Jude U. Ohaeri|Abdel W. Awadalla
The reliability and validity of the short version of the WHO Quality of Life Instrument in an Arab general population
Kuwait University
original articlethe reliability validity short version quality life instrument arab general population jude u ohaeri abdel w awadalla jude u ohaeri department psychiatry psychological medicine hospital safat kuwait abdel w awadalla department psychiatry faculty medicine kuwait university jabriya kuwait published online2 apr 2009httpsdoiorg1041030256494751790sectionspdf toolsadd favoritesdownload citationtrack citations shareshare onfacebooktwitterlinked inredditemail aboutabstractbackground objectives rising interest quality life qol research arabian countries aim study assess nationwide sample kuwaiti subjects reliability validity world health organization quality life whoqolbref shorter version widely used qol assessment instrument comprises 26 items domains physical health psychological health social relationships environmentmethods oneinthree systematic random proportionate sample consenting kuwaiti nationals attending large cooperative stores municipal government offices six governorates completed arabic translation questionnaire indices assessed included testretest reliability internal consistency item internal consistency iic item discriminant validity idv knowngroups construct validityresults 3303 participants 448 males 552 females mean age 354 years range 16 87 years intraclass correlation testretest statistic internal consistency values full questionnaire domains cronbachs alpha07 24 items constitute domains 21 met iic requirement correlation 04 corresponding domain 16 met idv criterion higher correlation corresponding domain domains domain scores discriminated significantly well sick groups factor analysis four strong factors emerged construct reportconclusion arabic translation whoqolbref impressive reliability validity indices poor idv findings due multidimensional nature questionnaire highly significant validity indices reassure researchers questionnaire represents constructs across cultures negatively worded items possibly need refinementintroductionrecent interest quality life qol outcome measure medicine inspired studies chronic medical13 general population subjects45 arab neighboring countries interest important use assessment instruments psychometrically sound crosscultural validity make findings comparable across countries regard short version world health organizations qol instrument whoqolbref6 interest following reasons first simultaneously developed diverse cultures thus overcoming usual controversy problem applying questionnaire articulated one culture different culture7 means instrument strong potential easy crosscultural applicability since items framed cultureneutral terminology second items include widely valued contextual factors life generally regarded healthrelated8 therefore generic instrument assesses healthrelated qol hrqol social environmental subjective wellbeing issuesthe arabic translation whoqolbref shown highly significant structural integrity characteristics9 persian translation shown significant values reliability validity indices4 study sought contribute published data arab population sampling kuwaiti subjects specific objectives assess following reliability validity indices comparison 23country report6i testretest reliability whoqolbref ii floorceiling effect acceptability whoqolbref well internal consistency full questionnaire constituent four domains qol iii iteminternal consistency iic itemdiscriminant validity idv10 iv construct validity exploratory factor analysis knowngroups validity analyzing differences domain scores sick well subjects based published information469 hypothesized reliability validity indices arab population would consistent indices populations furthermore domains expected strongly positively correlated concept overall qol health ie general facet health qol6methodsof 34 million population kuwait kuwaiti nationals make 11 million 489 male 511 female 2007 census 97 live urban areas adult literacy rate arabic 835 2003 estimate unemployment rate 23 2004 estimate kuwait public authority civil information administratively country divided six governorates consisting centrally located large cooperative supermarket store well municipal government immigration offices sampling framework six governorates participants recruited locations sample size guided recommendation international quality life assessment iqola project researchers sample size general population norming 2500300010we obtained census data governorate public authority civil information using quota sampling generated number potential participants would constitute proportionate representation governorates gender sample size least 3000 subjects although kuwait infrastructure generating sampling framework representative general population study eg telephone listing voting register strict conservative culture makes impossible carry housetohouse surveys private studies overcome obstacle researchers attempted target people visit popular government administrative offices eg municipal government immigration offices large cooperative shops recent kuwaiti study11 found large cooperative shops constituted convenient venues interviewing women traditional social roles represented work force study comparing attitudes towards women kuwait qatar abdalla12 overcame difficulty housetohouse surveys interviewing respondents work placesto obtain fairly representative national sample used methodologies sample prospective respondents popularly accessed facilities governorates sampling methodology feasible kuwait small population urban residence favorable education employment circumstances hence reasonable assume fairly representative proportion kuwaiti nationals patronize popular urban places literate enough arabic complete uncomplicated questionnaires own11for operational definition qol