Development of a mental health recovery module for the WHOQOL

  • Melissa J. RowthornEmail author
  • D. Rex Billington
  • Christian U. Krägeloh
  • Jason Landon
  • Oleg N. Medvedev



The WHOQOL tools are widely used, multi-faceted, patient-rated, quality of life (QoL) measures, developed by the World Health Organization. The WHOQOL questionnaires are used to assess generic quality of life issues affected by all health problems. This study developed a module to use with the WHOQOL tools to improve their sensitivity to Health Related QoL issues relevant to mental health recovery.


Using a sequential mixed-methods approach, two research stages occurred. A qualitative stage invited 88 participants with experience of mental health recovery, into focus groups and importance rating activities, to identify candidate items for the new module. Following this, a quantitative stage involved 667 participants with, and without, mental health/addiction issues completing online or paper-based questionnaires to analyze which candidate items differentiated between those with and without mental health/addiction issues. Classical test theory and iterative Partial Credit Rasch Analysis were used to identify the most suitable candidate items for a reliable and valid mental health recovery module to be used with the WHOQOL tools.


Seventeen candidate items captured important HRQoL facets relevant to mental health recovery. Rasch analysis removed 10 misfitting items. The final 7-item module, which demonstrated the best Rasch model fit, enquires about recovery beliefs, identifying strengths, self-awareness, acceptance, capacity to relate, feeling understood, and recovery progress. Ordinal-to-interval conversion tables have been developed to optimize measurement precision when using the module.


Important HRQoL issues central to mental health recovery can be reliably evaluated by using the recovery module with the WHOQOL tools.


Quality of life Patient-reported outcome Measurement Rasch model WHOQOL Mental health recovery 



Appreciation and acknowledgement goes to the individual participants who contributed the information that has led to the outcomes of this research and to the individuals and organisations that have supported this research: Connect Supporting Recovery, Pathways & Ross Phillips, Emerge Aotearoa & Sarah Andrews, Walsh Trust, EQUIP, Comcare, Changing Minds, Sarah Gordon, DRIVE network, Northland DHB, Paul Clements and Granville Hendricks, Midland DHB, Southland DHB & Patricia Hsu, Sandra Finlay, Oliver Rowthorn, Jason Verburg, Supporting Families, Mike King & the Nutters Club, as well as Platform Trust, Phillipa Gaines & the members of the WHOQOL outcome Forum, Te Pou, and Wild Bamboo, all whom gave time or assisted in various promotional and practical ways with this study. Much appreciation for the support, guidance, and experience of the team of researchers and co-authors involved with this study, and to AUT university for making this study possible.


No Grants or external funding were involved in this research.

Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflicts of interest.

Ethical approval

This article does not contain any studies with animals performed by any of the authors. All procedures performed in studies involving human participants were reviewed and approved by the Auckland University of Technology Ethics Committee (AUTEC Approval Reference 14/227) which is aligned with New Zealand National Ethics Committee guidelines and the 1964 ethical standards within the Helsinki declaration and its later amendments. Agencies were approached and gave consent to invite the people receiving and working in their services into the study. Participants with lived experience of mental illness were in stable states of mental health, identifying themselves as being in mid-later stages of recovery. All participants were provided with information sheets detailing the purposes of the study, activities involved, their rights to withdraw, contact details to request further information about the study, consent forms, and opportunities to ask questions with staff and of the researcher. Support was available to participants during and following research activities. Participants had a choice of participating in group or individual interviews in Stage 1, or of completing online or paper versions of the survey in Stage 2, as well as choices to enter a grocery voucher draw or to receive information about the study at its conclusion, if desired. All participants self-identified themselves as capable of participating in the study by signing paper-based consent forms in both studies or by clicking on a progress to the survey link, after reading the online information sheet, if they consented to participate in the online version of the questionnaire in Stage 2. Participants knew they could withdraw at any time with no consequences to them in both studies.

Supplementary material

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Supplementary material 1 (DOCX 18 kb)


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Psychology DepartmentAuckland University of Technology, AR BuildingAucklandNew Zealand
  2. 2.University of WaikatoHamiltonNew Zealand

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