World Health Organization Quality of Life (WHOQOL-BREF)

WHOQOL-BREF is a 26-item quality-of-life check across the past two weeks.

The four WHOQOL domains stay separate from the two general WHO items.
Each item keeps the original response wording for its question type.
Responses stay in this browser unless you intentionally export them.

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Quality-of-life profile

Within-tool profile mean across the four WHOQOL-BREF domains

Overall QoL {{ generalItemRows[0].responseText }} Health {{ generalItemRows[1].responseText }} {{ row.shortLabel }} {{ formatScore(row.transformedScore) }}

Domain radar

Quality-of-life domain rings

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Next moves

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Current snapshot

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General WHO items

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Follow-up note: {{ supportNote }}

Focus-to-anchor table

#	Current anchor	Lower-scoring domain	Why it stands out	One next move	Copy
{{ row.id }}	{{ row.supportLabel }}	{{ row.focusLabel }}	{{ row.reason }}	{{ row.action }}

Domain audit

Domain	Items	Mean / 5	Raw 4-20	Score	Interpretation	Copy
{{ row.label }} {{ row.statusLabel }}	{{ row.itemCount }}	{{ formatScore(row.meanScore) }}	{{ formatScore(row.rawScore) }}	{{ formatScore(row.transformedScore) }}	{{ row.note }}

Lower-scoring items

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No normalized item landed in the lower 1 to 2 range on this run.

Current support items

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No normalized item landed in the higher 4 to 5 range on this run.

Answer review

#	Domain	Item	Response	Norm.	Reverse	Status	Copy
{{ row.id }}	{{ row.domainLabel }}	{{ row.text }}	{{ row.responseText }}	{{ row.normalizedLabel }}	{{ row.reverseLabel }}	{{ row.statusLabel }}

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Quality of life is partly about symptoms, but it is not the same as symptom severity. Two people can live with the same diagnosis, workload, or care plan and still report very different daily life because pain, sleep, money, transport, safety, relationships, and emotional strain do not affect everyone in the same way.

The World Health Organization Quality of Life brief questionnaire, usually shortened to WHOQOL-BREF, treats quality of life as a person's own view of life within their culture, goals, expectations, and concerns. That framing matters because a score is not trying to rank people from healthy to unhealthy. It is trying to describe how life has felt across several practical areas during the past two weeks.

WHOQOL-BREF uses 26 five-point questions. Two questions ask for broad judgments: overall quality of life and satisfaction with health. The other 24 questions form four scored domains, so a low physical-health result, a stronger social result, and an uneven environment result can remain visible instead of being flattened into one label.

WHOQOL-BREF domain overview
Domain	What it covers	Common interpretation mistake
Physical	Pain, treatment dependence, energy, sleep, mobility, daily activities, and work capacity.	Reading it only as illness severity instead of daily function.
Psychological	Enjoyment, meaning, concentration, body image, self-regard, and negative feelings.	Treating it as a diagnosis rather than a quality-of-life signal.
Social	Personal relationships, sex life satisfaction, and support from friends.	Forgetting that three items make each answer carry visible weight.
Environment	Safety, physical surroundings, money, information, leisure, living place, health services, and transport.	Assuming a low score is only personal distress when practical barriers may be driving it.

WHOQOL-BREF answers flow into four scored domains and two separate general items

Results are easiest to use when the domains are treated as a profile. A low Environment score can point to transport, money, housing, service access, or safety rather than a change in mood. A low Psychological score may deserve care and attention, but it does not by itself diagnose depression, anxiety, or any other condition. Repeating the same questionnaire under similar conditions can show whether a pattern persists, but one run is still a self-report snapshot.

The broad quality-of-life and health-satisfaction items deserve separate attention. They can agree with the domain scores, or they can disagree when a recent event, a new health worry, strong social support, or a practical barrier affects the person's overall impression more than one domain alone.

How to Use This Tool:

Use the assessment as one complete past-two-weeks snapshot, then read the domain pattern before relying on the average.

Select Begin assessment and answer each of the 26 WHOQOL-BREF questions with the response wording shown for that item.
Watch the progress bar and question navigator while answering. The navigator marks completed questions and lets you return to any item before results appear.
If the result area is missing, look for a progress value below 26 / 26 answered. Select the unanswered question in the navigator, choose a response, and the assessment will continue.
Start with the summary: Profile mean, Spread, Overall QoL, Health, Primary focus, and Strongest support give the first read.
Use Domain radar, Quality-of-life domain rings, and Domain audit to compare the four transformed domain scores, raw 4-20 scores, item counts, and status labels.
Open Lower-scoring items, Current support items, and the Focus-to-anchor table when a domain result seems surprising. Those sections connect the domain score back to specific item wording and a possible next move.
Before using Share result or the Answer review exports, check that you are comfortable sharing answer-level quality-of-life details with the recipient.