accepted definition individuals perception life context culture value system live relation goals expectations standards concerns6 measure focused subjective qol distinct objective qol13the whoqolbrefthe whoqolbref 26item selfadministered generic questionnaire short version whoqol100 scale6 response options range 1 dissatisfiedvery poor 5 satisfiedvery good assessments made preceding two weeks consists domains facets subdomains items overall rating qol oqol subjective satisfaction health constitute general facet oqol health popular model interpreting scores four domains namely physical health seven items psychological health six items social relations three items environment eight items analysis based model domain scores whoqolbref computed three ways first summation raw scores constituent items second third ways consist transforming raw scores second way raw scores transformed scores range 420 line whoql100 instrument third way converts 420 scores onto 0100 scale14data collectionthe study took place 20062007 questionnaire translated arabic method backtranslation ethical approval study obtained kuwait university kuwait foundation advancement science kfas obtained permission authorities study location interview kuwaiti nationals attending facility participants gave verbal informed consent staff professional social research company responsible circulating retrieving questionnaires research assistants ras kuwaiti nationals aged 21 27 years previously undergone 2month course research methods interview techniques kuwait university pairs ras one male one female worked governorates residence familiar cultural environment rule prospective female respondents approached female ra recruit prospective respondents ras positioned main entrance place introduced kuwaitis research politely asked nationality prospective participant ensure kuwaiti nationals recruited thereafter objectives study explained subject informed penalty would result declining participate used systematic random sampling oneinthree subjects gender subject declined participate next third person approached continued way reached population quota governorate preliminary stage study ras trained use studys questionnaires oneweek period compute interrater reliability questionnaires administered selfreport subjects literate arabic invited participate cases participants completed questionnaire anonymously privately ras nearby offer assistance clarifying items subjects completed arabic translation questionnaire testretest reliability done giving questionnaire twice oneweek period 50 subjects participate main studydata analysisdata analyzed spss version 11 spss inc chicago illinois qol domain scores range 420 0 100 generated organizing items four domains recommended6 data testretest reliability analyzed intraclass correlation coefficient icc internal consistency full questionnaire domains assessed cronbachs alpha 3303 participants recommended cutoff value 07 acceptability questionnaire assessed missing values proportion respondents failed complete item cutoff value 25 recommended item10 proportion respondents scoring lowest level floor effect highest level ceiling effect item assessed measure sensitivity change far item assumed capturing full range potential responses population10 item internal consistency iic item discriminant validity idv measured pearson correlation assessed controlling item overlap corresponding scale iic idv concern relationship item hypothesized scale domain iic rule requires item correlate r 04 adjusted scale score idv item highest correlation scale comparison scales questionnaire10the construct validity whoqolbref assessed exploratory factor analysis using principal components analysis orthogonal rotation factors eigen values 16 knowngroups validity assessed testing significant differences domain scores subjects rated well rated sick using standardized effect size calculations relationship general facet domains assessed pearson correlation missing data handled excluding cases analysis analysis level statistical significance set 5 tests twotailedresultssociodemographic characteristicsof 3376 subjects agreed participate study 73 questionnaires voided subjects complete 20 items whoqolbref recommended whoqol group6 hence report data 3303 subjects 3303 participants consisted 448 n1479 men 552 n1824 women aged 16 87 years mean sd 354 119 years proportionate representation six governorates kuwaiti national general population women majority 24 subjects 65 years age older subjects predominantly educated 599 least college education employed skilled work 584 married 608descriptive statistics internal consistencythe icc testretest statistic 095 highly significant similarly internal consistency values full questionnaire domains met 07 cronbachs alpha value requirement table 1 exception item sexual satisfaction 79 proportion missing values ranged 006 1 18 items 1 18 seven items shows contents questionnaire generally acceptable respondents rate missing values item sexual satisfaction comparable 60 reported higher 25 reported iran4 questionnaire intervieweradministered mean sd scores items ranged 339 12 389 099 23 items 40 11 two items mobility transport 296 098 one item negative feelings regard floor ceiling effects total frequency lowest scores 47 range 22 89 total frequency highest scores 249 range 68 422 comparable figures report 40 range 17 88 175 range 101 352 respectively6table 1 internal consistency whoqolbref participants testretest reliability nonparticipating subjectsquestionnairedomain qolno itemscronbachs alphasplithalf reliabilityinternal consistencywhoqolbref n330326093089physical health domain whoqolbref7080psychological health domain6077social relations domain3069environment domain8083testretest reliability95 ci262whoqolbref n50095 094097intraclass correlation coefficient 95 confidence intervalitem internal consistency item discriminant validityof 24 items constitute domains 21 met