Evaluating a new methodology for providing individualized feedback in healthcare on quality of life and its importance, using the WHOQOL-BREF in a community population

Psychometric properties of the World Health Organization WHOQOL-AGE Scale in Singapore

WHOQOL-AGE is a promising quality of life (QOL) tool that has not been fully validated in Asia. The present study aimed to verify its factor structure and psychometric properties among community-dwelling older adults in Singapore. This study was cross-sectional and used data (N = 593) from the Community Health and Intergenerational study that interviewed older adults between 2018 and 2021. Confirmatory factor analysis (CFA) was used to examine the factor structure of the WHOQOL-AGE, and Cronbach's alpha coefficients were employed to examine internal consistency. Spearman's rho correlations coefficients between WHOQOL-AGE and other related scales (Satisfaction with Life and the Friendship) examined convergent validity. A Pearson's correlation coefficient between WHOQOL-AGE and compassion scale examined discriminant validity. An independent t test was used to demonstrate known-groups validity, examining differences in QOL scores between individuals with and without chronic medical conditions. Findings supported a bifactor model with more satisfactory goodness-of-fit indices than the original two-factor model and the two-correlated factor model. WHOQOL-AGE showed adequate internal consistency (Cronbach's alpha coefficients > .70). Good convergent validity was demonstrated by moderate-to-large correlations between WHOQOL-AGE and satisfaction with life (rs = .54) as well as social connectedness (rs = .33). Discriminant validity was shown by low correlations between WHOQOL-AGE and compassion (r = .19). Findings also indicated good known-groups validity (p < 0.01). The WHOQOL-AGE showed promising psychometric properties using an Asian convenience sample and can be useful in large-scale studies or busy clinical settings.

A systematic review of quality of life and health-related quality of life as outcomes in substance and behavioural addictions

ISSUES

Consideration of an individual's quality of life (QoL) can benefit assessment and treatment of addictive disorders, however, uncertainty remains over operationalisation of the construct as an outcome and the appropriateness of existing measures for these populations. This systematic review aimed to identify and evaluate QoL and health-related QoL outcome instruments used in addiction-related risk and harm research and map their conceptualised domains.

APPROACH

Three electronic databases and a specialised assessment library were searched on 1 February 2022 for QoL or health-related QoL outcome instruments used with addiction-related risk and harm populations. PRISMA reporting guidance was followed and included outcome instruments were appraised using mixed methods. Psychometric evidence supporting their use was summarised. The COSMIN risk of bias tool was used to assess validation studies.

KEY FINDINGS

A total of 298 articles (330 studies) used 53 outcome instruments and 41 unique domains of QoL. Eleven instruments' psychometric properties were evaluated. No instrument was assessed for any parameter in at least five studies for meta-analytic pooling. Cronbach's alpha (α) internal consistency was the most widely assessed parameter with the AQoLS, WHOQOL-BREF, ALQoL-9, Q-LES-Q-SF, SF-12, DUQoL, QLI and SF-36 displaying promising statistics (α > 0.70).

IMPLICATIONS AND CONCLUSION

Many instruments have been utilised. However, a significant proportion of studies applied a small number of instruments with minimal high-quality validation evidence supporting their use within addiction-related risk and harm. Promising instruments are recommended, however, the paucity of supporting evidence limits confidence in the reliability and validity of QoL measurement in these populations.

Exploring Quality of Life Reported by Norwegian Older Adults Using Classification Tree Approach on Group Profiles

This study aims to explore the variation between- and within subgroups of older adults with regard to low, medium, and high levels of self-reported quality of life (QoL) measured by the WHOQOL-BREF scale. The contribution of interacting personal and contextual life conditions to QoL was examined in a sample of 1,910 (sample frame 6,000) Norwegian men and women aged 62 to 99 years. The data collected by a postal questionnaire were analyzed using the Chi-square Automatic Interaction Detection (CHAID) classification method in order to detect unique profiles of groups who shared common characteristics. The CHAID model revealed 15 relatively homogenous groups, but distinct from one another, whose profiles were defined by unique constellations of several interacting variables significantly related to a given QoL level. Mental functioning was predominantly linked to perception of life meaning along with health status, and/or in some cases living arrangement, loneliness, neighborhood quality, and satisfaction with income, and placed an individual at different likelihood levels of reporting low, medium, or high QoL. Socio-demographics had no statistically significant impact on QoL for any subgroup. Through this individual-oriented approach, a periodically ongoing assessment of subjective quality of life (QoL) may be sufficiently powerful to allow detecting and addressing personal concerns and specific needs that detract from quality of life in advancing age.

