WHOQOL Spirituality‚ Religiousness and Personal Beliefs (SRPB)

Overall Quality of Life and General Health
·         How would you rate your overall quality of life? (response scale G) (BREF)
·         How satisfied are you with your quality of life? (E)
·         In general‚ how satisfied are you with your life? (E)
·         How satisfied are you with your health? (E) (BREF)
Domain 1: Physical Health
1. Pain and discomfort
·         How often do you suffer physical pain? (H)
·         Do you worry about your pain or discomfort? (A)
·         How difficult is it for you to handle any pain or discomfort? (B)
·         To what extent do you feel that physical pain prevents you from doing what you need to do? (A) (BREF)
2. Energy and fatigue
·         Do you have enough energy for everyday life? (D) (BREF)
·         How easily do you get tired? (B)
·         How satisfied are you with the energy that you have? (E)
·         How bothered are you by fatigue? (B)
3. Sleep and rest
·         How well do you sleep? (G)
·         Do you have any difficulties with sleeping? (A)
·         How satisfied are you with your sleep? (E) (BREF)
·         How much do any sleep problems worry you? (A)
Domain 2: Psychological
4. Positive feelings
·         How much do you enjoy life? (A) (BREF)
·         Do you generally feel content? (H)
·         How positive do you feel about the future? (B)
·         How much do you experience positive feelings in your life? (A)
5. Thinking‚ learning‚ memory and concentration
·         How would you rate your memory? (G)
·         How satisfied are you with your ability to learn new information? (E)
·         How well are you able to concentrate? (A) (BREF)
·         How satisfied are you with your ability to make decisions? (E)
6. Self-esteem
·         How much do you value yourself? (A)
·         How much confidence do you have in yourself? (A)
·         How satisfied are you with yourself? (E) (BREF)
·         How satisfied are you with your abilities? (E)
7. Bodily image and appearance
·         Are you able to accept your bodily appearance? (D) (BREF)
·         Do you feel inhibited by your looks? (B)
·         Is there any part of your appearance that makes you feel uncomfortable? (A)
·         How satisfied are you with the way your body looks?
8. Negative feelings
·         How often do you have negative feelings‚ such as blue mood‚ despair‚ anxiety‚ depression? (H) (BREF)
·         How worried do you feel? (B)
·         How much do any feelings of sadness or depression interfere with your everyday functioning? (A)
·         How much do any feelings of depression bother you? (A)
Domain 3: Level of Independence
9. Mobility
·         How well are you able to get around? (G) (BREF)
·         How satisfied are you with your ability to move around? (A)
·         How much do any difficulties in mobility bother you? (A)
·         To what extent do any difficulties in movement affect your way of life? (A)
10. Activities of daily living
·         To what extent are you able to carry out your daily activities? (D)
·         To what extent do you have difficulty in performing your routine activities? (A)
·         How satisfied are you with your ability to perform your daily living activities? (E) (BREF)
·         How much are you bothered by any limitations in performing your everyday living activities? (A)
11. Dependence on medication or treatment
·         How dependent are you on medications? (D)
·         How much do you need any medication to function in your daily life? (A)
·         How much do you need any medical treatment to function in your daily life? (A) (BREF)
·         To what extent does your quality of life depend on the use of medical substances or medical aids? (A)
12. Working capacity
·         Are you able to work? (D)
·         Do you feel able to carry out your duties? (D)
·         How would you rate your ability to work? (G)
·         How satisfied are you with your capacity for work? (E) (BREF)
Domain 4: Social Relations
13. Personal relationships
·         How alone do you feel in your life? (B)
·         Do you feel happy about your relationship with your family members? (F)
·         How satisfied are you with your personal relationships? (E) (BREF)
·         How satisfied are you with your ability to provide for or support others? (E)
14. Social support
·         Do you get the kind of support from others that you need? (D)
·         To what extent can you count on your friends when you need them? (D)
·         How satisfied are you with the support you get from your family? (E)
·         How satisfied are you with the support you get from your friends? (E) (BREF)
15. Sexual activity
·         How would you rate your sex life? (G)
·         How well are your sexual needs fulfilled? (B)
·         How satisfied are you with your sex life? (E) (BREF)
·         Are you bothered by any difficulties in your sex life? (B)
Domain 5: Environment
16. Physical safety and security
·         How safe do you feel in your daily life? (B) (BREF)
·         Do you feel you are living in a safe and secure environment? (B)
·         How much do you worry about your safety and security? (A)
·         How satisfied are you with your physical safety and security? (E)
17. Home environment
·         How comfortable is the place where you live? (A)
·         To what extent does the quality of your home meet your needs? (D)