Interpreting Results:

Higher domain scores mean better perceived quality of life for that domain. The most useful result is usually the shape of the four domains: the lowest domain, the strongest domain, and the gap between them. The Profile mean is a within-tool summary of the four transformed domain scores, not an official WHO single-index diagnosis.

The Focus, Watch, and Support labels are reading aids. By default, a transformed domain score below 50 / 100 is treated as Focus, a score from 50 / 100 up to but not including 70 / 100 is Watch, and a score at or above 70 / 100 is Support. These labels do not change the WHOQOL-BREF answers and should not be read as clinical cutoffs.

WHOQOL-BREF interpretation checks
Result cue	Plain reading	Verification step
`Spread` above 20 points	The profile is uneven, so the average can hide a much lower domain.	Compare `Primary focus` with `Strongest support` before acting on the mean.
Physical is lowest	Pain, sleep, energy, mobility, treatment burden, daily activities, or work capacity may be limiting daily life.	Review items 3, 4, 10, and 15-18 in `Answer review`.
Psychological is lowest	Enjoyment, meaning, concentration, body image, self-regard, or negative feelings may need attention.	Check item 26 because frequent negative feelings are reverse-scored.
Social is lowest	Relationship satisfaction, sex life satisfaction, or support from friends may be weaker than other areas.	Read all three social items because each answer has a large effect.
Environment is lowest	Safety, money, information, leisure, living place, health services, or transport may be the practical barrier.	Look for supports outside the person, not only personal coping changes.
General items disagree with domains	The broad life or health judgment may be affected by a recent event, worry, or support not captured by the lowest domain.	Keep `Overall QoL` and `Health` visible instead of averaging them into the profile.

A high domain score does not prove that no support is needed, and a low score does not identify a condition. Confidence improves when the same domain pattern matches real examples, appears again after a similar follow-up interval, and agrees with the answer-level review.

Technical Details:

WHOQOL-BREF scoring starts by preserving the direction of meaning. Most items already use higher response values for better quality of life. Items about pain interference, need for medical treatment, and negative feelings are reverse-scored so that the final scored item value still points in the same direction as the rest of the domain.

The four domains have different item counts, so each domain is built from its own item mean before being scaled. Physical has 7 items, Psychological has 6, Social has 3, and Environment has 8. The two general items stay outside domain scoring and are reported as their original response text.

Formula Core

Each answered item has a raw response from 1 to 5. Reverse-scored items use 6 - response, domain means are converted to the WHOQOL 4-20 scale, and transformed scores are shown on a 0-100 scale.

\begin{array}{rcl} s i & = & 6 - v i, for reverse-scored items \\ s i & = & v i, for forward-scored items \\ m d & = & \frac{\sum s i}{n} \\ r d & = & m d \times 4 \\ t d & = & \frac{r d - 4}{16} \times 100 \end{array}

In this formula, vi is the original 1-5 response, si is the scored item value, nd is the number of answered items in that domain, md is the domain mean, rd is the raw 4-20 domain score, and td is the transformed 0-100 score. For example, seven Physical scored item values of 2, 4, 3, 3, 2, 3, and 3 produce a domain mean of 2.86, a raw score of 11.43, and a transformed score of 46.4 / 100 after display rounding.

WHOQOL-BREF score construction
Score element	Items used	Displayed form	Important scoring rule
General WHO items	1 and 2	Original response text	Kept separate from the four domain scores.
Physical	3, 4, 10, 15, 16, 17, 18	Mean / 5, raw 4-20, transformed 0-100	Items 3 and 4 are reverse-scored.
Psychological	5, 6, 7, 11, 19, 26	Mean / 5, raw 4-20, transformed 0-100	Item 26 is reverse-scored.
Social	20, 21, 22	Mean / 5, raw 4-20, transformed 0-100	Three items mean one answer can visibly move the score.
Environment	8, 9, 12, 13, 14, 23, 24, 25	Mean / 5, raw 4-20, transformed 0-100	Combines personal surroundings, access, safety, money, services, and transport.

