadings for each item and latent factor by country Table 5 Matrix of factor loadings estimated through EFA under the
(factor saturation for the whole sample) assumption of cross-country invariance
Items Physical Psychological Social Environmental Items Factor 1 Factor 2 Factor 3 Factor 4
QOL QOL QOL QOL
Item 3 -.442** -.030 -.103 -.144
Item 3 .12 to .14
Item 4 -.712** -.056 -.088 -.126
(.13)
Item 5 .827** .091 -.010 .003
Item 4 .23 to .32
(.29) Item 6 .496** .474** -.054 .082
Item 5 .33 to .49 Item 7 .114 .793** -.057 .025
(.49) Item 8 .177 .551** -.053 .003
Item 6 .38 to .55 Item 9 -.025 .487** .216 .055
(.54)
Item 10 .024 .208 .450** .117
Item 7 .35 to .49
(.42) Item 11 -.076 .089 .587** .176
Item 8 .11 to .27 (.26) Item 12 -.028 .006 .572** .013
Item 9 .09 to .33 (.31) Item 13 .018 .133 .025 -.622**
Item 10 .32 to .42 Item 14 .121 .106 .128 -.883**
(.40) Item 15 .137 .580** .188 .139
Item 11 .41 to .62 Item 16 .163 .557** .103 .200
(.59)
Item 17 .537** .086 .157 .028
Item 12 .16 to .41 (.40)
Item 18 .228 .388 .251 .175
Item 13 .21 to .32 (.31)
Item 19 .038 .227 .407** .192
Item 14 .09 to .23 (.22)
Item 20 .035 .176 .415** .213
Item 15 .19 to .28
(.26) Item 21 .432** .166 .156 .284
Item 16 .23 to .44 Item 22 .348 .305 -.016 .218
(.44) Item 23 .205 -.093 .658** .048
Item 17 .33 to .38 Item 24 .168 .047 .618** .108
(.36)
Item 25 .095 -.014 .509** .054
Item 18 .39 to .51
(.51) Item 26 .180 .209 .061 .409**
Item 19 .26 to .41 Variance explained 32.11 % 21.10 % 8.11 % 7.49 %
(.39) total = 68.81 %
Item 20 .12 to .27 ** Most statistical significant loadings (p \ .001)
(.27)
Item 21 .21 to .44
(.43)
Item 22 .18 to .31 Analyses of exploratory factor analysis
(.31)
Item 23 .10 to .41 (.41)
After demonstrating that the original theoretical model was
Item 24 .23 to .51 (.51)
not viable, we estimated a factor structure for four factors
Item 25 .19 to .54 (.52)
based on the original 24 items. In this case, we chose to
Item 26 .31 to .44
(.43) maintain the same assumptions already formulated. How-
ever, we added a varimax rotation to establish orthogo-
nality between factors, and given the previous results, we
given that these are confirmatory models, modification chose a factor extraction through principal components
indexes were estimated for the non-specified factor load- analysis. The estimation was conducted by using the mul-
ings and significant indexes were obtained for 14 of the 24 tigroup strategy defined for Mplus (version 5.1) and
defined factor loadings (p \ .01). Given these findings, we assuming a free distribution (see Marsh et al. [25]). In this
concluded that the originally proposed structure should be manner, we estimated the best solution for the matrix of
revised to establish a new factor structure that would be factor loadings that was able to withstand the assumption
more in keeping with the distribution observed. As con- of invariance across countries and showed good fit to the
sequence, we analyzed the data with exploratory statistical total sample, assuming it was the same sampling popula-
techniques to estimate a model that would fit a new tion. Table 5 shows the best factorial solution.
