Cross-national comparability of the WHOQOL-BREF: a measurement invariance approach

Qual Life Res. 2010 Mar;19(2):219-24. doi: 10.1007/s11136-009-9577-9. Epub 2010 Jan 20.


Purpose: To evaluate whether the WHOQOL-BREF measures the QOL construct in the same way across nations.

Methods: Students from Flanders, Belgium and Iran completed the WHOQOL-BREF as part of a larger Quality of Life questionnaire. Their responses were compared using a multi-group confirmatory factor analysis.

Results: In general, the QOL construct appears rather similar in both cultures; however, participants from both countries seem to respond differently to particular items of the WHOQOL-BREF. Especially for the physical and psychological domain, this is problematic, because none of their indicators works in the same way across samples.

Conclusions: Notwithstanding some limitations of this study, it must be concluded that the WHOQOL-BREF should only be used with great caution in cross-national comparisons.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Belgium
  • Cross-Cultural Comparison*
  • Culture
  • Factor Analysis, Statistical
  • Female
  • Humans
  • Internationality
  • Iran
  • Male
  • Psychometrics
  • Quality of Life / psychology*
  • Surveys and Questionnaires
  • Young Adult