Quality of Life Research

, Volume 27, Issue 4, pp 1015–1025 | Cite as

Measurement invariance of the WHOQOL-AGE questionnaire across three European countries

  • David Santos
  • Francisco J. Abad
  • Marta Miret
  • Somnath Chatterji
  • Beatriz Olaya
  • Katarzyna Zawisza
  • Seppo Koskinen
  • Matilde Leonardi
  • Josep Maria Haro
  • José Luis Ayuso-Mateos
  • Francisco Félix Caballero



Developing valid and reliable instruments that can be used across countries is necessary. The present study aimed to test the comparability of quality of life scores across three European countries (Finland, Poland, and Spain).


Data from 9987 participants interviewed between 2011 and 2012 were employed, using nationally representative samples from the Collaborative Research on Ageing in Europe project. The WHOQOL-AGE questionnaire is a 13-item test and was employed to assess the quality of life in the three considered countries. First of all, two models (a bifactor model and a two-correlated factor model) were proposed and tested in each country by means of confirmatory factor models. Second, measurement invariance across the three countries was tested using multi-group confirmatory factor analysis for that model which showed the best fit. Finally, differences in latent mean scores across countries were analyzed.


The results indicated that the bifactor model showed more satisfactory goodness-of-fit indices than the two-correlated factor model and that the WHOQOL-AGE questionnaire is a partially scalar invariant instrument (only two items do not meet scalar invariance). Quality of life scores were higher in Finland (considered as the reference category: mean = 0, SD = 1) than in Spain (mean = − 0.547, SD = 1.22) and Poland (mean = − 0.927, SD = 1.26).


Respondents from Finland, Poland, and Spain attribute the same meaning to the latent construct studied, and differences across countries can be due to actual differences in quality of life. According to the results, the comparability across the different considered samples is supported and the WHOQOL-AGE showed an adequate validity in terms of cross-country validation. Caution should be exercised with the two items which did not meet scalar invariance, as potential indicator of differential item functioning.


Quality of life Measurement invariance Multi-group confirmatory factor analysis WHOQOL-AGE Bifactor model 



The present research has been funded by the Seventh Framework Programme of the European Commission (FP7/2007-2013) under Grant Agreement Number 223071 (COURAGE in Europe), by the Instituto de Salud Carlos III-FIS research Grant Numbers PS09/00295 and PS09/01845, by the Spanish Ministry of Science and Innovation’s ACI-Promociona (ACI2009-1010), and the Mental Health and Disability Instrument Library Platform (CIBERSAM). The study was also supported by the Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III. D.S. is grateful to the Universidad Autónoma de Madrid for the doctoral fellowship (Reference No. FPI-UAM2015). F.J.A. is grateful to the Ministerio de Economia y Competitividad (Grant PSI2013-44300-P). All authors gratefully acknowledge the input of Prof. Mick Power during the process of selecting the WHOQOL-AGE items.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2017

Authors and Affiliations

  • David Santos
    • 1
  • Francisco J. Abad
    • 1
  • Marta Miret
    • 2
    • 3
    • 4
  • Somnath Chatterji
    • 5
  • Beatriz Olaya
    • 3
    • 6
  • Katarzyna Zawisza
    • 7
  • Seppo Koskinen
    • 8
  • Matilde Leonardi
    • 9
  • Josep Maria Haro
    • 3
    • 6
  • José Luis Ayuso-Mateos
    • 2
    • 3
    • 4
  • Francisco Félix Caballero
    • 2
    • 3
    • 4
  1. 1.Department of PsychologyUniversidad Autónoma de MadridMadridSpain
  2. 2.Department of PsychiatryUniversidad Autónoma de MadridMadridSpain
  3. 3.CIBER of Mental HealthMadridSpain
  4. 4.Instituto de Investigación Sanitaria (IIS-Princesa)Hospital Universitario de La PrincesaMadridSpain
  5. 5.Information, Evidence and ResearchWorld Health OrganizationGenevaSwitzerland
  6. 6.Parc Sanitari Sant Joan de DéuUniversitat de BarcelonaBarcelonaSpain
  7. 7.Department of Medical Sociology, Chair of Epidemiology and Preventive MedicineJagiellonian University Medical CollegeKrakowPoland
  8. 8.National Institute for Health and WelfareHelsinkiFinland
  9. 9.Fondazione IRCCSNeurological Institute Carlo BestaMilanoItaly

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