invariant factor structure across the countries under It is clear that these results should be contemplated and
investigation. understood within the framework of factor orthogonality

123
2210 Qual Life Res (2014) 23:2205–2212

Table 6 Goodness-of-fit indexes obtained through ESEM of the Table 7 Factor loadings derived from the ESEM estimation under
exploratory measurement models assuming invariance of the WHO- the assumption of cross-country invariance
QOL-BREF factor structure and cross-factor orthogonality
Items Factor 1 Factor 2 Factor 3 Factor 4
Models v2 p RMSEA 90 % CI CFI
Item 3 -.451* -.017 -.088 -.163
Costa Rica 336.78 .11 .042 .03–.05 .955 Item 4 -.707* -.062 -.096 -.119
Peru 392.44 .13 .044 .03–.06 .941 Item 5 .825* .093 -.008 .004
Mexico 412.77 .10 .051 .04–.07 .934 Item 6 .494* .477* -.050 .079
Cuba 389.11 .16 .048 .03–.05 .951 Item 7 .117 .791* -.055 .025
Paraguay 402.39 .11 .042 .02–.05 .943 Item 8 .182 .547* -.058 .008
Argentina 422.19 .15 .055 .04–.07 .961 Item 9 -.028 .491* .220 .050
Colombia 399.12 .18 .061 .04–.08 .988 Item 10 .026 .207 .448* .118
Spain 445.89 .12 .043 .03–.05 .971 Item 11 -.080 .094 .589* .173
Chile 399.11 .14 .059 .03–.06 .945 Item 12 -.028 .007 .572* .013
Total sample. 289.77 .21 .032 .02–.04 .967 Item 13 .020 .134 .022 -.621*
configurational
Item 14 .124 .106 .128 -.882*
Measurement 437.89 .28 .039 .02–.05 .977
Item 15 .138 .578* .186 .141
Equal intercept 523.12 .23 .033 .02–.05 .978
Item 16 .163 .558* .103 .200
v2 chi-square test, RMSEA root mean square error of approximation, Item 17 .535* .090 .158 .027
CI confidence interval of RMSEA, CFI comparative fit index
Item 18 .225 .391 .249 .176
Item 19 .036 .230 .403* .196
Item 20 .032 .178 .418* .410*
imposed in the rotation, which was used to maintain that Item 21 .434* .163 .152 .488*
part of the theoretical model proposed previously. Esti- Item 22 .348 .307 -.017 .218
mating the most exploratory solution would mean estab- Item 23 .209 -.097 .659* .049
lishing the same estimation while assuming non- Item 24 .166 .048 .621* .106
orthogonality. To this end, we assessed the same structure Item 25 .100 -.021 .506* .059
by means of the aforementioned ESEM modification, Item 26 .181 .207 .063 .409*
which was based on the specification of all the factor Variance explained 38.12 % 24.33 % 9.46 % 8.19 %
loadings as free parameters within the SEM logic and the Total = 80.1 %
estimation of the different parameters linked to the mea-
* Statistically significant saturations (p \ .01)
surement model proposed. The previous EFA data allowed
us to analyze the viability of factors orthogonality.
Table 8 Correlation matrix across factors derived from the ESEM
Analyses of exploratory factor analysis (ESEM) solution
Factors Factor 1 Factor 2 Factor 3 Factor 4
Just as in the previous cases, the estimations were based on
Spearman’s correlations between indicators and a free- Factor 1 1
distribution parameter estimation was used in Mplus (ver- Factor 2 .524** 1
sion 5.1), according to the aforementioned scheme by Factor 3 .297* .306** 1
Marsh et al. [25] and applied by Chahin, Cosi, Lorenzo- Factor 4 .320** .318** .330** 1
Seva, and Vigil-Colet [30]. The result of this estimation is * p \ .01, ** p \ .001
presented in Table 6.
These results indicated that the resulting factor structure
can be assumed to be invariant across countries and sup-
ports the assumption of one population with an insignifi- estimation of the correlation between factors of the ESEM
cant country effect. The table of invariant factor loadings solution yields a non-orthogonal matrix, as shown in
derived from the ESEM estimation is shown in Table 7. Table 8.