iic requirement correlation 04 table 2 three negatively worded items pain need medical treatment negative feelings meet requirement however three items among 16 met idv criterion higher correlation corresponding domain domains two items equal correlation least one domain corresponding domain 23country report6 noted 7 24 centers items pain need medical treatment generally problematic itemtotal correlations physical domain addition poor itemtotal correlation 03 noted negative feelings one centertable 2 iteminternal consistency itemdiscriminant validity whoqolbref pearsons r04whoqol items arranged 4 domainsphysical healthpsychological healthsocial relationsenvironmentphysical health pain prevents activities034017008011 enough energy daily life060064049059 able get around062051046051 satisfaction sleep057054049056 satisfaction adl069061053059 satisfaction work capacity059055052051 need treatment function039019014016psychological health much enjoy life048063047059 feel life meaningful043063047056 able concentrate046053042053 accept bodily appearance049046038049 satisfaction self059058063059 often negative feelings026027022026social relations satisfaction personal relationships048058057055 satisfaction sex life045049045044 satisfaction friends support039044049052environment feel safe daily life048063048059 healthy physical environment040059045059 enough money needs042053041058 satisfaction information daytoday life046053041056 leisure opportunity039044035046 satisfaction living place045051054059 satisfaction access health service035034036049 satisfaction transport043042044053corrected overlap items domainitems bold belong corresponding domainconstruct validity factor analysisin factor analysis 26 items four strong factors ie 3 items one weak factor 3 items emerged accounting 587 variance item loaded highly 045 corresponding factor table 3 interestingly four strong factors emerged exactly sequence construct report three negatively worded items constituted fifth factor 8 items factor five belong original physical health domain noteworthy two general facet items representing subjective wellbeing factor factor ii conceptually similar original psychological health domain five constituent items three belong psychological health factor iii conceptually similar original social relations domain contains three items define domain factor iv appears tighter definition environment domain seven items derived domaintable 3 factor analysis using 26 items whoqolbreffactor labelitems whoqolbrefitem loadingeigen value variancetotal variancefactor general physical health overall qolability get around071102391587energy life066satisfaction general health058satisfaction work capacity056accept bodily appearance054activities daily living054overall rating qol049satisfaction sleep046factor ii psychological healthfeel life meaningful0671766enjoyment life067physical environment health065feel safe daily life065able concentrate052factor iii social relationssatisfaction personal relations0681247satisfaction sex064satisfaction self063satisfaction support friends058factor iv environmentsatisfaction access health service0731245satisfaction transport057enough money needs056satisfaction condition place living053opportunity leisure activities048satisfaction available information047factor v health care needspain0861039need medical treatment079negative feelings052kaisermeyerolkin measure sampling adequacy095knowngroups validity relationship domains general facetusing 0100 scale scores effect size calculations effect size 95 confidence interval found rated well significantly higher scores domains physical health 050 043057 psychological health 036 029044 social relations 031 024038 environment 030 023038 domains p0001 finally general facet score highly significantly correlated scores domains physical health r063 psychological health r066 social relations r053 environment r061 domains p0001discussiona major limitation study subjects representative housetohouse sample general population particular attend study locations represented limitation inherent sociocultural circumstances country1112 view limitation practically possible keep track number refusals characteristics however reasonable assume nationwide sample adequate characteristics estimate psychometric properties whoqolbref10in line hypothesis reliability validity indices similar populations arabic translation whoqolbref generally met statistical criteria reliability issues investigated particular findings similar 23country report6 three notable discrepancies relatively high proportion missing values item sexual satisfaction failure three negatively worded items meet iic requirement fact 16 items met idv requirement relatively minor discrepancy fact alpha coefficient social relations domain 069 short 07 mark discrepancies well known literature sexual item usually problem respondents complete questionnaire study taiwanese study rate missing values ranged 09 7715 general population studies poland iran social relations domain failed meet required value internal consistency416 problem related fact domain three itemswe could attribute poor iic performance three negatively worded items translation problems met idv requirement problem also evident centers report furthermore items loaded highly 05 factor analysis issue poor performance iic idv noted ways studies used rasch item response theory models1718 attributable multidimensional nature instrument18our impressive findings construct knowngroups validity first four factors fair representation original data6 replicated others1920 sudanese study following factors replicated social relations environment small factor containing three negatively worded items furthermore confirmatory factor analysis fourdomain model best fit indices9 results thus support impression perceptions whoqolbref found across cultures disease conditions19 cardinal requirement crossculturally useful questionnaire furthermore two general