Examining the World Health Organization's WHOQOL-BREF: assessing the structural and convergent validity in a general U.S. sample

Psychometric exploration of the World Health Organization Quality of Life Questionnaire-BREF (WHOQOL-BREF, WHOQOL Group, 1998) is warranted. The role of life satisfaction in health and social outcomes, variations within and across populations surrounding quality of life, and the potential influence of social and political changes since the development of the measure beget assessment of the structural and construct validity of the WHOQOL-BREF in a general U.S. population. We examined the reliability, convergent and discriminant construct validity, and multiple-fit indexes of both first-order and second-order models of the measure using a convenience sample of U.S. adults obtained through Prolific (c) (n = 302). Mean scores were lower than scores reported among several inter-national and U.S. samples and reflect values parallel to that of unhealthy or patient populations. Fit indexes indicate the second-order model of the WHOQOL-BREF outperforms the first-order model (chi(2)/df = 485/242 = 2.00; NFI = .89; NNFI = .94; CFL = .94; and IFI = .94). Also, a large number of floor and ceiling effects were also observed indicating limitations with capturing respondents' life satisfaction and potential concerns with validity. Limitations related to response patterns are highlighted and recommendations for future research with underrepresented groups and the use of cognitive interviewing are indicated.