The Factor Structure of the Adapted WHO Quality of Life BREF questionnaire in a sample of adolescents in Nigeria

  • Onoja Mathew Akpa
  • Kayode Raphael Fowobaje


The World Health Organization’s Quality of Life Instrument (WHOQOL-BREF) is widely validated and popularly used in assessing perceived quality of life (QOL) of adolescents and the general population. Though the WHOQOL-BREF has been used in some studies in Nigeria, its theoretical structure has not been comprehensively investigated. We examined the psychometric properties and the theoretical structure of the WHOQOL-BREF in a large sample of adolescents in Nigeria. Data on demographic characteristics and QOL were extracted for a total of 1,963 adolescents who participated in a state-wide study on psychosocial functioning and quality of life of adolescents in Benue state, Nigeria. Descriptive statistics were used to describe the distribution of the data while Cronbach’s alpha and Polychoric ordinal alpha were used to describe the internal consistency (reliability) of the adapted WHOQOL-BREF. Structural analysis was performed to extract the underlying factors while confirmatory factor analyses were used to assess some hypothesized structure of the adapted WHO-QOL BREF. Relative chi-square test  value ≤3.0 was regarded a good fit while multiple fit indexes with values ≥0.90 (for acceptable fit) were used for assessing diverse aspects of the models. All analyses were performed at 5% significance level using IBM SPSS statistics version 20, R package and AMOS version 21. Participants were mostly male (54.8%) and 14.71±1.43 years old with 51.0% residing in rural areas. The overall internal consistency of the 4-factor model was 0.862 (for Cronbach’s Alpha) and 0.989 (for Polychoric Alpha) while the 2-factor model had 0.870 (for Cronbach’s Alpha) and 0.990 (for Polychoric Alpha). The the Cattelle’s Scree plot, Horn’s parallel analysis and the confirmatory factor analysis revealed a 2-factor model as the best model for the WHO-QOL BREF. The 23-item 2-factor structure had a relative Chi-square value  with all fit indices within the acceptable range. The adapted WHO QOL BREF can be safely used to assess quality of life among Adolescents in Nigeria and related settings. Using the two factors extracted in the present study may yield better results in settings similar to the present study location


Adeolu Oladayo Akinboro, Suliat Omolola Akinyemi, Peter B. Olaitan, Ajani Adeniyi Raji, Adetoun Adetayo Popoola, Opeyemi Roseline Awoyemi and Olugbenga. (2014). Quality of life of Nigerians living with human immunodeficiency virus. Pan African Medical Journal. 2014; 18:234
Akpa OM, Bamgboye EA and Baiyewu O. (2015). The Adolescents’ Psychosocial Functioning Inventory(APFI): scale development and initial validation using Exploratory and Confirmatory Factor Analysis. Afr J Psychol Study Soc Issues. 2015; 18(1): 1-21.
Arash Mirabzadeh, Monir Baradaran Eftekhari, Ameneh Setareh Forouzan, Homeira Sajadi and Hassan Rafiee (2013). Relationship between ways of coping and quality of life in married women: Toward Mental Health Promotion. Iranian Red Crescent Medical Journal. 2013 August; 15(8): 743-8.
Ayuk AC, Oguonu T, Ikefuna AN and Ibe BC (2013). Health-related quality of life in school-aged children with and without asthma in Enugu, South East Nigeria. Niger J Paed 2013; 40 (4): 364 –369
Berlim MT, Pavanello DP, Caldieraro MA, and Flck MP (2005). Reliability and validity of the WHOQOL BREF in a sample of Brazilian outpatients with major depression. Quality of Life Research, 14, 561–564.
Chien C, Wang J, Yao G, Sheu C and Hsieh C (2007). Development and validation of a WHOQOL-BREF Taiwanese audio player-assited interview version for the elderly who use a spoken dialect. Quality of Life Research, 16, 1375–1381.
