The Reliability and Construct Validity of American College Students' Responses to the WHOQOL-BREF

Article excerpt

Introduction

Quality of life (QOL) is a term used to describe an individual's physical and mental well-being. Like many terms used in health promotion, there is debate about how QOL should be defined and measured. One of the difficulties in defining QOL is that the concept includes both objective and subjective components of mental and physical well-being. (1) The QOL definition applied in this study is "an individual's perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards and concerns." (2)

Consistent with their definition of QOL, The World Health Organization (WHO) developed a multidimensional instrument to assess QOL that can be used across cultures. Initiated in 1991, the WHOQOL project was a collaborative effort to create a measure of cross-cultural QOL. According to the WHO, the WHOQOL-100 instrument assesses aspects of QOL that include culture and value systems, goals, expectations, and concerns. (3) The development of this instrument was collaborative among 15 cultural settings, including three English speaking populations. It has been piloted in 37 field centers and is available in 29 languages. The WHOQOL-100 is intended to measure six domains of health: Physical, Psychological, Independence, Social, Environmental, and Spiritual. Literate participants may take about 30 minutes to complete the assessment, while semi-literate or illiterate populations may take between 40 and 90 minutes. The WHOQOL-BREF, an abbreviated 26-item assessment adapted from the WHOQOL-100, can be used when there is limited time. Both the full length and the brief assessment can be used to measure QOL in clinical, educational, and health promotion settings.

In most languages, the psychometric properties of the WHOQOL-100 and WHOQOL-BREF instruments have been shown to be adequate. However, the only published validation study of the US version of the WHOQOL-100 did not establish construct validity through confirmatory factor analysis due to an inadequate sample size. (4) The authors also pointed out issues with the overall structure of the US version and suggested the need for additional testing of psychometric properties of the instrument. Such results support the need to complete construct validity of the US version through confirmatory factor analysis.

Bonomi (4) questioned the usefulness of the WHOQOL100 in the elderly population. Power et al (5) described the need to develop the WHOQOL-OLD module for population comparisons. Issues with use of the WHOQOL-100 among the elderly population led to the creation of the WHOQOL-OLD, a 24-item 6facet module that can be used in conjunction with the WHOQOL-BREF or the WHOQOL-100 for assessment of QOL. Like older adults, college students have specific QOL issues related to stage of lifespan. Furthermore, college students may even have different QOL issues than people of the same age group that are not enrolled in higher education. Consequently, the appropriateness of using the WHOQOL-100 and WHOQOL-BREF in college populations should be explored. In this study, the WHOQOL-BREF was selected due to time limitations for taking the survey. Ultimately, it is important to determine if another version of the instrument and/or supplemental module like the "WHOQOL-BREF-COLLEGE" is warranted.

Past research has explored the use of the WHOQOL-BREF with college students with mixed outcomes. It was used to measure QOL in medical students through pre and post course data .6 In particular, Wu and Yao (7) used the WHOQOL-BREF with students enrolled at the National Taiwan University to assess sense of control on the relationship between self-certainty and QOL. A two-factor confirmatory factor analysis revealed that a positive relationship existed between self-certainty on interpersonal traits and QOL. However, the researchers only reported internal consistency (Cronbach's alpha) coefficients ranging from . …