Convergent and Discriminant Validity of the WHOQOL-BREF Using a Multitrait-Multimethod Approach

The WHOQOL-BREF is a commonly used questionnaire in quality of life research. Previous research has shown that the four domains of the WHOQOL-BREF (physical health, psychological health, social relationships, and environmental health) are highly related. Whether these high correlations reflected the true relations across the domains or the influence of common method effect; however, is still unknown. This study examines the convergent and discriminant validity of the four domains of the WHOQOL-BREF by using the multitrait-multimethod (MTMM) approach to control the method effect. Two different samples, with a total of 186 and 201 adults, respectively, were used in the present study. Each participant filled out the WHOQOL-BREF questionnaires using four different scaling methods (Likert-type scale, visual analogue scale, pie scale, and partner rating). The covariance matrix of the MTMM result was analyzed with confirmatory factor analysis modeling. Two models were applied, including the correlated traits-correlated uniqueness (CTCU) model and the uncorrelated traits-correlated uniqueness (UTCU) model. Results showed that the CTCU model fit the data better than did the UTCU model, suggesting that the variables tapping the four domains of the WHOQOL-BREF have excellent convergent validity; the four domains have moderate correlations, indicating that the four domains are related but not identical.     

Preliminary Evaluation of the Validity and Reliability of the Spanish Version of the Therapeutic Alliance with Clinician (TAC) Questionnaire

As part of a broader study aimed at evaluating perceived alliance with service providers and level of satisfaction with services received, 103 monolingual Spanish speaking Hispanic women were interviewed. Participants were receiving ongoing behavioral health treatment at three different community service provider sites located in the greater New Haven area in Connecticut. These sites included a community health center (n = 40), a community behavioral health center (n = 40), and a faith-based agency (n = 23). As part of this study, the English version of the Therapeutic Alliance with Clinician (TAC) questionnaire was translated into Spanish and administered to our sample of Hispanic women. Results on the psychometric properties of the Spanish version of the TAC are presented in this article.     

Using Perceived Health to Test the Construct-related Validity of Global Quality of Life

Quality of life (QOL) is considered as aglobal, yet unidimensional, subjectiveassessment of one's satisfaction with life. Weexamine the construct validity of the availableindicators of global QOL by constructing acausal model in which QOL is viewed as causallyresponding to several dimensions of perceivedhealth. Global QOL is measured with fiveindicators derived from the literature, andperceived health is measured by eightdimensions of the SF-36 Health Survey. Thestructural equation model describes the QOL andperceived health assessments of 306 coronaryartery bypass graft (CABG) patients andprovides a stringent test of theunidimensionality of the global QOL indicators.The evidence regarding QOL is worrisome, butnot devastating. The acceptable model fit wasachieved by introducing direct effects leadingfrom the General Health Perceptions concept totwo of the five indicators of global QOL. Thissuggests that there are some mechanisms thatinfluence these indicators without firstaltering QOL, or that these indicators are notresponding in unison to QOL. Furthermore, theFaces QOL indicator required measurement errorcorrelations to two of the perceived healthindicators. This also suggests that there aremechanisms beyond pure QOL that act upon thisindicator. But the problematic effects anderror correlations are modest, so the evidenceagainst these indicators is not particularlystrong. Overall, the Self-Anchoring StrivingScale (SASS) indicator and the Life-as-a -Wholeindicator (from Multiple Discrepancies Theory)seem to be the cleanest indicators of globalQOL. General health perceptions and perceivedmental health both influenced global QOL, whilethe other six health perception concepts had noconsistent impact on global QOL.     

