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Psychometric evaluation of the WHOQOL-BREF in community-dwelling older people in Taiwan using Rasch analysis

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Abstract

Objective

To examine the psychometric characteristics of the brief version of the World Health Organization Quality of Life (WHOQOL-BREF) questionnaire in rural-community-dwelling older people in Taiwan using Rasch analysis.

Methods

This is a cross-sectional study. A total of 1200 subjects aged ≥65 years were recruited to complete the 26-item WHOQOL-BREF. Scale dimensionality, item difficulty, scale reliability and separation, item targeting, item-person map, and differential item functioning (DIF) were examined.

Results

The four WHOQOL-BREF scales (physical capacity, psychological well-being, social relationships, and environment) were found to be unidimensional and reliable. The item–person map for each domain indicated that the spread of the item thresholds sufficiently covered the latent trait continuum being measured. However, gaps in content coverage were identified in the social domain. Analyses of the DIF revealed that one psychological item (body image) exhibited DIF across the two age groups (old–old vs. young–old) and that two social items (sexual activity and friends’ support) displayed DIF across genders and the two age groups.

Conclusions

Rasch analysis is a comprehensive method of psychometric evaluation of the WHOQOL-BREF and identifies areas for improvements. Three items displaying age-related DIF (body image, sexual activity, and friends’ support) may potentially cause biased health-related QOL assessments, and their impacts on scores should be carefully examined.

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Abbreviations

CTT:

Classical test theory

DIF:

Differential item functioning

HRQL:

Health-related quality of life

IRT:

Item response theory

WHOQOL-BREF:

World Health Organization Quality of Life-BREF

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Acknowledgments

This study was supported by the National Health Research Institutes (NHRI-EX98-9805PI and NHRI-EX95-9204PP), China Medical University (CMU96-225), and the National Science Council (NSC93-2320-B-039-013 and NSC95-2314-B-038-008) of Taiwan, Republic of China. We are most grateful to all of the subjects who participated in this study.

Author information

Authors and Affiliations

  1. Graduate Institute of Biostatistics, Institute of Environmental Health, Biostatistics Center, China Medical University, Taichung, Taiwan, ROC

    Wen-Miin Liang

  2. Buehler Center on Aging, Health & Society, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Chih-Hung Chang

  3. Graduate Institute of Biostatistics, China Medical University, Taichung, Taiwan, ROC

    Chih-Hung Chang

  4. Biostatistics Center, China Medical University, Taichung, Taiwan, ROC

    Yi-Chun Yeh

  5. Department of Mathematics, National Changhua University of Education, Changhua, Taiwan, ROC

    Haw-Yaw Shy

  6. Institute of Environmental Health, China Medical University, Taichung, Taiwan, ROC

    Hung-Wei Chen

  7. Institute of Injury Prevention and Control, Taipei Medical University, 250 Wu-Hsing Street, Taipei, Taiwan, ROC

    Mau-Roung Lin

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  1. Wen-Miin Liang
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  2. Chih-Hung Chang
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  3. Yi-Chun Yeh
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  4. Haw-Yaw Shy
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  5. Hung-Wei Chen
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  6. Mau-Roung Lin
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Corresponding author

Correspondence to Mau-Roung Lin.

Appendix

Appendix

See Table 3.

Table 3 The WHOQOL-BREF
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Liang, WM., Chang, CH., Yeh, YC. et al. Psychometric evaluation of the WHOQOL-BREF in community-dwelling older people in Taiwan using Rasch analysis. Qual Life Res 18, 605–618 (2009). https://doi.org/10.1007/s11136-009-9471-5

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