Self-Assessment - WHO Quality of Life Caldwell 1

Self-Assessment - WHO Quality of Life Caldwell 1 Kara Caldwell RTH 401.01 Debbie Logan 19 September 2016 Self Assessment-WHO Quality of Life Overview of the WHO Quality of Life The World Health Organization developed the WHO Quality of Life (QOL) assessment to globally measure an individual s overall well-being in addition to their quality of life. While more attention was being focused on the impact of disease and daily living, very limited information circulated regarding quality of life (Harper, 1996). Researchers felt the need to develop an assessment that more directly addressed the individual s overall perception of life. Secondly, other renowned quality of life assessments proved to be unsatisfactory due to their geographical establishment (Harper, 1996). Translating the documents proved to be tedious, time-consuming, and substandard. Lastly, many medical models focused solely on the absence of disease instead of the individual s personal pleasure and well-being. Harper (1996) expressed a more humanistic component of healthcare, calling for quality of life assessments in health care, attention is focused on this aspect of health, and resulting interventions will pay increased attention to this aspect of patients' well-being (p. 5). Ultimately, the purpose of producing the WHO Quality of Life assessment was to develop an international, cross-cultural assessment that focused directly on quality of life instead of absence of disease (Harper, 1996). Numerous steps were involved in the production of the WHO QOL assessment. First, researchers aimed to establish and agree upon a definition for quality of life (Harper, 1996). As

Self-Assessment - WHO Quality of Life Caldwell 2 expressed by Harper (1996), 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 (p. 5). Since the definition emphasizes the participants perceived quality of life, it is intended to measure the effects of disease and health interventions (Harper, 1996). Second, fifteen culturally diverse field centers were created for the purpose of establishing a list of components that each center felt was relevant and pertinent to quality of life (Harper, 1996). These assemblies held meetings and produced a maximum of six specialized categories they desired to be addressed within the assessment. Lastly, all questions generated from each center were united into a global pool and 236 items covering 29 facets were included in a final assessment (Harper, 1996, p. 6). WHO QOL Domains The first domain assessed in the WHO QOL assessment is physical health. According to Harper, physical health impacts activities of daily living, dependence on medicinal substances and medical aids, energy and fatigue, mobility, pain and discomfort, sleep and rest, and work capacity (Harper 1996). A single physical condition could negatively influence one, if not all of the previously listed aspects. Physical health naturally affects quality of life because it could restrict an individual from participating in numerous recreational activities, accessing facilities and goods, and participating in other physically-demanding events. The second domain is related to psychological health. Aspects of this section include bodily image and appearance, negative feelings, positive feelings, self-esteem, spirituality/religion/personal beliefs, thinking, learning, memory, and concentration (Harper,

Self-Assessment - WHO Quality of Life Caldwell 3 1996). Ultimately, conditions relevant to psychological health develop internally and cannot be easily identified from an outwardly appearance. The WHO QOL assessment would be beneficial in detecting an issue of this sort due to its focus on perceived well-being. Physiological health affects quality of life because it can hinder learning, communication, personal self-worth, and many other aspects of daily life. The third domain addressed in the WHO QOL assessment is social relationships. This may include personal relationships, social support, and sexual activity (Harper, 1996). Hindrances to this section could result in isolation, sexual confusion, or psychosocial complications. Social relationships are vital because the quality of an individual s social life directly affects their outlook on life as a whole. The final domain is related to environmental characteristics. According to Harper, environmental elements affect 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), and transportation (Harper, 1996). Ultimately, the environment affects quality of life because if an individual fails to feel safe, comfortable, and empowered, they may be weary to participate in activities of daily life. Reliability and Validity of the WHO QOL In order for the WHO QOL assessment to be recognized as a strong evidence-based assessment, its reliability and validity must be accurately addressed. First, reliability is tested by an assessment s consistency and dependability. This measurement is impertinent because

Self-Assessment - WHO Quality of Life Caldwell 4 instructors must be able to administer the assessment with minimal faults and then interpret the results. For instance, the WHO QOL assessment was tested to be reliable across several populations- including homeless veterans. While earlier studies focused on basic needs of these veterans, little research had been conducted addressing the individual s perception of their own quality of life. In a study conducted by the Department of Veterans Affairs, the results confirmed that the WHO QOL assessment was reliable in assessing the homeless population (Garcia-Rea & LePage, 2008). In fact, Internal consistencies were above a 0.80 for all domains and above 0.70 for most facets these results were encouraging considering the unstable nature of the population and the potential for significant life changes (Garcia-Rea & LePage, 2008, p. 623). Ultimately, the study indicated that the WHO QOL assessment could be used consistently across various populations. In the same way, validity must be addressed in order to test an assessment s accuracy in measuring its intended qualities. In order for the researchers to confirm that the WHO QOL assessment was an accurate indicator of these characteristics in relation to homeless veterans, the domain scores of veterans facing medical problems, depression, or poor social support were compared with veterans that were absent of these issues (Garcia-Rea & LePage, 2008). As predicted by examiners, those with medical problems scored lower on the physical domain portion of the WHO QOL scale, those with an indication of depression scored lower on the psychological portion, and those expressing concerns with social interaction scored lower on social relationships domain (Garcia-Rea & LePage, 2008). These results confirm that the WHO QOL assessment is accurate and measuring individual s perceived quality of life. In another case, a study was performed to validate the use of the condensed version of the World Health