Health and the Quality of Life

The aim of this investigation was to explain theimpact of peoples self-reported health on theirlevels of satisfaction with their health, and theimpact of these things plus satisfaction with otherspecific domains of their lives on the perceivedquality of their lives. The latter was operationalized as general happiness, satisfactionwith life as a whole and overall satisfaction with thequality of life. Seven hundred and twenty-three (723)usable questionnaires returned from a mailout randomsample of 2500 households of Prince George, BritishColumbia in November 1998 formed the working data-setfor our analyses. Among other things, mean respondentscores on the SF-36 health profile were found to belower than published norms from the UK, USA,Netherlands and Sweden, but higher than scores fromAberdeen, Scotland. Mean scores on the CES-Ddepression scale also indicated that our respondentstended to have more depressive symptoms thancomparison groups in Winnipeg and the USA. A review oftrends in mean scores on 17 quality of life items(e.g., satisfaction with family life, financialsecurity, recreation, etc.) from 1994, 1997 and 1998revealed that there were only 7 statisticallysignificant changes across the four year period andthey were all negative. Multivariate regressionanalysis showed that health status measured with avariety of indicators could explain 56% of thevariation in respondents reported satisfaction withtheir health. A combination of health status plusdomain satisfaction indicators could explain 53% ofthe variation in respondents reported happiness, 68%of reported life satisfaction and 63% of reportedsatisfaction with the overall quality of life. Sixtypercent of the explained variation in happiness scoreswas attributable to self-reported health scores, whileonly 18% of the explained variation in satisfactionwith life and with the overall quality of life scoreswas attributable self-reported health scores.     

Quality of Life in a City: The Effect of Population Density

There exist a number of concepts andoperational definitions of quality of life. Inthe present study the aim has been to develop acomprehensive, global index of quality of life,and relate the sub-indexes and global index tovarious socio-demographic variables, somatichealth and density of population in theresidential area. The sample consisted of 2066individuals between 18 and 65 years old fromthe common population. Seven sub-indexes weredeveloped. They constituted one factor withmoderate intercorrelations between thesub-indexes. Good somatic health, living in astable relationship with a partner, preferablymarried, in a less densely populated area,having a good education, a good income andbeing a younger female were the independentstatistical determinants of global quality oflife. However, various sub-indexes were relatedto different socio-demographic variables. Agewas oppositely related to differentsub-indexes. The study shows the importance ofwhat type of quality of life is investigated.To our knowledge, this is the first study ofthe effect of population density on quality oflife.     

Introduction: Quality of Life of Chinese People in a Changing World

Asking clients to document their perceived quality of life during and after intervention is a popular approach employed by helping professionals to evaluate intervention programs. In the Project Positive Adolescent Training through Holistic Social Programmes (P.A.T.H.S.), students participating in the Experimental Implementation Phase and Full Implementation Phase were invited to write reflective journals in the form of weekly diaries to reveal their perceptions and feelings regarding the program and the perceived benefits of the program. Based on multiple studies, results showed that the respondents generally (a) had positive views on the program, (b) had positive views on the instructors, and (c) perceived that they had acquired competencies at the societal, familial, interpersonal and personal levels and their quality of life was promoted after joining the program. Acknowledging the limitations of diaries, the present qualitative findings provide support for the effectiveness of the Tier 1 Program of the Project P.A.T.H.S. in Hong Kong.     

Reliability and Validity of an Adapted Version of the Cantril Ladder for Use with Adolescent Samples

There are a number of measures of life satisfaction for use with adolescent samples. The adapted Cantril Ladder is one such measure. This has been collected by the Health Behaviour in School-aged Children (HBSC) study in HBSC member countries across Europe and North America for several survey cycles, dating back to 2002. Although this measure has been piloted in the HBSC member countries, and analysed and reported in several international scientific journals and reports, it has never been formally validated. This study aims to be a first step in validating the adapted Cantril Ladder to establish if it is fit for purpose in the measurement of global life satisfaction among adolescents in Scotland. The study found that across samples of 11–15 year old pupils, the Cantril Ladder showed good reliability, and among 11 year olds, better than that of the Students’ Life Satisfaction Scale, an often used measure in adolescent samples. The Cantril Ladder also showed good convergent validity with other emotional well-being measures, perceived health and subjective health. Gender differences were noted in the convergent analysis suggesting gender differences in factors influencing or influenced by life satisfaction measured using this instrument.     

