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WHO Quality of Life
Courtney McLaughlin
RTH 401 Client Assessment
Debbie Logan
9/17/16
WHO Quality of Life
Overview:
The WHO Quality of Life assessment was developed by the World Health Organization as a way to assess individual’s quality of life, which would be applicable not just in America, but also cross-culturally (Harper, 1996). The purpose of this assessment was to go beyond normal ideas of health, and to take into account other aspects of health such as disability in to health. The developmental process of the WHO Quality of Life assessment came together after several different stages. The first stage was simply to come up with an agreed definition of quality of life. The definition given by the world health organization is “Quality of life is defined as individuals' perceptions 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” (Harper, 1996, p.?). The second stage was having some focus groups with 15 different groups of people, to figuring out what they thought was important when looking at someone’s overall health. The third stage of development was the last stage, and consisted of compiling the information that was gathered in stage two, into 239 questions coving 29 areas and administrating the questions to at least 300 people from every group from stage two (Harper, 1996).
WHO QOL Domains:
There are four domains that are assessed in the WHO QOL; they are physical, psychological, social, and environmental. Physical aspect looks at activities of daily living, dependence on medicinal substances and medical aids, energy and fatigue, pain and discomfort when walking (Harper, 1996). Anything that your body physically does or experiences would fall under this domain. Psychological aspect looks at bodily image and appearance, negative feelings, positive feelings, self-esteem, spirituality / religion / personal beliefs, thinking, learning, memory and concentration (Harper, 1996). All things that effects how you think or feel are examined under the psychological domain. Social relationships look at person’s personal relationships, social support, and sexual activity. Environment looks at an individual’s financial resources, freedom, physical safety and security, health and social care: accessibility and quality, home environment, opportunities for acquiring new information and skills, participation in and opportunities for recreation / leisure activities, physical environment (pollution / noise / traffic / climate), transport (Harper, 1996). Anything that affects how a person lives and where they live is considered part of their environment and are examined here.
Reliability and Validity:
In New Zealand, a study was done using the WHO QOL on medical students in their fourth and fifth year in the program. The study consisted of 274 individuals 150 of which were female of varying ethnic backgrounds, the majority of which were European and Asian (Krageloh et al., 2011). To have both reliability and validity, the results must depict a correlation score of -1.0 to +1.0, Reliability should be higher than validity, a Reliability score of +.70 to +.99, +.60 or lower would indicate poor reliability; and should not be used, and a validity score of +.30 (Logan, 2016, slide 6). The study proved to have both reliability and validity, for the most part the correlation score remained be -1.0 and +1.0, with a few questions being a little higher or lower. The overall reliability was .89, with each domain also being over .70 and a validity score of .38 (Krageloh et al., 2011). Although a few questions challenged the stipulations set forth for reliability and validity, it would still be considered reliability and validity, since the majority does meet the stipulations. Additionally, two items from the Overall quality of Life and General Health facet have been included. These questions, are the first two, and do not really count in the score.
Another study of 250 homeless veterans also proved that the WHO QOL has both reliability and validity. In this study the reliability score was over .80, and the validity score was over .6 (Garcia-Rea & LePage, 2008). Since the reliability and validity has been proven time and time again with different ability levels, and populations it is safe to say that the WHO QOL assessment is a good assessment to give in numerous RT settings.
Administration Features:
When giving the assessment to someone it is important to keep the 26 questions in the order that they are listed for many reasons, the main reason being that it could change the meaning of the question if it is giving in a different order (Harper, 1996). The WHO QOL should be given to at least 300 people, with three stipulations to it, 50 percent of should be adults under age 45, with the other 50 percent over age 45, it should be even between men and women, and 250 of the ones tested should have an impairment of some kind the other 50 should be in good health and should be given in two week increments (Harper, 1996). Capable individuals should administer the test to themselves, if needed they can have it read to them (Harper, 1996).
Scoring the WHO QOL:
You are given several scores for this test, you get 2 scores per domain, a raw score, a standard score, and a quality of life score. The four domain scores are an individual’s perception of quality of life in each domain. Domain scores are scaled in a positive direction with higher scores showing a higher quality of life (Harper, 1996). To score you add up the questions it says for that domain, some of the questions are reverse coded to prevent cheating, so you may have to subtract first, this is your raw score. To get your standard score, you take your raw score and see where it falls in the chart and that will tell you your standard score. To determine your quality of life score you add all your standard scores together and divide by four, the higher the score the higher quality of life that person has (Harper, 1996).
