Generic questionnaires in

assessment of quality of life

Achyut Bikram Thapa
Kathmandu University

Submitted to: Prof. Anantha Naik Nagappa

June 27, 2022
Content
• Introduction
• Approaches to define QOL
• Assessment of QOL
1. QOL Scale (Flanagan, 1978)
2. McGill Quality of Life Questionnaire — Expanded (Cohen et al., 2019)
3. Health-Related Quality of Life Questionnaire (CDC, 2000)
4. World Health Organization Quality of Life Instrument (WHO, 2012)
5. Global Quality of Life Scale (1996)

• Questionnaires/Assessment in disease specific conditions

• Conclusion

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Introduction
• Quality of life (QoL) is a multidimensional concept that refers to 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, and standards” and is affected by a person’s physical health
and psychological state
• QoL should consider aspects of physical health, psychological state, level of
autonomy, family/social relationships, beliefs, and relationship to salient
features of the environment.

• WHO defines Quality of Life 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

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 Approaches to define QOL
Felce and Perry (1995) summarized four approaches to defining QOL.
• The sum of a range of objectively measurable life conditions. That is, a person’s QOL across
a range of domains (e.g., social relationships, physical health, personal circumstances, etc.)
is determined numerically and then compared against a larger population distribution.
• Satisfaction with the sum of these life conditions. The difference between this and the first
approach is that personal welfare is based on a subjective reaction to life conditions, rather
than how a person’s standing on these conditions compares numerically to others in a
broader population.
• Third approach is the combination of both objective life conditions and satisfaction with
those conditions (Brown, Bayer, & MacFarlane, 1989).
• Fourth approach is an objective assessment of life conditions and subjective assessment of
satisfaction, weighted according to the significance an individual places on each particular
domain.

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Assessment of QOL
• Five different questionnaire scales are used to assess QOL. These scales will vary
in specificity, such that some drill down to assessing QOL in different domains,
while others will serve as a more concise, global assessment.

1. QOL Scale (Flanagan, 1978)

2. McGill Quality of Life Questionnaire — Expanded (Cohen et al., 2019)
3. Health-Related Quality of Life Questionnaire (CDC, 2000)
4. World Health Organization Quality of Life Instrument (WHO, 2012)
5. Global Quality of Life Scale (1996)

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 QOL Scale (Flanagan, 1978)
• Flanagan’s (1978) Quality of Life Scale (QOLS) is one of the most widely used QOL
assessments, applied predominantly in the healthcare sector.
• Interview questions from 3,000 Americans, representing a broad range of ages, races, and
backgrounds.
• These responses were filtered down to fifteen quality-of-life components (or domains), each
represented by one item, using an inductive process. later 16th domain was added and the
domains regrouped under six higher domains
1. Physical and material wellbeing (2 domains)
2. Relations with other people (4 domains)
3.  Social, Community, and Civic Activities (2 domains)
4. Personal Development and Fulfillment (4 domains)
5. Recreation (3 domains)
6. Independence (1 domain)

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 McGill Quality of Life Questionnaire
2019)
Expanded (Cohen et al.,

• Published in 1996, the McGill Quality of Life Questionnaire (MQOL) was designed to
assess the QOL of patients facing life-threatening illnesses. Today, the questionnaire is used
extensively in palliative care research.
• Originally only 4 dimensions were included and later increased to 8 to assess the domains
that people nearing the end of their life report as important to their QOL
• Physical, physiological, existential, Social, Environment, Cognition, Healthcare, Burden
• Domains in the MQOL-Expanded (MQOL-E) are assessed using multiple items. The
response anchors for the subscales vary by item but are always on an 11-point scale ranging
from 0 to 10.

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McGill Quality of Life Questionnaire
2019)
Expanded (Cohen et al.,

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McGill Quality of Life Questionnaire
2019)
Expanded (Cohen et al.,

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 Health-Related Quality of Life Questionnaire (CDC, 2000)
• … aspects of overall quality of life that can be clearly shown to affect health–either physical
or mental.
Centers for Disease Control and Prevention (CDC, 2000, p. 6)
• The HRQOL Questionnaire combines three separate modules to assess perceptions of
HRQOL.
• first module: Core Healthy Days Measures,
• second module: Activity Limitations Module
• final module: Healthy Days Symptoms Module

• It is widely used by health professionals and was designed to bridge the gap between
disciplines, such as sociology, psychology, and economics, about the drivers of QOL.
• It is for this reason that the questionnaire is fairly broad in its focus.