A Validity and Reliability Study of the Multidimensional Trust in Health-Care Systems Scale in a Turkish Patient Population

The importance of trust within health care is widely acknowledged. Measuring patients’ trust in health care systems may contribute to plans for the financing, delivery, and outcomes of health services. Although many scales are available to measure patient trust, less attention has been paid to the multidimensional nature of trust in health care systems. The purpose of this methodological study was to adapt the Multidimensional Trust in Health-Care Systems Scale into Turkish and to evaluate its psychometric properties for a Turkish patient population. The scale was adapted into Turkish through a translation and back-translation process. The content validity of the scale was assessed using expert approval. The psychometric properties of the scale were investigated by collecting data from 232 hospitalised patients in Ankara during theperiod of 1 January–30 December 2010. An exploratory factor analysis identified that the eigenvalues for the three factors of the scale were 7.30, 2.61, and 1.21; these three factors explained 65 % of the variance. A confirmatory factor analysis indicated a sufficient model fit for the construct validity of the scale. Cronbach’s α for the total scale was 0.87, as well as 0.91, 0.82, and 0.61 for the three subscales; the Spearman-Brown split half reliability coefficient was 0.67. Despite the low internal consistency of the subscale 3, evidence from this study supports the validity and reliability of the Multidimensional Trust in Health-Care Systems Scale. This instrument can be used to measure multiple aspects of trust in the health care system; however, as trust is a contextual phenomenon, further work is needed to test the psychometric properties of this scale both in Turkish and different cultures.     

Subjective Health-Related Quality of Life in Homeless and Vulnerably Housed Individuals and Its Relationship with Self-Reported Physical and Mental Health Status

Although the association between homelessness and objective indicators of poor health is well-established, little research has focused on the subjective health-related quality of life of homeless and vulnerably housed (HVH) individuals. This study examined the subjective health-related quality of life of HVH individuals, using the Multiple Discrepancies Theory (MDT) Scale for Health of the Quality of Life for Homeless and Hard-to-House Individuals (QoLHHI) Inventory, and its association with self-reported functional health status, as measured by the SF-12, and self-reported physical and mental health conditions in a sample of 100 HVH individuals recruited in Vancouver, Toronto and Ottawa. Our findings indicate that physical and mental health conditions are highly prevalent among HVH individuals and that the SF-12 Physical and Mental Component Summary scores are substantially lower compared to US population norms. The MDT Health items were not statistically significantly associated with physical or mental health conditions and only showed correlations of small to moderate magnitude with the SF-12 Component Summary Scales. These findings suggest that the QoLHHI MDT Scale for Health can provide information about HVH individuals’ subjective health experiences that is different from, and can serve as a valuable complement to, health status information for use in research and evaluation studies, as well as for policy purposes to make informed decisions based on subjective health-related quality of life data from HVH individuals.     

Application and Testing the Reliability and Validity of a Modified Version of Herek's Attitudes Toward Lesbians and Gay Men Scale in China

The present study was the first attempt to test the reliability and validity of Herek's Attitudes Toward Lesbians and Gay Men Scale (ATLG; Herek, 1988 Herek, G. M. 1988. Heterosexuals' attitudes toward lesbians and gay men: Correlatesand gender differences. The Journal of Sex Research, 25(4): 451–477. [Taylor & Francis Online], [Web of Science ®] , [Google Scholar]) in the Chinese population. Participants (n = 2,391 for the field trials and n = 200 for test–retest reliability) were asked to complete the translated, slightly modified version of the ATLG. The resulting ATLG has a two-dimensional factor structure as well as good validity and reliability in the Chinese culture. ATLG scores followed distinct patterns according sex and level of education that were consistent with previous studies in other populations. The significance of these findings in Chinese culture is discussed.     

Construct and Criterion Validity of a Norwegian Instrument for Health Related Quality of Life Among Elderly Women Living at Home

Purpose of the study: The aim of the current study is to validate an instrument consisting of five items and first used in the Nord-Trondelag Health Survey (HUNT-5), as a measure of health related quality of life (QOL) in a population of elderly women living at home. Design and methods: A random sample of 307 women aged 75 years and over (mean 80.8 years, response rate 74.5%) and living at home were interviewed using the HUNT-5 instrument, the 20-question version of the General Health Questionnaire (GHQ-20) and the respondents’ records of their health status and functional ability. Results: No significant relationships were found between age and the sumscores of GHQ-20 and HUNT-5. Factor analysis indicated that HUNT-5 is primarily unidimensional. The Cronbach α for HUNT-5 was 0.79 and that for GHQ-20 was 0.87. The correlation between the HUNT-5 and the GHQ-20 sumscores was 0.75 (p < 0.001). There were significant correlations between some of the health and function items and the two QOL instruments (ranging from 0.14 to 0.68). Implications: This evaluation supports the psychometric validity of HUNT-5 for elderly women living at home. It is important to take into consideration the women’s own experience of their health and functional ability in planning therapy and in obtaining the best possible QOL for them.     

