Abstract
BackgroundThe WHOQOL-BREF is a frequently used instrument for the assessment of health-related quality of life. Unlike other generic instruments used for the assessment of this construct, little is known about its properties in individuals with headache disorders. The present study examines the reliability and factorial validity of the WHOQOL-BREF in individuals with chronic headache residing in Austria.MethodsData from a representative population-based survey on 963 individuals with chronic headache surveyed between 2013 and 2015 was used. The factorial validity was examined by means of confirmatory factor analysis. Differential item functioning related to sex was analyzed using multiple indicators multiple causes models.ResultsInformation on 239 men and 724 women with chronic headache was available. The four-factor, 24-item baseline model showed a moderate fit (RMSEA = 0.066; CFI = 0.868; TLI = 0.852; SRMR = 0.053), which improved significantly after the addition of six error covariances (RMSEA = 0.052; CFI = 0.920; TLI = 0.908; SRMR = 0.046). Sex-related differential item functioning was observed in two items of the environment factor, two items of the psychological health factor and two items of the physical health factor.ConclusionsAfter some modifications to the measurement model, the WHOQOL-BREF shows a satisfactory fit among individuals with chronic headache in Austria. Because of these modifications and the questionnaire’s susceptibility for differential item functioning, a latent variable framework should be employed for the analysis. Future studies need to confirm these results for other language regions and should also examine different subtypes of headache.
Highlights
The World Health Organization Quality of Life (WHOQOL)-BREF is a frequently used instrument for the assessment of health-related quality of life
Based on the 100item WHOQOL [7], the WHOQOL-BREF consists of 24 Likert scale items on different facets of Health-related quality of life (HRQOL) which represent four latent HRQOL dimensions: physical health, psychological health, social relationships and environment
Extending own previous research on the subject [31], the aim of the present study was to examine the reliability and factorial validity of the WHOQOL-BREF in a representative population-based sample of individuals with self-reported chronic headache residing in Austria and to assess its measurement equivalence between men and women
Summary
The WHOQOL-BREF is a frequently used instrument for the assessment of health-related quality of life. Health-related quality of life (HRQOL) is an important patient-reported outcome in health research and practice. It is used as an indicator in clinical trials, in the evaluation of health care services and for benchmarking purposes. An important requirement for the use of HRQOL as an indicator in research and practice is the valid and reliable assessment of this construct. Comparable to other psychological constructs, HRQOL is usually assessed by means of multi-item self- or interviewer-administered questionnaires where different latent dimensions (‘factors’) are measured by a set of observable items (‘indicators’) [5]. The WHOQOL-BREF is either examined based on the four aforementioned dimensions (e.g., [8–11]) or these dimensions are summarized into a global quality of life score, effectively extending the four-factor measurement model into a second-order model (e.g., [12– 15])
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