Enhancing the multi-dimensional assessment of quality of life: introducing the WHOQOL-Combi

INTRODUCTION

We revisited the global concept of subjective quality of life (QoL) as assessed by the WHOQOL-BREF to investigate whether it could be elaborated into a conceptually more comprehensive instrument with good psychometric properties. Responding to a growing need for shorter QoL measures with broader social, spiritual and environmental contents, facets from WHOQOL international modules were examined for potential integration into the new WHOQOL-Combi.

METHOD

Adults over 65 years, diagnosed with one or more chronic diseases (n = 2833), completed 41 WHOQOL items during the CLASSIC survey; each item represented a WHOQOL facet. This pool of specific QoL facets contained 24 from the WHOQOL-BREF (excluding general items), and 17 from recent international WHOQOL short-form modules, selected for their generic properties. Rasch modelling reduced the final item pool when assessing the WHOQOL-Combi's conceptual structure. Comparisons are made with the WHOQOL-BREF.

RESULTS

Modelling confirmed the tenability of a 36-item solution scored as a five-domain profile, comprised of 24 WHOQOL-BREF facets and 12 new facets from modules. Social and psychological domains were strengthened by three facets, spiritual QoL by five, and physical QoL by one. The WHOQOL-Combi showed sound model fit, excellent internal consistency (α = .95), and scores discriminated between socio-demographic categories. Concurrent validity with the EQ-5D-5L was confirmed for physical and psychological domains. Performance was similar to the WHOQOL-BREF.

CONCLUSION

The WHOQOL-Combi offers a contemporary, comprehensive, integrated, multi-dimensional subjective QoL instrument with enhanced evaluations of social, spiritual, psychological and physical QoL. Acceptable to older people, future research should evaluate younger age groups and other cultures.

Does quality of life feedback promote seeking help for undiagnosed cancer?

PURPOSE

Diagnosing cancer early is an imperative, as help-seeking delays affect survival. Quality of life (QoL) deteriorates after diagnosis, but decline may start when cancer is suspected at the earliest stage of the pathway to treatment. This study examined whether offering guided feedback about personal QoL to adults with potential cancer symptoms, living in deprived communities, changes QoL and promotes help-seeking in primary care.

METHODS

Visitors to a CRUK mobile cancer roadshow were recruited in 43 sites. A prospective longitudinal (2 × 2) repeated-measures design was applied. Where they presented a potential cancer symptom, and were 'signposted' to a GP, they were allocated to a symptom condition, or a lifestyle condition, if seeking cancer risk advice. Randomisation was to an Intervention group, who received feedback about personal QoL results (WHOQOL-BREF and WHOQOL importance measures), or a Control group who assessed QoL without feedback. Depression was screened.

RESULTS

Of 107 participants, the mean age was 53; 50% were women, 57% were without tertiary education, 66% were unemployed and 45% were currently ill. Over 10 weeks, 54% of all those with symptoms sought help from a medical source and 42% specifically from a GP. Thirty-one completed all three assessments. With symptoms present, psychological, social and environmental QoL were poor, becoming poorer over time. When the symptoms group received feedback, psychological QoL increased, but GP visits were unaffected. However, feedback increased help-seeking from informal social contacts. Lifestyle groups reported consistently good psychological and social QoL.

CONCLUSION

This early cancer research offers practical and theoretical implications for QoL interventions in deprived communities.

Chiropractors' Perspectives on the Meaning and Assessment of Quality of Life Within Their Practice in New Zealand: An Exploratory Qualitative Study

OBJECTIVE

The purpose of this study was to gain an understanding on what quality of life (QOL) and its assessment means to chiropractors in everyday practice.

METHODS

This study captured chiropractors' perspectives on the QOL construct and its assessment using a qualitative descriptive methodology that comprised 2 focus groups, each with 4 participants using semi-structured, open-ended questioning. Participants from Aotearoa, New Zealand, were also asked to evaluate 4 QOL patient-reported outcome measurements from a clinical perspective.

RESULTS

Two of the participants were faculty at the New Zealand College of Chiropractic, 5 were in full-time practice, and 1 was practicing part time. Using qualitative content analysis, 3 main themes were identified. These chiropractors perceived that patients have misconceptions about how chiropractic can affect QOL. They lacked clarity in communicating QOL and its related concepts to establish a clinically meaningful patient encounter. Finally, there is uncertainty in how and when to measure QOL, which appears to affect how they discuss and assess QOL in practice.

CONCLUSION

There is a complex combination of factors that makes communication regarding QOL challenging. This exploratory qualitative study helps to understand the challenges faced in how and when to communicate and assess QOL more effectively in chiropractic practice.