Daire Hooper, Joseph Coughlan and Michael R. Mullen (2008). Structural Equation Modelling: Guidelines for determining model fit. Electronic Journal of Business Research Methods Volume 6 Issue 1 2008 (53-60)
David R, Allison L, Leslie S, Julie R, Kathleen S, Kimberlee G, Edward P and Charles L (2004). Psychosocial Factors and Quality of Life in Children and Adolescents with Implantable Cardioverter-Defibrillators. American Journal of Cardiology. 2004;93:582-587
Dejan S, Ivana T and Tanja N (2011). Health-Related Quality of Life in Children and Adolescents with Epilepsy: A Systematic Review, Epilepsy in Children – Clinical and Social Aspects, Dr. Zeljka Petelin Gadze (Ed.), ISBN: 978-953-307-681-2, InTech, Available at
Elizabeth Mousley, Kebede Deribe, Abreham, and Gail Davey (2013). The impact of podoconosis on quality of life in Northern Ethiopia. Health and Quality of Life Outcomes 2013, 11:122
Fairclough DL (2002). Introduction in design and analysis of Quality of Life Studies in Clinical Trials New York: Chapman and Hall/CRC; 2002:4-15.
Fang CT, Hsiung PC, Yu CF, Shen MY and Wang JD (2002). Validation of the Wolrd Health Organization quality of life instrument in patients with HIV infection. Quality of Life Research, 11, 753–762.
Fox, J. (2010). polycor: Polychoric and polyserial correlations. R package version 0.7-8. Retrieved from
Gadermann AM, Guhn M, & Zumbo BD (2012). Estimating ordinal reliability for likert-type and ordinal item response data: a conceptual, empirical, and practical guide. Practical Assessment, Research & Evaluation, 17(3):1–13. Retrieved from
Hair Jr J. F, Anderson R. E, Tatham R. L, & Black W. C. (1998). Multivariate Data Analysis (5th ed). New York: Macmillan Publisher Company. Retrieved from||771Hancock.pdf
Hayton JC, Allen DG and Scarpello V (2004). Factor Retention Decisions in Exploratory Factor Analysis: A Tutorial on Parallel Analysis. Organizational Research Methods, 7, 191-205.
Hengqing T, Shudan L, Yang Y and Yichao P (2010). Analysis of Quality of Life in Cancer Patients by Structural Equation Model. Journal of Cancer Therapy. 2010, 1, 71-75
Izutsu T, Tsutsumi A, Islam MA, Mstsuo Y, Yamada HS, Kurita H, et al. (2005). Validity and reliability of the Bangla version of WHOQOL-BREF on an adolescent population in Bangladesh. Quality of Life Research, 14, 1783–1789.
Jamie DeCoster (1998). Overview of Factor Analysis. Retrieved from
Jude U. Ohaeri, Abdel W Awadalla, Abdul-Hamid M El-Abassi and Anila Jacob (2007). Confirmatory factor analytical study of the WHOQOL-Bref: experience with Sudanese general population and psychiatric samples. BMC Medical Research Methodology 2007, 7:37. Doi:10.1186/147-2288-7-37
Kasturi Agnihotri, Shally Awasthi, Hem Chandra, Uttam Singh and Savitri Thankur (2010). Validation of WHO QOL-BREF Instrument in Indian Adolescents. Indian J Pediatr 2010; 77 (4): 381-386
Ladesma RD and Pedro VM (2007). Determining the number of factors to retain in EFA: An easy-to-use computer program for carrying out parallel analysis. Practical Assessment, Research & Evaluation, 12(2). Available online:
Laura J. Burton and Stephanie M. Mazerolle (2011). Survey instrument validity part 1: Principles of Survey Instrument Development and Validation in Athletic Training Education Research. Athletic Training Education Journal 2011;6(1):27-35.
Maydeu-Olivares, A., Coffman, D. L., and Hartmann, W. M. (2007). Asymptotically distribution free (ADF) interval estimation of coefficient alpha. Psychological Methods, 12, 157-176. doi: 10.1037/1082-989X.12.2.157
Min SK, Kim Ki, Lee CI, Gung YC, Suh SY and Kim DK (2002). Development of the Korean version of WHO Quality of Life scale and WHOQOL-BREF. Quality of Life Research, 11, 593–600.
NBS (2012). National Baseline Youth Survey. NBS Final Report in collaboration with Federal Ministry of Youth Development
Nedjat S, Montazeri A, Holakouie K, Mohammad K and Majdzadeh R (2008). Psychometric properties of the Iranian interview-administered version of the World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF): A population-based study. BMC Health Services Research, 8, 61. doi:10.1186/1472-6963-8-61.