Self-Assessment - WHO Quality of Life Caldwell 5 Organization Quality of Life (WHOQOL-BREF) questionnaire in association with medical students. A sample of 274 medical students competed the WHOQOL-BREF assessment and validity was assessed by correlating item and domain scores with the score of each of the two global items (Krageloh, Henning, Hawken, Zhao, Sheperd, & Billington, 2011, p. 3). Results indicated that the WHOQOL-BREF measured its intended characteristics and the assessment was valid to utilize with medical students in order to assess their quality of life in terms of health (Krageloh et al., 2011). In both instances, the WHO QOL assessment demonstrated validity because it was accurate in measuring all indicated qualities. Administration Features When conducting the first trial, the researchers provide a few recommendations to administering the WHO QOL assessment. It is encouraged that the assessment is conducted on at least three-hundred individuals in order to produce accurate results (Harper, 1996). Also, it is recommended that the assessment be provided to only adults- half under and half over 45 years old, half male and half female, and 250 individuals with a disease/impairment and 50 healthy individuals (Harper, 1996). Utilizing this guide has been proved to produce the most accurate results. It is encouraged that the groups contain a cross-section of individuals with variances in their quality of life (Harper, 1996). According to researchers, this may be achieved by sampling patients from a cross-section of primary care settings, hospitals and community care settings (Harper, 1996, p. 9). If possible, it is recommended that the assessment is self-administered. If not, the assessment instructions should be read out loud to the respondents (Harper, 1996). This should

Self-Assessment - WHO Quality of Life Caldwell 6 be done to limit result errors. While the WHO QOL assessment has a time frame of two weeks, alterations to the set time frame is tolerable (Harper, 1996). Additionally, the proposed uses of the WHO QOL assessment is in clinical trials, in establishing baseline scores, and observing deviations in quality of life over a single intervention (Harper, 1996). It is imperative to note that the WHO QOL assessment will also be of value where disease prognosis is likely to involve only partial recovery or remission, and in which treatment may be more palliative than curative (Harper, 1996, p. 9). In other words, this assessment may be a good tool for determining the long-term effectiveness of an intervention. Scoring of the WHO QOL After completing the WHO QOL assessment, the answers must be scored. The assessment focuses on four domain scores in addition to two items that are examined separately: question 1 asks about an individual s overall perception of quality of life and question 2 asks about an individual s overall perception of their health (Harper, 1996, p. 10). Questions from each domain (physical, psychological, social, and environmental) are collected and the respondent must add their responses (1-5) from each question to equal a grand total, also known as the raw score. Domain scores are scaled in a positive direction, indicating that higher scores represent higher quality of life (Harper, 1996). It is imperative to note that some questions are reverse scored in order to prevent error. Once each domain s raw score and the overall raw score has been calculated, a provided key can be utilized to translate the raw score into the standard score, which will lie between 4-20. Next, the individual will add the four domain scores and divide by four to determine the total score. The best way to interpret the meaning of an

Self-Assessment - WHO Quality of Life Caldwell 7 individual s results is to determine how close the individual s standard score is to 20- the higher the number, the better the quality of life for that individual. Appropriateness to RT Practice The WHO QOL assessment can be utilized across most typical recreational therapy populations. Since recreational therapists focus on the overall health of an individual instead of just the absence of disease, the WHO QOL assessment would be a beneficial tool for recreational therapists in determining an individual s perceived quality of life. At the admittance of an individual into the facility/clinic, a recreational therapist could examine the individual s independent domain scores to identify which area(s) needs to be addressed and then determine an intervention to meet the client s needs. For instance, an individual with a physical impairment may take the WHO QOL assessment and score very low on the physical health domain. This would indicate to the recreational therapist that the physical domain of this individual needs to be altered to better improve their well-being and overall quality of life. Similarly, people with other physical impairments, mental disorders, social interaction issues, or difficulties in their environment may also be identified by the WHO QOL assessment and therefore be addressed by the recreational therapist. Also, it would not only be beneficial to have the individuals complete the WHO QOL assessment throughout the intervention, but at the conclusion of treatment. This would provide the recreational therapist with an indicator of the effectiveness of their treatment. Personal Assessment and Results and Reflection After completing the WHO QOL assessment, I computed my scores. With possible scores ranging from 4-20, my standard score for physical health domain was 18, psychological