This solution is clearly different from the EFA solution Although these values do not indicate particularly large
and is much more complex than the theoretically proposed effect sizes, they should not be discarded. As a result, we
CFA. It is fitted to the empirical behavior of the observed concluded that the strictly orthogonal solution might be a
distribution. Further, the ESEM solution calls into question somewhat rigid assumption in a Spanish-speaking
the assumption of factor orthogonality given that the population.

123
Qual Life Res (2014) 23:2205–2212
Discussion
The main goal of the present study was to analyze the
factor structure of the Spanish version of WHOQOL-BREF
in a sample of Spanish-speaking individuals from different
countries. The results obtained lead us to conclude that the
model best adapted to the data are the four-factor model
proposed by the classic theoretical model, given that all the
solutions examined demonstrated acceptable statistical
behavior under that set of assumptions. The essential issue
was the limitations introduced by the estimated factor
loadings in a confirmatory solution (CFA)—they indicate
the poor fit of model—which misleadingly suggested that
the theoretical model is not valid in a Spanish-speaking
population. The data from that CFA solution showed that a
one-factor solution is not viable, either, given that the
results of the four-factor solution indicated a better fit
compared to the null model of maximum independence or
the one-factor model. In summary, the four-factor structure
seems reasonable—unlike the item distribution—and,
therefore, so does each factor’s theoretical definition.
The exploratory results based on the EFA and ESEM
solutions yielded an alternative structure, which respected
the cross-country invariance assumption, but showed cer-
tain discrepancies regarding the orthogonality of the four
factors. We obtained a more complex factor structure using
ESEM that saturated the four factors adequately and
resulted in a very high level of explained variance
(80.1 %). This finding allowed us to consider this structure
as possibly valid for a Spanish-speaking population. The
structure resulting from the ESEM yielded a solution with
items 3, 4, 5, 6, 17, and 21 loading onto factor 1; items 6, 7,
8, 9, 15, and 16 loading onto factor 2; items 10, 11, 12, 19,
20, 23, 24, and 25 loading onto factor 3; and items 13, 14,
20, 21, and 26 loading onto factor 4. After analyzing the
structure derived from the ESEM solution compared to the
original theoretical model, we determined that the four
factors generally follow the same pattern as those proposed
initially but with more extended operational definitions. In
our findings, the components were somewhat more com-
plex than the original ones, and the assumption of
orthogonality was invalid. Overall, the current model is a
much more complex structure than the one proposed and at
least in the case of a Spanish-speaking population, the
factorization of the measurement model is different.
Additionally, this proposal confirmed some more recent
conceptions concerning the QOL construct, formulated
more amply than as established in the WHOQOL-BREF
theoretical model. For example, the infradefinition of the
third factor (Social QOL), with a scarce number of indi-
cators in the original version, is now better defined, as the
number of items linked to this factor increased consider-
ably. The modification of the factor structure supported by
2211
our data therefore adds more evidence to what other
researchers have concluded previous [5, 18, and 20]. Fur-
thermore, complementary analyses are needed in relation
to the scale’s global indices, despite the fact that the real
usefulness of those indicators is always debatable.
In conclusion, we would like to note, as did Marsh,
Muthén et al. [25] and Marsh et al. [26] in their respective
studies on the application of ESEM, that it is reasonable to
consider ESEM to be a useful approach in the analysis of
the factor structures of instruments measuring complex
psychological phenomena.
Acknowledgments This study was supported by the Agència de
Gestió d’Ajuts Universitaris i de Recerca de la Generalitat de Ca-
talunya and the Grup de Recerca en Tècniques Estadı́stiques A-
vançades Aplicades a la Psicologia (GTEAAP). This research was
made possible by the PSI2010-21214-C02-01 project and was carried
out by members of the Generalitat de Catalunya’s SGR 388 Con-
solidated Research Group.
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