Quality of Life Research

, Volume 13, Issue 1, pp 23–34 | Cite as

Can we identify the poorest quality of life? Assessing the importance of quality of life using the WHOQOL-100

  • Suzanne M. Skevington
  • Kathryn A. O'Connell


In this study, WHOQOL survey data obtained from 4802 sick and well participants in 15 countries were used to investigate the relationship between judgements about different dimensions of quality of life (QOL) (core scores) and the importance attributed to them. As a theoretical framework, we applied the WHOQOL Group's (1995) definition of QOL which indicates that those who report the very poorest QOL will be least likely to have met their own ‘...goals, expectations, standards and concerns’. Those with the poorest QOL would therefore be expected to show the biggest difference between core and importance scores, and therefore be distinguishable from respondents whose QOL was poor, better or best. The main effects from overall analyses confirmed that those reporting the largest negative differences tended to report the poorest QOL and also attached a high degree of importance to these dimensions. Evidence for a decreasing differential across the four groups (poorest to best) was confirmed for the majority (18) of facets. However facet level analyses comparing groups with different levels of QOL showed that only five facets distinguished those with the poorest QOL from those whose QOL was poor, so the theory is not well supported. Furthermore the contribution of core-importance facet differences reduced the overall prediction of QOL, when compared with a regression of core scores alone. Importance information about specific facets may have limited potential to be used alongside the main instrument to identify areas of the poorest QOL for clinical or social action.

Assessment Health Importance Quality of life WHOQOL 


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    The WHOQOL Group. The development of the World Health Organisation Quality of Life Assessment Instrument (the WHOQOL). In: Orley J, Kuyken W (eds), Quality of Life Assessment: International Perspectives, Heidelberg: Springer-Verlag, 1994.Google Scholar
  2. 2.
    Fallowfield L. The Quality of Life: The Missing Measurement in Health Care. London: Souvenir Press, 1990.Google Scholar
  3. 3.
    Bowling A. Measuring Disease. Buckingham, UK: Open University Press, 1995.Google Scholar
  4. 4.
    Skevington SM, Mc Arthur P, Somerset M. Developing items for the WHOQOL: An investigation of contemporary beliefs about quality of life related to health in Britain. Br J Health Psychol 1997; 2: 55-72.Google Scholar
  5. 5.
    Kind P. The Euroqol Instrument: An index of health related quality of life. In: Spilker B (ed), Quality of life and Pharmacoeconomics in Clinical Trials, USA: Lippincott: Raven Publishers, 1996; 91.Google Scholar
  6. 6.
    Kaplan RM, Feeny D, Revicki D. Methods for assessing relative importance in preference based outcome measures. In: Joyce CRB, O'Boyle CA, McGee H (eds), Individual Quality of Life approaches to Conceptualisation and Assessment, Amsterdam: Harwood Academic Press, 1999.Google Scholar
  7. 7.
    Browne J. Selected methods for assessing individual quality of life. In: Joyce CRB, O'Boyle CA, McGee H (eds), Individual Quality of Life Approaches to Conceptualisation and Assessment, Amsterdam: Harwood Academic Press, 1999.Google Scholar
  8. 8.
    Ferrans CE, Powers MJ. Psychometric assessment of the quality of life index. Res Nurs Health 1992; 15: 29-38.Google Scholar
  9. 9.
    Dazord A, Gerin P, Boissel JP. Subjective quality of life assessment in therapeutic trials: Presentation of a new instrument in France (SQLP: subjective quality of life profile) and first results. In: Orley J, Kuyken W (eds), Quality of Life Assessment: International Perspectives, Heidelberg: Springer-Verlag, 1994; 185-195.Google Scholar
  10. 10.
    McGee HM, O'Boyle CA, Hickey A, O'Malley K, Joyce CRB. Assessing the quality of life of the individual — the SEIQOL with a healthy and gastroenterology unit population. Psychol Med 1991; 21: 749-759.Google Scholar
  11. 11.
    Ruta DA, Garratt AM, Leng M, Russell IT, MacDonald LM. A new approach to the measurement of quality of life — the patient generated index. Med Care 1994; 32: 1109-1126.Google Scholar
  12. 12.
    Dunbar GC, Stoker MJ, Hodges TCP, Beaumont G. The development of the SBQOL — a unique scale for measuring quality of life. Br J Med Econ 1992; 65-74.Google Scholar
  13. 13.
    Campbell A, Converse PE, Rogers WL. Quality of American Life Perceptions, Evaluations and Satisfaction. New York: Russell Sage Foundation, 1976.Google Scholar
  14. 14.
    Calman KC. Quality of life of cancer patients — a hypothesis: J Med Ethic 1984; 10: 124-127.Google Scholar
  15. 15.
    Cella D, Tulsky DS. Measuring quality of life today: Methodological aspects. Oncology 1990; 5: 29-38.Google Scholar
  16. 16.
    The WHOQOL Group. Study protocol for the World Health Organisation project to develop a quality of life assessment instrument (the WHOQOL). Qual Life Res 1993; 2: 153-159.Google Scholar
  17. 17.
    Leplege A, Hunt S. The problem of quality of life in medicine. J Am Med Assoc 1997; 278: 47-50.Google Scholar
  18. 18.
    Skevington SM. Social comparisons in cross-cultural quality of life assessment. Int J Mental Health 1994; 2: 29-47.Google Scholar
  19. 19.
    The WHOQOL Group. The World Health Organisation Quality of Life assessment (WHOQOL): Position paper from the World Health Organisation. Soc Sci Med 1995; 41: 1403-1409.Google Scholar
  20. 20.
    The WHOQOL Group. The World Health Organisation quality of life assessment (WHOQOL): Development and general psychometric properties. Soc Sci Med 1998; 46: 1569-1585.Google Scholar
  21. 21.
    Szabo S, Orley J, Saxena S. An approach to response scale development for cross cultural questionnaires. Eur Psychol 1997; 2: 270-276.Google Scholar
  22. 22.
    Streiner DL, Norman GR. Health Measurement Scales: A Practical Guide to their Development and Use. UK: Oxford Medical, 1995.Google Scholar
  23. 23.
    Sartorius N, Kuyken W. Translation of health status instruments. In: Orley J, Kuyken W (eds), Quality of Life Assessment: International Perspectives. Heidelberg: Springer-Verlag, 1994; 3-18.Google Scholar
  24. 24.
    Skevington SM, Bradshaw J, Saxena S. Selecting national items for the WHOQOL: Conceptual and psychometric considerations. Soc Sci Med 1999; 48: 473-487.Google Scholar
  25. 25.
    Schwartz CE, Sprangers MAG (eds), Adaptation to Changing Health: Response Shift in Quality of Life Research. Washington: American Psychological Association, 2000.Google Scholar
  26. 26.
    Raphael D, Renwick R, Brown I, Rootman I. Quality of life indicators and health: Current status and emerging conceptions. Soc Indic Res 1996; 39: 65-88.Google Scholar

Copyright information

© Kluwer Academic Publishers 2004

Authors and Affiliations

  • Suzanne M. Skevington
    • 1
  • Kathryn A. O'Connell
    • 1
  1. 1.Department of Psychology, University of BathWHO Centre for the Study of Quality of LifeBathUK

Personalised recommendations