WHO Quality of Life Scale

Questions refer to the last two weeks.
1.    How would you rate your quality of life?
(1) Very poor; (2) Poor; (3) Neither poor nor good; (4) Good; (5) Very good
2.    How satisfied are you with your health?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied
The following questions ask about how much you have experienced certain things in the last two weeks.
3.    To what extent do you feel that physical pain prevents you from doing what you need to do?
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
4.    How much are you bothered by any physical problems related to your HIV infection?
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
5.    How much do you need any medical treatment to function in your daily life?
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
6.    How much do you enjoy life?
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
7.    To what extent do you feel your life to be meaningful?
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
8.    To what extent are you bothered by people blaming you for your HIV status
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
9.    How much do you fear the future?
(1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
10. How much do you worry about death? (1) Not at all; (2) A little; (3) A moderate amount; (4) Very much; (5) An extreme amount
11. How well are you able to concentrate?
(1) Not at all‚ (2) A little‚ (3) A moderate amount‚ (4) Very much‚ (5) Extremely
12. How safe do you feel in your daily life?
(1) Not at all‚ (2) A little‚ (3) A moderate amount‚ (4) Very much‚ (5) Extremely
13.How healthy is your physical environment?
(1) Not at all‚ (2) A little‚ (3) A moderate amount‚ (4) Very much‚ (5) Extremely
The following questions ask about how completely you experience or were able to do certain things in the last two weeks.
14.Do you have enough energy for everyday life?
(1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
15.Are you able to accept your bodily appearance?
(1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
16.Have you enough money to meet your needs?
(1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
17.To what extent do you feel accepted by the people you know?
(1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
18.How available to you is the information that you need in your day-to-day life?
(1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
19. To what extent do you have the opportunity for leisure activities?
(1) Not at all; (2) A little; (3) Moderately; (4) Mostly; (5) Completely
20.How well are you able to get around?
(1) Very poor; (2) Poor; (3) Neither poor nor good; (4) Good; (5) Very good
The following questions ask you how good or satisfied you have felt about various aspects of your life over the last two weeks.
21.How satisfied are you with your sleep?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
22.How satisfied are you with your ability to perform your daily living activities?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
23.How satisfied are you with your capacity for work?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
24.How satisfied are you with yourself?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
25.How satisfied are you with your personal relationships?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
26.How satisfied are you with your sex life?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
27.How satisfied are you with the support you get from your friends?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
28.How satisfied are you with the conditions of your living place?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
29.How satisfied are you with your access to health services?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
30.How satisfied are you with your transport?
(1) Very dissatisfied; (2) Dissatisfied; (3) Neither satisfied nor dissatisfied; (4) Satisfied; (5) very satisfied dissatisfied
The following question refers to how often you have felt or experienced certain things in the last two weeks.
31.How often do you have negative feelings such as blue mood‚ despair‚ anxiety‚ depression?
(1) Never; (2) Seldom; (3) Quite often‚ (4) Very often; (5)Always
Did someone help you to fill out this form?
How long did it take to fill this form out?
Do you have any comments about the assessment?
 
Domain I: Physical (Pain and discomfort‚ Energy and fatigue‚ Sleep and rest‚ Symptoms of PLWHA*)
Domain II: Psychological (Positive feelings‚ Thinking‚ learning‚ memory and concentration‚ Self-esteem‚ Bodily image and appearance‚ Negative feelings)
Domain III: Level of Independence (Mobility‚ Activities of daily living‚ Dependence on medication or treatments‚ Work capacity)
Domain IV: Social Relationships (Personal relationships‚ Social support‚ Sexual activity‚ 51 Social Inclusion)
Domain V: Environment (Physical safety and security‚ Home environment‚ Financial resources‚ Health and social care: accessibility and quality‚ Opportunities for acquiring new information and skills‚ Participation in and opportunities for recreation/ leisure activities‚ Physical environment (pollution/noise/traffic/climate)‚ Transport)
Domain VI: Spirituality/Religion/ Personal Beliefs (SRPB‚ Forgiveness and Blame‚ Concerns about the Future‚ Death and Dying)
Overall quality of life and general health perceptions
*PLWHA- the Persons Living with HIV/AIDS
 
 Domain 1: (6-Q3) + (6-Q4) + Q14 + Q21
Domain 2: Q6 + Q11 + Q15 + Q24 + (6-Q31)
Domain 3: (6-Q5) + Q20 + Q22 + Q23
Domain 4: Q17 + Q25 + Q26 + Q27
Domain 5: Q12 + Q13 + Q16 + Q18 + Q19 + Q28 + Q29 + Q30
Domain 6: Q7 + (6–Q8) + (6-Q9) + (6-Q10)
 
 

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