Appropriateness to RT practice:
The WHOQOL assessment can be extremely useful in the RT practice, it can tell who would benefit most in clinical trials, it gives baseline scores in a several areas, which allows us to see changes in quality of life over the course of interventions (Harper, 1996). The WHO QOL also highlights areas where a patient is most affected by disease, so the RT can design interventions specified for that patient that will help them the most (Harper, 1996). The test gives RTs and other health care professionals a starting point, so the client can get the best treatment for them in a timely fashion, without wasting their time or the health professionals time either.
Personal Assessment Results and Reflection:
Very poor / Poor / Neither poor nor good / Good / Very good1. / How would you rate your quality of life? / 1 / 2 / 3 / 4 / 5
Very poor / Poor / Neither poor nor good / Good / Very good
2. / How satisfied are you with your health? / 1 / 2 / 3 / 4 / 5
The following questions ask about how much you have experienced certain things in the last four weeks.
Not at all / A little / A moderate amount / Very much / Extremely3. / To what extent do you feel that physical pain prevents you from doing what you need to do? / 1 / 2 / 3 / 4 / 5
4. / How much do you need any medical treatment to function in your daily life? / 1 / 2 / 3 / 4 / 5
5. / How much do you enjoy life? / 1 / 2 / 3 / 4 / 5
6. / To what extent do you feel your life to be meaningful? / 1 / 2 / 3 / 4 / 5
7. / How well are you able to concentrate? / 1 / 2 / 3 / 4 / 5
8. / How safe do you feel in your daily life? / 1 / 2 / 3 / 4 / 5
9. / How healthy is your physical environment? / 1 / 2 / 3 / 4 / 5
The following questions ask about how completely you experience or were able to do certain things in the last four weeks.
Not at all / A little / Moderately / Mostly / Completely10. / Do you have enough energy for everyday life? / 1 / 2 / 3 / 4 / 5
11. / Are you able to accept your bodily appearance? / 1 / 2 / 3 / 4 / 5
12. / Have you enough money to meet your needs? / 1 / 2 / 3 / 4 / 5
13. / How available to you is the information that you need in your day-to-day life? / 1 / 2 / 3 / 4 / 5
14. / To what extent do you have the opportunity for leisure activities? / 1 / 2 / 3 / 4 / 5
Very poor / Poor / Neither poor nor good / Good / Very good
15. / How well are you able to get around? / 1 / 2 / 3 / 4 / 5
Very dissatisfied / Dissatisfied / Neither satisfied or dissatisfied / Satisfied / Very satisfied
16. / How satisfied are you with you sleep? / 1 / 2 / 3 / 4 / 5
17. / How satisfied are you with your ability to perform your daily living activities? / 1 / 2 / 3 / 4 / 5
Very dissatisfied / Dissatisfied / Neither satisfied or dissatisfied / Satisfied / Very satisfied
18. / How satisfied are you with your capacity for work? / 1 / 2 / 3 / 4 / 5
19. / How satisfied are you with yourself? / 1 / 2 / 3 / 4 / 5
20. / How satisfied are you with your personal relationships? / 1 / 2 / 3 / 4 / 5
21. / How satisfied are you with your sex life? / 1 / 2 / 3 / 4 / 5
22. / How satisfied are you with the support you get from your friends? / 1 / 2 / 3 / 4 / 5
23. / How satisfied are you with the conditions of your living place? / 1 / 2 / 3 / 4 / 5
24. / How satisfied are you with your access to health services? / 1 / 2 / 3 / 4 / 5
25 / How satisfied are you with your transport? / 1 / 2 / 3 / 4 / 5
The following question refers to how often you have felt or experienced certain things in the last four weeks.