Self-Assessment - WHO Quality of Life Caldwell 8 domain was 17, social relationship domain was 17, and environment domain was 18. My overall quality of life score was 17.5. While there is always room for improvement, this information indicates that my perceived quality of life is overall fairly high. The domain results were similar in scoring and none were identifiably lower, indicating that there is not a specific section that needs immediate attention. From completing the WHO QOL assessment, I learned the importance of assessing an individual and determining their perceived quality of life. The assessment provides reliable information about an individual s personal perception of life and provides a strong indicator on which aspects need to be addressed. In the future, this assessment should not only provide me with valuable information regarding a client s life, it should allow me to assess the effectiveness of an intervention. Also, my personal experience completing the assessment will help me better understand the results of my clients and more effectively address their needs. As a result, my errors should be limited and I should be more comfortable when administering the assessment. Futuristically, I hope to utilize the knowledge I gained from this experience and use it to improve my practice as a recreational therapist. Personal Copy of Completed WHO QOL Assessment WHO Quality of Life-BREF (CLICK TO HIDE) The following questions ask how you feel about your quality of life, health, or other areas of your life. I will read out each question to you, along with the response options. Please choose the answer that appears most appropriate. If you are unsure about which response to give to a question, the first response you think of is often the best one. Keep in mind your standards, hopes, pleasures and concerns. Think about your life in the last four weeks. Name Kara Caldwell Date Administered 09/09/16 Neither poor poor Poor Good good nor good 1. How would you rate your quality of life?

Self-Assessment - WHO Quality of Life Caldwell 9 poor Poor Neither poor nor good 2. How satisfied are you with your health? 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 much Extremely 3. To what extent do you feel that physical pain prevents you from doing what you need to do? 4. How much do you need any medical treatment to function in your daily life? 5. How much do you enjoy life? 6. To what extent do you feel your life to be meaningful? 7. How well are you able to concentrate? 8. How safe do you feel in your daily life? 9. How healthy is your physical environment? The following questions ask about how completely you experience or were able to do certain things in the last four weeks. Not at A all little Moderately Mostly Completely 10. Do you have enough energy for everyday life? 11. Are you able to accept your bodily appearance? 12. Have you enough money to meet your needs? 13. How available to you is the information that you need in your day-to-day life? 14. To what extent do you have the opportunity for leisure activities? Neither poor Poor Good poor nor good good 15. How well are you able to get around? dissatisfied Dissatisfied Neither satisfied or dissatisfied Good Satisfied good satisfied 16. How satisfied are you with you sleep? 17. How satisfied are you with your ability to perform your daily living activities? dissatisfied Dissatisfied Neither satisfied or dissatisfied Satisfied satisfied 18. How satisfied are you with your capacity for work? 19. How satisfied are you with yourself?

Self-Assessment - WHO Quality of Life Caldwell 10 20. How satisfied are you with your personal relationships? 21. How satisfied are you with your sex life? 22. How satisfied are you with the support you get from your friends? 23. How satisfied are you with the conditions of your living place? 24. How satisfied are you with your access to health services? 25 How satisfied are you with your transport? The following question refers to how often you have felt or experienced certain things in the last four weeks. Never Seldom Quite often often Always 26. How often do you have negative feelings such as blue mood, despair, anxiety, depression? Do you have any comments about the assessment? No SCORING: Equations for computing domain scores Domain 1 Physical Health (6-Q3) + (6-Q4) + Q10 + Q15 + Q16 + Q17 + Q18 5+5+4+5+4+5+4 Domain 2 Psychological Q5 + Q6 + Q7 + Q11 + Q19 + (6-Q26) 4+5+4+3+4+5 Domain 3 Social Q20 + Q21 + Q22 Relationships 5+4+4 Domain 4 Environment Q8 + Q9 + Q12 + Q13 + Q14 + Q23 + Q24 + Q25 5+4+4+4+4+5+5+5 Raw Standard Score Score 32 18 25 17 13 17 36 18 Total Domain Scores 106 70 Quality of Life Score (divide the Standard Total Domain Scores by 4) 17.5

Self-Assessment - WHO Quality of Life Caldwell 11 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 on 09/08/16 from https://wcu.blackboard.com/courses/1/fall2016.rth401-01/content/_1930945_1/reliability%20and%20validity%20of%20the%20who%20qua lity%20of%20life%20on%20homeless%20veterans_2008.pdf Harper, A. (1996). WHOQOL-BREF introduction, administration, scoring, and generic version of the assessment. Retrieved on 09/08/16 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 on 09/08/16 from https://wcu.blackboard.com/bbcswebdav/pid-1930945-dt-content-rid- 12874573_1/courses/FALL2016.RTH401-01/Validation%20of%20the%20WHOQOL_BREF_2011.pdf