Noerholam V, Groenvold M, Watt T, Bjorner JB, Rasmussen NA and Bech P (2004). Quality of life in the Danish general population-normative data and validity of WHOQOL-BREF using Rasch and item response theory models. Quality of Life Research, 13, 531–540.
O. Aloba, O. Fatoye, B. Mapayi, and S. Akinsulore (2013). A review of quality of life studies in Nigerian patients with psychiatric disorders. Afr J Psychiatry 2013; 16:333-337
O’Connor BP (2000). SPSS and SAS programs for determining the number of components using parallel analysis and Velicer’s MAP test. Behavior Research Methods, Instrumentation, and Computers. 2000; 32:396-402.
Onoja Matthew Akpa and Elijah Afolabi Bamgboye (2015). Correlates of the Quality of life of Adolescents in families affected by HIV/AIDS in Benue State, Nigeria. Vulnerable Child Youth Stud. 2015; 10(3): 225-242. doi: 10.1080/17450128.2015.1066914.
Onyiriuka AN and Ehkator CN (2013). Psycho-social Issues among adolescents with Diabetes Melitus: Experience from Two Nigerian hospitals. Journal of Community Medicine and Primary Health Care,25:31-38.
Osburn, H. G. (2000). Coefficient alpha and related internal consistency reliability coefficients. Psychological Methods, 5, 343-355. doi: 10.1037/1082-989X.5.3.343
Ping X, Ningxiu L, Kit-Tai H, Chaojie L and Yubo L (2012). Quality of life of Chinese urban community residents: a psychometric study of the mainland Chinese version of the WHOQOL-BREF BMC Medical Research Methodology 2012, 12:37 Retrieved from
Pinterits EJ, Poteat VP and Spanierman (2009). The White Privilege Attitude Scale: Development and Initial validation. Journal of Counseling Psycho;ogy. 2009; 56:417-429
Saharnaz Nedjat, Ali Montazeri Kourosh Holakouie, Kazem Mohammad and Reza Majdzadeh, (2008). Psychometric properties of the Iranvian intewrview-administered version of the World Health Organization’s Quality of Life Questionnaire (WHOQOL-BREF): A population-based study. BMC Health Services Research 2008, 8:61 doi:10.1186/1472-6963-8-61

Sik-Yum Lee, Xin-Yuan Song, Suzanne Skevington and Yuan-Tao Hao (2005). Application of Structural Equation Models to Quality of Life. Structural Equation Modeling, Lawrence Erlbaum Associates, Inc. 12(3), 435-453
The World Health Organization Quality of Life group: The World Health Organization Quality of Life assessment (WHOQOL); 1991.Management of substance abuse. Retrieved from
Tiffany Szu-Ting Fu, Yung-Change Tuan, Muh-Yong Yen, Wei-Hsin Wu, Chun-Wei Huang, Wei-Ti Chen, Chiang-Shan R Li and Tony Szu-Hsien Lee (2013). Psychometric properties of the World health Organization quality of life assessment – brief in methadone patients: a validation study in northern Taiwan. Harm reduction Journal 2013, 10:37
Trompenaars FJ, Masthoff ED, Van Heck GL, Hodiamont PP and De Vries J (2005). Content validity, construct validity, and reliability of the WHOQOL-Bref in a population of Dutch adult psychiatric outpatients. Quality of Life Research, 14, 151–160.
Usefy AR, Ghassemi GhR, Sarrafzadegan N, Mallik S, Baghaei AM and Rabiei K (2010). Psychometric Properties of the WHOQOL-BREF in an Iranian Adult Sample. Community Ment Health J (2010) 46:139–147
Ware JE, Snow KK, Kosinski M and Gadek B (1993). SF-36 health survey: Manual and interpretation guide. MA, USA: New England Medical Center.
WHO (2014a). Maternal, new born, child and adolescent health 2014.Adolescents and mental health. Retrieved from
Yao, G., & Wu, C. (2005). Factorial invariance of the WHOQOLBREF among diseases groups. Quality of Life Research, 14, 1881–1888.
Yang Y, & Montgomery D (2011). Exploratory and Confirmatory Factor Analyses of the Multicultural Teaching Scale. Journal of Psychoeducational Assessment; 29:261–272.
Section A (Public Health Research)