WHOQOL-BREF local status label rules
Status label	Default boundary	Meaning in the report
`Focus`	Transformed score < 50 / 100	A lower domain that deserves the first review.
`Watch`	50 / 100 <= transformed score < 70 / 100	A middle domain that should be read with the whole profile.
`Support`	Transformed score >= 70 / 100	A stronger area that may help anchor follow-up plans.

The scoring path requires a complete 26-item response set before results appear, so it does not use missing-item substitution. Displayed domain means, raw scores, transformed scores, profile mean, and spread are rounded to one decimal for readability.

Limitations:

WHOQOL-BREF is an informational quality-of-life profile. It is not a clinical diagnosis, risk score, or substitute for professional care.

Answers are self-reported and use a past-two-weeks recall window, so illness flares, recent losses, travel problems, or temporary support can strongly affect one run.
Scoring uses only complete response sets and does not apply official missing-item substitution rules.
Ordinary answering and scoring happen in the browser, but copied result links and exports can include answer-level details. Treat them as private health-adjacent notes.
If low scores match ongoing distress, safety concerns, or functional difficulty, discuss the pattern with a qualified clinician, counselor, support professional, or other appropriate professional.

Worked Examples:

Physical strain is the first focus. A person reports pain interference as Very much, sleep satisfaction as Dissatisfied, and work capacity as Neither satisfied nor dissatisfied. If the seven Physical scored item values are 2, 4, 3, 3, 2, 3, and 3, Domain audit shows a Physical score of 46.4 / 100. With the default status boundaries, Physical becomes Focus, and Lower-scoring items should be checked before assuming the whole profile is low.

A support domain can sit beside a low general item. A Psychological pattern with scored item values of 4, 4, 4, 4, 4, and 3 produces a transformed score of 70.8 / 100, which is Support. If the separate Health item is Dissatisfied, the domain still remains a support area, but the general health answer should be reviewed as its own concern.

No result appears at 25 answers. Someone reaches 25 / 26 answered and sees no result sections. The fix is to select the remaining item in the navigator, answer it, and then review Answer review. If the missing item is item 26 and the answer is Always, it becomes a low normalized score after reverse scoring and may explain a lower Psychological result.

FAQ:

Is WHOQOL-BREF a mental health diagnosis?

No. It is a quality-of-life questionnaire. A low Psychological score or low general health satisfaction can be a useful discussion cue, but it does not diagnose depression, anxiety, chronic illness severity, or any other condition.

Why are overall quality of life and health satisfaction separate?

Items 1 and 2 are broad general items. The four domain scores use the other 24 items, so Overall QoL and Health are reported beside the domain profile instead of being averaged into it.

Why can a negative-feelings answer lower the Psychological score?

Item 26 is reverse-scored because more frequent negative feelings indicate lower quality of life for that item. The Answer review shows the original response, the normalized score, and whether reverse scoring was used.

Can I compare my score with someone else's score?

Use caution. WHOQOL-BREF reflects personal perception within a life context, and language, culture, age, health status, and living conditions can affect answers. The clearest comparison is usually your own repeated profile under similar conditions.

Why do results not appear before all items are answered?

The scoring path uses a complete response set. Use the progress bar and question navigator to find the missing item, answer it, and then check the Quality-of-life profile result.

What should I know before sharing a result link?

A copied result link can preserve the answer pattern needed to reopen the result. Share it only with someone you trust, and check the Answer review first because it contains sensitive answer-level details.

Glossary:

WHOQOL-BREF: The 26-item brief World Health Organization quality-of-life questionnaire.
Domain: A scored area of quality of life: Physical, Psychological, Social, or Environment.
Reverse-scored item: An item where a higher raw response reflects more difficulty, so the scored value is flipped before domain scoring.
Transformed score: The 0-100 version of a domain score after the raw 4-20 score is converted.
Profile mean: The average of the four transformed domain scores used as a within-tool summary.
Spread: The point gap between the highest and lowest transformed domain scores.
Focus: A local status label for a lower-scoring domain that should be reviewed first.

References:

WHOQOL-BREF: introduction, administration, scoring and generic version of the assessment, World Health Organization, 16 June 2012.
WHOQOL-BREF scoring and translation files, World Health Organization.
The WHOQOL-BREF questionnaire, World Health Organization.
The World Health Organization's WHOQOL-BREF quality of life assessment, Skevington, Lotfy, O'Connell, and the WHOQOL Group, Quality of Life Research, 2004.