The World Health Organization and the Globalization of Chronic Noncommunicable Disease

Chronic noncommunicable diseases (NCDs) in low‐ and middle‐income countries have recently provoked a surge of public interest. This article examines the policy literature—notably the archives and publications of the World Health Organization (WHO), which has dominated this field—to analyze the emergence and consolidation of this new agenda. Starting with programs to control cardiovascular disease in the 1970s, experts from Eastern and Western Europe had by the late 1980s consolidated a program for the prevention of NCD risk factors at the WHO. NCDs remained a relatively minor concern until the collaboration of World Bank health economists with WHO epidemiologists led to the Global Burden of Disease study that provided an “evidentiary breakthrough” for NCD activism by quantifying the extent of the problem. Soon after, WHO itself, facing severe criticism, underwent major reform. NCD advocacy contributed to revitalizing WHO's normative and coordinative functions. By leading a growing advocacy coalition, within which The Lancet played a key role, WHO established itself as a leading institution in this domain. However, ever‐widening concern with NCDs has not yet led to major reallocation of funding in favor of NCD programs in the developing world.     

Non-Economic Quality of Life and Population Density in South Africa

The purpose of this study is to investigate the relationship between population density and non-economic quality of life. Popular opinion has generally been that population density can be seen as beneficial for economic growth, as it allows for greater productivity, greater incomes and can be translated into higher levels of quality of life. Recently though, growing evidence tends to suggest the exact opposite in that increases in productivity and incomes are not translated into better quality of life. As economic or income variables have always played a significant role in this research, questions regarding the relationship between population density and non-economic quality of life has largely remained unanswered. In this light, the paper utilises a panel data set on the eight metropolitan cities in South Africa for the period 1996–2014 to determine the relationship between population density and non-economic quality of life in the South African context. In the analyses we make use of panel estimation techniques which allows us to compare changes in this relationship over time as well as adding a spatial dimension to the results. This paper contributes to the literature by firstly studying the aforementioned relationship over time and secondly conducting the analyses at a sub-national level in a developing country. Our results show that there is a significant and negative relationship between population density and non-economic quality of life. Based on our findings policy measures to encourage urbanisation should not be supported if the ultimate outcome is to increase non-economic quality of life.     

Quality of Life Across Population Groups: Women in the Workplace: Gender and Wage Differentials

Social Indicators Research - The purpose of this study is to clarify the real causes of gender wage differentials in Korea by analyzing changes over the period 1988–1999. The participation...     

Developing the Psychological Strain Scales (PSS): Reliability, Validity, and Preliminary Hypothesis Tests

Since its inception, the Strain Theory of Suicide has been tested and supported in a number of empirical studies. This social psychological theory can be employed as a complementary conceptualization to account for suicidal behaviors as well as mental disorders. However, the lack of consistent measurements of the strains limits the application of the theory in scientific research. Our research team has developed such scales for future testing of the Strain Theory of Suicide in a more systematic approach. For the initial items to measure the four strains (value, aspiration, deprivation, and coping), we solicited approximately 40 items for each strain with high face validity by about 30 fellow researchers. A preliminary examination of about 160 items for consistency and validity, with a sample of about 300 college students, yielded 20 consistent items for each of the four strain scales. Then, a second study was conducted at a different university with approximately 500 students to further streamline each of the four strain scales and test the validity of each with corresponding established scales and variables. As a result, 15 items were selected for each of the four Psychological Strain Scales (PSS). In correlation and multiple regression analyses, we found support for the hypotheses regarding the positive associations between psychological strains measured by the PSS and psychopathology including suicidal ideation. Follow up research with the new scales needs to be carried out in order to test the effects of psychological strains on suicide and mental disorders for various populations.     

Frailty in the Old Age as a Direct Marker of Quality of Life and Health: Gender Differences

Social Indicators Research - Aging of the population emphasizes the need for research on aging-related problems, among which frailty is a key element because of its clinical as well as social...     