How will the sustainable development goals deliver changes in well-being? A systematic review and meta-analysis to investigate whether WHOQOL-BREF scores respond to change

Introduction

The Sustainable Development Goals (SDGs) 2015 aim to ‘…promote well-being for all’, but this has raised questions about how its targets will be evaluated. A cross-cultural measure of subjective perspectives is needed to complement objective indicators in showing whether SDGs improve well-being. The WHOQOL-BREF offers a short, generic, subjective quality of life (QoL) measure, developed with lay people in 15 cultures worldwide; 25 important dimensions are scored in environmental, social, physical and psychological domains. Although validity and reliability are demonstrated, clarity is needed on whether scores respond sensitively to changes induced by treatments, interventions and major life events. We address this aim.

Methods

The WHOQOL-BREF responsiveness literature was systematically searched (Web of Science, PubMed, EMBASE and Medline). From 117 papers, 15 (24 studies) (n=2084) were included in a meta-analysis. Effect sizes (Cohen’s d) assessed whether domain scores changed significantly during interventions/events, and whether such changes are relevant and meaningful to managing clinical and social change.

Results

Scores changed significantly over time on all domains: small to moderate for physical (d=0.37; CI 0.25 to 0.49) and psychological QoL (d=0.22; CI 0.14 to 0.30), and small for social (d=0.10; CI 0.05 to 0.15) and environmental QoL (d=0.12; CI 0.06 to 0.18). More importantly, effect size was significant for every domain (p<0.001), indicating clinically relevant change, even when differences are small. Domains remained equally responsive regardless of sample age, gender and evaluation interval.

Conclusion

International evidence from 11 cultures shows that all WHOQOL-BREF domains detect relevant, meaningful change, indicating its suitability to assess SDG well-being targets.

"Am I normal?" The Wishes of Patients With Lymphoma to Compare Their Patient-Reported Outcomes With Those of Their Peers

Background

Providing feedback to patients on their patient-reported outcomes (PROs) can help patients in monitoring their functioning and symptoms and may help empower them.

Objective

The objective of this study was to investigate whether patients with lymphoma wished to receive PRO feedback, including the option to compare their scores with those of their peers, and how this feedback was evaluated.

Methods

We invited 64 patients participating in a lymphoma cohort who were eligible for a follow-up questionnaire and gave them the option to receive PRO feedback. Patients completed questions about health-related quality of life (HRQoL) and symptoms. PRO feedback was provided via bar charts.

Results

Of the 64 invited patients, 45 participated (response rate 70%) and 36 of those (80%) wished to receive PRO feedback. The vast majority (34/36, 94%) compared their scores with those of a lymphoma reference cohort, and 64% (23/36) compared their score with those of a normative population without cancer. All patients wished to receive feedback on their HRQoL, and 29 (81%) to 33 (92%) wanted feedback on their functioning, fatigue, neuropathy, anxiety, and depressive symptoms. Of the 36 participants wishing to receive PRO feedback, 35 (97%) viewed it as being useful, with reassurance and knowledge about their own functioning in relation to what is “normal” being the most frequently mentioned reasons.

Conclusions

A high number of patients with lymphoma wished to receive PRO feedback. Patients reported the comparison of their scores versus a lymphoma reference cohort as most valuable. Further research should investigate whether PRO feedback could increase empowerment and possibly improve HRQoL.

Electronic Quality of Life Assessment Using Computer-Adaptive Testing

Background

Quality of life (QoL) questionnaires are desirable for clinical practice but can be time-consuming to administer and interpret, making their widespread adoption difficult.

Objective

Our aim was to assess the performance of the World Health Organization Quality of Life (WHOQOL)-100 questionnaire as four item banks to facilitate adaptive testing using simulated computer adaptive tests (CATs) for physical, psychological, social, and environmental QoL.

Methods

We used data from the UK WHOQOL-100 questionnaire (N=320) to calibrate item banks using item response theory, which included psychometric assessments of differential item functioning, local dependency, unidimensionality, and reliability. We simulated CATs to assess the number of items administered before prespecified levels of reliability was met.

Results

The item banks (40 items) all displayed good model fit (P>.01) and were unidimensional (fewer than 5% of t tests significant), reliable (Person Separation Index>.70), and free from differential item functioning (no significant analysis of variance interaction) or local dependency (residual correlations < +.20). When matched for reliability, the item banks were between 45% and 75% shorter than paper-based WHOQOL measures. Across the four domains, a high standard of reliability (alpha>.90) could be gained with a median of 9 items.

Conclusions

Using CAT, simulated assessments were as reliable as paper-based forms of the WHOQOL with a fraction of the number of items. These properties suggest that these item banks are suitable for computerized adaptive assessment. These item banks have the potential for international development using existing alternative language versions of the WHOQOL items.