facet items loaded highly factor indicates importance general facet first deconstruct qol construct21 hence fair representation idea global qol subjective wellbeing2223 support point general facet highly significantly correlated four domains6in conclusion arabic translation whoqolbref high reliability validity indices represents constructs across cultures19 validity data support impression whoqolbref crossculturally valid generic instrument composed parts address main issues subjective qol construct medicine namely hrqol contextual issues subjective wellbeing8 possible area needing development phrasing negatively worded items perhaps rated positive direction itemsarticle references1 alshehri ah taha az bahnassy aa salah healthrelated quality life type 2 diabetic patients ann saudi med 2008 28352360 google scholar2 alshubaili af ohaeri ju awadalla aw mabrouk aa quality life multiple sclerosis kuwaiti msqol54 experience acta neurol scand 2008 11738492 google scholar3 awadalla aw ohaeri ju gholoum khalid ao hamad hma jacob factors associated quality life outpatients breast cancer gynecologic cancers family caregivers controlled study bmc cancer 2007 7102 google scholar4 nedjat montazeri holakouie k mohammad k majdzadeh r psychometric properties iranian interviewadministered version world health organizations quality life questionnaire whoqolbref populationbased study bmc health serv res 2008 861 google scholar5 sabbah ai drougby n sabbah retelrude n mercier quality life rural urban populations lebanon using sf36 health survey health qual life outcomes 2003 130 google scholar6 skevington sm lofty oconnell ka world health organizations whoqolbref quality life assessment psychometric properties results international field trial report whoqol group qual life res 2004 13299310 google scholar7 warner r emics etics quality life assessment soc psychiatry psychiatr epidemiol 1999 34117121 google scholar8 katschnig h katschnig h freeman h sartorius n useful concept quality life psychiatry quality life mental disorders 2006west sussex england john wiley sons ltd317 google scholar9 ohaeri ju awadalla aw ghoulum elabassi jacob confirmatory factor analytical study whoqolbref experience sudanese general population psychiatric samples bmc med res methodol 2007 737 google scholar10 ware je gandek b methods testing data quality scaling assumptions reliability iqola project approach j clin epidemiol 1998 51945952 google scholar11 eid alzayed knowledge symptoms treatment schizophrenia depression among kuwaiti population arab j psychiatry 2005 166277 google scholar12 abdalla ia attitudes towards women arabian gulf region women management rev 1996 112939 google scholar13 olusina ak ohaeri ju subjective quality life recently discharged nigerian psychiatric patients soc psychiatry psychiatr epidemiol 2003 38707714 google scholar14 whoqol user manual 1998geneva switzerland world health organization program mental health google scholar15 lin mr hwang hf chen cy chiu wt comparisons brief form world health organization quality life short form36 persons spinal cord injuries j phy med rehabil 2007 86104113 google scholar16 jaracz k kalfoss grna k baczyk g quality life polish respondents psychometric properties polish whoqolbref scand j caring sci 2006 2025160 google scholar17 wang wc yao g tsai yj wang jd hsieh cl validating improving reliability estimating correlation four subscales whoqolbref using multidimensional rasch analysis qual life res 2006 15607620 google scholar18 noerholm v groenvold watt bjorner jb rasmussen na bech p quality life danish general populationnormative data validity whoqolbref using rasch item response theory models qual life res 2004 13531540 google scholar19 yao g wu ch factorial invariance whoqolbref among disease groups qual life res 2005 1418811888 google scholar20 min sk kim ki lee ci jung yc suh sy kim dk development korean version quality life scale whoqolbref qual life res 2002 11593600 google scholar21 huang ic wu aw frangakis c sf36 whoqolbref measure constructs evidence taiwan population qual life res 2006 151524 google scholar22 cummins ra moving quality life concept theory j intellect disabl res 2005 49699706 google scholar23 diener e suh em lucas smith hl subjective well three decades progress psychol bull 1999 125276302 google scholarthe english versions quality lifebref available online httpwwwwhointsubstanceabuseresearchtoolswhoqolbrefen arabic version part electronic version article available httpwwwsaudiannalsnet previous article next article figuresreferencesrelateddetailscited byelsous radwan askari e mustafa 2019 quality life among elderly residents gaza strip communitybased study annals saudi medicine 391 17 online publication date 1jan2019alkatheri al bekairy aburuz qandil khalidi n abdullah k al sayyari bustami r al harbi al raddadi al thiab k saleh k al shaya 2015 exploring quality life among renal liver transplant recipients annals saudi medicine 355 368376 online publication date 1sep2015alawadhi ohaeri j 2010 validity reliability european organization research treatment cancer quality life questionnaire eortc qlq experience kuwait using sample women breast cancer annals saudi medicine 305 390396 online publication date 1sep2010 volume 29 issue 2marapr 2009 metrics history accepted1 january 2009published online2 april 2009 acknowledgementsthe project carried grant kuwait foundation advancement sciences kfas joy wilson coded data charles osuagwu played invaluable role locating literature staff albayan translation responsible administering questionnaire community dr yusuf alfailakiya coordinated work community thank staff heads administration participants various locations community study took placeinformationcopyright 2009 annals saudi medicinethis openaccess article distributed terms creative commons attribution license permits unrestricted use distribution reproduction medium provided original work properly citedpdf download