Demographic Characteristics as Predictors of Quality of Life in a Population of Psychiatric Outpatients

Studies examining relationships between demographic variables in a general population of psychiatric outpatients and quality of life (QOL), in which QOL was assessed according to current recommendations, have not been performed yet. The aim of this study was to examine one particular aspect of this relationship: the question to what extent QOL scores can be predicted by demographic variables. In a sample of adult Dutch psychiatric outpatients (n=495), demographics were recorded and the participants completed a questionnaire for measuring QOL (WHOQOL-100). The relationships of the demographic variables with the WHOQOL-100 domains Social Relationships and Environment, were stronger than those with the domains Physical Health and Psychological Health. The latter had only significant relationships with educational level and sick leave, which explain little of the variance of the concerning QOL domain. In general, the demographic characteristics used, explained only a relatively small part of the variance in QOL scores. An exception was sick leave, which, in participants with a job, explained an extensive part (27.4%) of the variance of scores on the domain Physical Health.     

Determinants of Health and the Quality of Life in the Bella Coola Valley

The aim of this investigation is to obtain some baseline self-reported data on the health status and overall quality of life of all residents of the Bella Coola Valley of British Columbia aged 17 years or older, and to measure the impact of a set of designated health determinants on their health and quality of life. In the period from August to November 2001, a variety of procedures were used to ensure that all eligible residents of the Valley received a copy of our questionnaire, and 687 useable questionnaires were obtained for our working dataset. Health status was measured by SF-36 and the U.S. Centers for Disease Control healthy days items. Thirty-one items were used to measure the Provincial Health Officer’s designated determinants of health in four clusters, namely, biological, social and economic, health behaviours and health services determinants. Quality of life was measured by satisfaction levels in 13 specific domains of life (e.g., family, financial security), four global items (e.g., happiness, life satisfaction) and one global Subjective Well-Being Index. Besides obtaining baseline figures on all our measures for the Valley, we made some comparisons among our figures and those from other areas, e.g., Prince George, BC. Most of the measures indicated that the health status and quality of life of Bella Coola Valley residents were lower than those of Prince George residents. For the sample as a whole, SF-36 scores on the eight dimensions ran from 82.3 (physical functioning) to 50.0 (social functioning), with a mean of 62.7. Residents in the Valley averaged 6.5 days in the past 30 in which their health was physically not good, 5.5 days when it was mentally not good and 4.1 days when their health limited their usual daily activities. Eleven percent of respondents described their general health as “excellent” and another 27% said it was “very good”. On a 7-point scale from 1=very dissatisfied to 7=very satisfied, respondents had average life satisfaction and satisfaction with the overall quality of life scores of 5.5. For specific domains of life, the lowest mean level of satisfaction was reported for federal and provincial government officials (3.3) and the highest was reported for living partners and personal safety around home (5.8). Regarding bivariate relations, each of the eight dimensions of SF-36 was significantly correlated with a single item measure of general health, and five of the eight were significantly correlated with the number of good health days. Happiness and the Subjective Well-Being Index were positively but moderately correlated with six of the eight dimensions, and life satisfaction was positively correlated with five. Age was negatively related to general health, but positively related to life satisfaction. Not being of aboriginal descent was positively related to all of the four global health indicators and to the Subjective Well-Being Index. Education was positively related to the four global health measures but not to the three global quality of life measures. The Social Support and Good Family Indexes were positively related to all seven global measures. There was a positive correlation between six of the seven global measures and the frequency with which respondents participated in activities sponsored by voluntary organizations. Frequency of smoking was negatively associated with every global dependent variable except the Physical Health Index. Frequency of skipping meals was negatively associated and average hours of sleep per night was positively associated with all seven global measures. Turning to multivariate relationships, the four clusters of health determinants explained from 12% (SF-36 Mental Health Index) to 24% (general health) of the variance in the dependent global health variables, and from 20% (happiness) to 26% (Subjective Well-Being Index) of the variance in the dependent global quality of life variables. Adding domain satisfaction scores to the total set of predictors allowed us to explain from 20% (SF-36 Mental health Index) to 29% (general health) of the variance in the dependent global health variables, and from 39% (happiness) to 62% (life satisfaction) in the dependent global quality of life variables. By including measures of social support and good family relationships in our set of health determinants, we practically guaranteed that the latter would be relatively strongly predictive of global quality of life.