Never / Seldom / Quite often / Very often / Always26. / How often do you have negative feelings such as blue mood, despair, anxiety, and depression? / 1 / 2 / 3 / 4 / 5
SCORING:
Equations for computing domain scores / Raw Score / Standard ScoreDomain 1 / Physical Health / (6-Q3) + (6-Q4) + Q10 + Q15 + Q16 + Q17 + Q18
1+ 2+ 3+ 1+ 3+ 3+ 4 / 17 / 10
Domain 2 / Psychological / Q5 + Q6 + Q7 + Q11 + Q19 + (6-Q26)
3+ 5+ 5+ 4+ 3+ 3 / 22 / 16
Domain 3 / Social Relationships / Q20 + Q21 + Q22
4+ 3+ 4 / 12 / 15
Domain 4 / Environment / Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25
5+3+ 4+ 5+ 4+ 4+ 4+ 5 / 32 / 16
Total Domain Scores / 83 / 57
Quality of Life Score (divide the Standard “Total Domain Scores by 4) / 14.25
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WHO Quality of Life
Domain I-PhysicalRaw / Standard
7 / 4
8-9 / 5
10-11 / 6
12-13 / 7
14 / 8
15-16 / 9
17-18 / 10
19-20 / 11
21 / 12
22-23 / 13
24-25 / 14
26-27 / 15
28 / 16
29-30 / 17
31-32 / 18
33-34 / 19
35 / 20
Domain II-Psych.
Raw / Standard
6 / 4
7-8 / 5
9 / 6
10-11 / 7
12 / 8
13-14 / 9
15 / 10
16-17 / 11
18 / 12
19-20 / 13
21 / 14
22-23 / 15
24 / 16
25-26 / 17
27 / 18
28-29 / 19
30 / 20
Domain III-Social
Raw / Standard
3 / 4
4 / 5
5 / 7
6 / 8
7 / 9
8 / 11
9 / 12
10 / 13
11 / 15
12 / 16
13 / 17
14 / 19
15 / 20
Domain IV-Environ.
Raw / Standard
8 / 4
9-10 / 5
11-12 / 6
13-14 / 7
15-16 / 8
17-18 / 9
19-20 / 10
21-22 / 11
23-24 / 12
25-26 / 13
27-28 / 14
29-30 / 15
31-32 / 16
33-34 / 17
35-36 / 18
37-38 / 19
39-40 / 20
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WHO Quality of Life
My Quality of life score was quite low, at 14.25 at this point in my life I would have to agree with my score. I think the biggest reason my score is so low is because of my disability. My disability has a huge impact of my physical and social health, which is evident by how low my scores in those domains areas. Since my disability is a chronic physical disability, I have to live with pain day in and day out which makes it harder to do some of the physical day-to-day activities such as walking. Socially I am affected, because I tend to close myself off from others due to fear of rejection or humiliation, because of my disability. Although my other two domains were low, I believe that I do handle things well mentally, and I am lucky to have the friends and family I do have to support me. I do believe that if I did not have a disability, that my score would be much higher than it is now. I never really understood why we use this assessment, but now after doing this paper I see how useful it can be and is, and will be able to use this later in life and share with others who may not understand why it is used how useful it is. I got to experience the mental debate of “am I a 3 or a 4” that many clients may have to go through as well, because of this I will be able to help them figure out the best answer for them by talking through it like I had to do with myself while taking the assessment.
References:
Garcia-Rea, E., & LePage, J.P. (2008). Reliability and validity of world health organization quality of life-100 in homeless substance-dependent veteran population. Journal of rehabilitation research & development. Dallas, TX, pp.619-626. Retrieved from https://wcu.blackboard.com/courses/1/FALL2016.RTH401-01/content/_1930945_1/Reliability%20and%20Validity%20of%20the%20WHO%20Quality%20of%20Life%20on%20Homeless%20Veterans_2008.pdf
Harper, A. (1996). WHOQOL-BREF introduction, administration, scoring, and generic version of the assessment. Retrieved from https://wcu.blackboard.com/courses/1/FALL2016.RTH401-01/content/_1930945_1/WHO%20Quality%20of%20Life%20Manual.pdf
Krageloh, C.G., Henning, M.A., Hawken, S.J., Zhao, Y., Sheperd, D., & Billington, R. (2011). Validation of the WHOQOL-BREF quality of life questionnaire for use with medical students. Education for health. Auckland, New Zealand. Retrieved from https://wcu.blackboard.com/bbcswebdav/pid-1930945-dt-content-rid-12874573_1/courses/FALL2016.RTH401-01/Validation%20of%20the%20WHOQOL_BREF_2011.pdf
Logan, D. (2016, September). The PSS and Psychometrics and Measurement Principles. RTH 401: Client assessment. Lecture conducted from Western Carolina University, Cullowhee, NC.