BAHIR DAR UNIVERSITY

COLLEGE OF MEDICINE AND HEALTH SCIENCES

SCHOOL OF MEDICINE

DEPARTMENT OF PSYCHIATRY

Seminar Presentation On: Measurement of Quality of Life

By: Mastewal Aschale

Bahirdar Ethiopia ,September 2014

Presentation Outline
 Objective
 Introduction
 Summary
 Reference
Objectives

At the end of these presentation the audience will be :

• Know what quality of life mean

• Identify measuring tools of quality of life

• Understand which measuring tool is mostly utilized in

Ethiopia.
 Introduction
• Quality of life” is defined by the World Health Organization (WHO) as:

• “A person’s perception of his/her position in life within the context of the

culture and value systems in which he/she lives and in relation to his/her
goals, expectations, standards and concerns” .

• Quality of life (QoL) is an ill-defined term.

• Measurement of quality of life (QoL) has gained more focus in

recent years.
 Cont…

• Quality of life (QoL) assessment is increasingly used in mental health.

• Multiple instruments exist, but the conditions for choosing one instrument
over another for purposes of a specific study are not clear.

• The instruments were systematically described regarding their intrinsic

properties generic vs. disease-specific and their characteristics of
utilization in studies study objectives.
WHOQOL-100

• The most frequently used measures of QoL

• Developed by the WHO two decades ago.

• Is a multidimensional scale and has 100 items.

• It was developed in six domains of QOL: physical, psychological,

social, environmental, spiritual and personal beliefs for use in
situations where time is limited.
WHOQOL-100

• Used for assessing a wide spectrum of psychological and physical

disorders, especially useful for research.

• Self administered

• Validated in Ethiopia for type-2 DM

 WHOQOL-BREF

• Is a short version of WHOQOL-100,

• Is a 26-item instrument consisting of four domains.

• Physical health (7 items), psychological health (6 items), social

relationships (3 items), and environmental health (8 items).

• Two other items measure overall QOL and general health.

WHOQOL-BREF…

• Each of these items are scored from 1 to 5 on a response scale, which

is agreed as a five-point Likert scale.
• Recommended for use when time is restricted or the burden on the
respondent needs to be minimized.
• Used in large epidemiological studies and clinical trials.
• Self administration if the respondent has adequate ability.
• Takes 15 to 20 minutes.
• Reliable instrument easily acceptable in routine evaluation.
 WHOQOL-HIV-BREF-Eth
• The WHOQOL-HIV-BREF-Eth has been shown to be a valid measure of
quality of life for use in clinical settings among people with HIV in
Ethiopia.

• The Cronbach’s α 0.93.

 Quality of life scale (QOLS)
• Was originally a 15-item instrument that measures five conceptual
domains of quality of life.

• Used in studies of health adults and patients in chronic medical illness,

PTSD and stress incontinence.

• It can completed in 15 minutes.

EuroQol five-dimensional (EQ-5D)
• Is a very popular generic and preference-based instrument to make
index values and health profiles.

• It is a multi attribute instrument, considers 5-dimentions including

mobility, self-care, usual activities, pain/discomfort, and
anxiety/depression.

• EQ-5D defines a total of 243 health states.

Cont…
• There are two versions of EQ-5D. In three-level version levels are,

“no problems, some problems, and severe problems”.

• Many studies reported measurement insensitivity and ceiling effect about

EQ-5D-3 L questionnaire.

• In five level version of EQ-5D the level changed to “no problems, slight
problems, moderate problems, severe problems, and unable to
do/extreme” (Emrani, Akbari Sari et al. 2020).
 Medical outcome study( SF-36)

• The SF-36 is a short-form measure of generic health status in the

general population.

• One of the most generally used HRQoL scale in the world.

• It is designed for self-administration and it can be administered to

anyone over the age of 14 years.
SF-36…

• Not specific to mental health but has been used for depression patient.

• Has multicultural scale.

• The SF-36 has been translated and adapted in many countries.