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 Health-Related Quality of Life Questionnaire (CDC, 2000)
• … aspects of overall quality of life that can be clearly shown to affect health–either physical
or mental.
Centers for Disease Control and Prevention (CDC, 2000, p. 6)
• The HRQOL Questionnaire combines three separate modules to assess perceptions of
HRQOL.
• first module: Core Healthy Days Measures,
• second module: Activity Limitations Module
• final module: Healthy Days Symptoms Module

• It is widely used by health professionals and was designed to bridge the gap between
disciplines, such as sociology, psychology, and economics, about the drivers of QOL.
• It is for this reason that the questionnaire is fairly broad in its focus.

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 Health-Related Quality of Life Questionnaire (CDC, 2000)
• first module: Core Healthy Days Measures,
Module 1 is: “Would you say that in general your health is…” with responses ranging from 1 (excellent) to 5 (poor).

• second module: Activity Limitations Module

• Assesses physical, mental, or emotional problems a person may face in their daily life.
• The module begins by asking: “Are you limited in any way in any activities because of any impairment or health problem?”
• If the respondent indicates ‘yes,’ he or she will be prompted to continue the module, which goes on to assess the nature of
the impairment, the duration of time that the impairment has exerted limitations, and whether or not the respondent requires
additional support in terms of personal care or maintenance of routine as a result of their impairment.

• final module: Healthy Days Symptoms Module

assesses how factors such as pain, depression and anxiety symptoms, insufficient sleep, and energy levels have affected
functioning over the past 30 days.

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 World Health Organization Quality of Life Instrument
• Trustworthy measure of QOL has been developed by The World Health Organization
(WHO).
• The instrument is called the WHOQOL-BREF or WHOQOL 100
• Used for comparing indices of QOL across cultures. It is for this reason that the scale is
available in over 40 languages.
• The instrument assesses QOL in the context of six domains:
1. Physical health
2. Psychological health
3. Level of Independence
4. Social relationships
5. Environment
6. Spirituality/Religion/Personal beliefs
• The instrument also contains several items assessing general health.
• The response anchors for the subscales vary by item but are always on a 5-point scale
ranging from 1 to 5. 13
 World Health Organization Quality of Life Instrument
• The WHOQOL-100 assesses 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.
• Developed collaboratively in some 15 cultural settings over several years and has now
been field tested in 37 field centers.
• It yields a multi-dimensional profile of scores across domains and sub-domains (facets)
of quality of life.
• More recently, the WHOQOL-BREF, an abbreviated 26 item assessment has been
developed.
• Used in medical practice, research, audit, policy making and in assessing the
effectiveness and relative merits of different treatments.
• They can also be used to assess variation in quality of life across different cultures, to
compare subgroups within the same culture and to measure change across time in
response to change in life circumstances.

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World Health Organization Quality of Life Instrument

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 Global quality of life scale
• Fascinating approach to assessing QOL developed by Hyland and Sodergren (1996)
• Respondents can mentally apply their own weighting system when assessing the various
facets of their life.
• QOL indicated in a scale ranging from 100-0, where 100 is labeled ‘Perfect quality of life,’
and 0 is labeled ‘Might as well be dead’.
• Eight additional labels are positioned along the scale as follows:
• 95 = Near perfect quality of life
• 85 = Very good quality of life
• 70 = Good quality of life
• 57.5 = Moderately good quality of life
• 40 = Somewhat bad quality of life
• 27.5 = Bad quality of life
• 15 = Very bad quality of life
• 5 = Extremely bad quality of life

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 Questionnaires/Assessment in disease specific conditions
• Chronic non communicable diseased case
• Assessment in cancer patients
• Assessment in adolescent and adults with no underlying conditions
• Assessment of aged group patient

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