• It consists of 36 items divided into 8 health profiles.
• Alpha’s ranging from 0.77 to 0.88.
• The Mental Health scale focuses mostly on affect (e.g., depression,
happiness, and anxiety) .
 Short-Form 36 health domains
Domains Description

Physical functioning Limitations in physical activity because of

health
problems (10 items)
Social functioning Limitations in social activities because of
physical or emotional problems (2 items)

Role limitations Limitations in usual role activities because

of
physical health problems (4 items)
Bodily pain Presence of pain and limitations due to pain
(2 items)
 Short-Form 36 health domains
Domains Description
General medical health Self-evaluation of personal health (5 items)

Mental health Psychological distress and well-being (5

items)

Role limitations emotional Limitations in usual role activities because

of emotional emotional problems (3 items)

Vitality Energy and fatigue (4 items)

General Health Questionnaire(GHQ)

• The GHQ is a most widely used (in population health surveys as well
as clinical settings) and quickly administered screening instrument
(alpha =.81).
• It can distinguish persons at risk for acute psychological distress from
"normals".
• Strength in assessing neurotic distress and anxiety.
 Quality of life instruments…
Instrument Relia Valid Internal Comments
bility ity consist
ency

SmithKline Beecham Quality Good Good  28 item-self-rating especially for

of Life Scale –SBQOL 0.95 patients suffering with depression.

Quality of Life in Depression Good Good 0.94  34 item-self-rating especially used

Scale – QLDS for QoL assessment depression.
Good
Quality of Life Inventory – Good 0.79  16 item-self-rating questionnaire
QOLI
 Quality of life instruments mainly used in psychiatric
field
Instrument Reliability Validity Comments

Quality of Life Scale- Fair Fair  21 item- semi structured interview

QLS useful scales for QoL assessment of
schizophrenia. alpha 0.97
Fair to Fair to
Lancashire Quality of  100 item-self-rating multidimensional
Good Good
Life – LQL questionnaire.. .
 Quality of life instruments…
Instrument Reliability Validity Comments

Quality of Life Enjoyment Good Good  58 item-self-rating questionnaire

and Satisfaction  used for depression, schizophrenic,
Questionnaire – Q-LES-Q substance abuse and anxiety
disordered.

Fair to Fair to
Quality of Life Interview –  96 items administered by interview
Good Good
QoLI used with chronic patients living in
rehabilitation facilities.
 Quality of life instruments…

Instrument Reliab Valid Comments

ility ity

WHOQOL -100(The Good Good  100 item self-rated instrument

WHOQOL Group,1998)

WHOQOL -BREF(The Good Good  26 item self-rated

WHOQOL Group,1998)
 Measurement tools in adult ADHD
Reference Measure Main outcomes/conclusions

Adult
29-item AAQoL measured four domains: life
attention
productivity, psychological health, relationships
deficit
and life outlook. Internal consistency was
Brod et al (2006) hyperactivity
adequate (0.93).
disorder
• Demonstrated the AAQoL as a valid measure
quality of life
of quality of life for ADHD adults.
(AAQoL)

AAQoL effect sizes were larger than those of

SF-36.
Matza et al AAQoL
• Strongly supporting the AAQoL as an outcome
(2007) SF-36
measure for treatment of ADHD in adults and as
a measure of QOL.
 AIM-A correlated strongly with the
Landgraf et al ADHD Impact Module
symptom scale. It serves as a powerful
(2007) Adult Version
quality of life measure.

Q-LES-Q-SF showed significantly

Quality of life Enjoyment poorer scores within ADHD patients,
Mick et al (2008) and Satisfaction strong internal consistency (0.88)
Questionnaire

Taiwan versions of SF-36 SF-36 measures health related QoL,

Huang et al (2006)
and WHOQoL WHOQoL measures global QOL.
Summary
• The most important is the World Health Organization Quality of
Life (WHOQOL) for assessing a wide spectrum of psychological
and physical disorders.

• Most utilized tools in Ethiopia:

• EuroQol five-dimensional (EQ-5D)

• WHOQOL
 References
• Emrani, Z., et al. (2020). "Health-related quality of life measured
using the EQ-5D–5 L: population norms for the capital of Iran."
Health and quality of life outcomes 18(1): 1-8.
• Fayers, P. M. and D. Machin (2013). Quality of life: the assessment,
analysis and interpretation of patient-reported outcomes, John Wiley &
Sons.
• Korkeila, J. (2000). "Measuring aspects of mental health."
• Reba, K., et al. (2019). "Validity and reliability of the Amharic version
of the World Health Organization’s quality of life questionnaire
(WHOQOL-BREF) in patients with diagnosed type 2 diabetes in
Felege Hiwot referral hospital, Ethiopia." Journal of diabetes research
2019.
 References

• Tesfaye, M., et al. (2016). "Adaptation and validation of the short

version WHOQOL-HIV in Ethiopia." International Journal of Mental
Health Systems 10(1): 1-10.
• Wells, G. A., et al. (2011). "Validity of quality of life measurement
tools—from generic to disease-specific." The Journal of
Rheumatology Supplement 88: 2-6.
• Atkinson, M. J. and S. L. Zibin (1996). Quality of life measurement
among persons with chronic mental illness: A critique of measures and
methods, The Directorate.