·         How satisfied are you with the conditions of your living place? (E) (BREF)
·         How much do you like it where you live? (A)
18. Financial resources
·         Have you enough money to meet your needs? (D) (BREF)
·         Do you have financial difficulties? (A)
·         How satisfied are you with your financial situation? (E)
·         How much do you worry about money? (A)
19. Health and social care: availability and quality
·         How easily are you able to get good medical care? (B)
·         How would you rate the quality of social services available to you? (G)
·         How satisfied are you with your access to health services? (E) (BREF)
·         How satisfied are you with the social care services? (E)
20. Opportunities for acquiring new information and skills
·         How available to you is the information you need in your day-to-day life? (D) (BREF)
·         To what extent do you have opportunities for acquiring the information that you feel you need? (D)
·         How satisfied are you with your opportunities for acquiring skills? (E)
·         How satisfied are you with your opportunities to learn new information? (E)
21. Participation in and new opportunities for recreation/leisure
·         To what extent do you have the opportunity for leisure activities? (D) (BREF)
·         How much are you able to relax and enjoy yourself? (D)
·         How much do you enjoy your free time? (A)
·         How satisfied are you with the way you spend your spare time? (E)
22. Physical environment (pollution/noise/traffic/climate)
·         How healthy is your physical environment? (B) (BREF)
·         How concerned are you with the noise in the area you live in? (A)
·         How satisfied are you with your physical environment (e.g.‚ pollution‚ climate‚ noise‚ attractiveness)? (E)
·         How satisfied are you with the climate of the place where you live? (E)
23. Transport
·         To what extent do you have adequate means of transport? (D)
·         To what extent do you have problems with transport? (A)
·         How satisfied are you with your transport? (E) (BREF)
·         How much do difficulties with transport restrict your life? (A)
Domain 6: Spirituality/Religion/Personal beliefs
24. Spiritual
·         Do your personal beliefs give meaning to your life? (A)
·         To what extent do you feel your life to be meaningful? (A) (BREF)
·         To what extent do your personal beliefs give you the strength to face difficulties? (A)
·         To what extent do your personal beliefs help you to understand difficulties in life? (A)
 
1.    To what extent does any connection to a spiritual being help you to get through hard times? (A)
2.    To what extent does any connection to a spiritual being help you to tolerate stress? (A)
3.    To what extent does any connection to a spiritual being help you to understand others? (A)
4.    To what extent does any connection to a spiritual being provide you with comfort /reassurance? (A)
5.    To what extent do you find meaning in life? (A)
6.    To what extent does taking care of other people provide meaning of life for you? (A)
7.    To what extent do you feel your life has a purpose? (A)
8.    To what extent do you feel you are here for a reason? (A)
9.    To what extent do you feel inner spiritual strength? (A)
10.To what extent can you find spiritual strength in difficult times? (A)
11.To what extent does faith contribute to your well-being? (A)
12.To what extent does faith give you comfort in daily life? (A)
13.To what extent does faith give you strength in daily life? (A)
14.To what extent do you feel spiritually touched by beauty? (B)
15.To what extent do you have feelings of inspiration / excitement in your life? (B)
16.To what extent are you grateful for the things in nature that you can enjoy? (B)
17.How hopeful do you feel? (B)
18.To what extent are you hopeful about your life? (B)
19.To what extent are you able to experience awe from your surroundings? (e.g. nature‚ art‚ music) (D)
20.To what extent do you feel any connection between your mind‚ body and soul? (D)
21.To what extent do you feel the way you live is consistent with what you feel and think? (D)
22.How much do your beliefs help you to cr‎eate coherence between what you do‚ think and feel? (D)
23.How much does spiritual strength help you to live better? (D)
24.To what extent does your spiritual strength help you to feel happy in life? (D)
25.To what extent do you feel peaceful within yourself? (D)
26.To what extent do you have inner peace? (D)
27.How much are you able to feel peaceful when you need to? (D)
28.To what extent do you feel a sense of harmony in your life? (D)
29.To what extent does being optimistic improve your quality of life? (D)
30.How able are you to remain optimistic in times of uncertainty? (D)
31.To what extent does faith help you to enjoy life? (D)
32.How satisfied are you that you have a balance between mind‚ body and soul? (E)
What is your gender? Male/ Female
What is your date of birth? ________/__________/_____
What is highest education you received? Primary school/ Secondary school/ University/Post-graduate
What is your marital status? Single/ Married/ Living as married/ Separated/ Divorced/ Widowed
How is your health? (G)
Are you currently ill?
If yes‚ what is your diagnosis? ___________________________
What health problems do you have at the moment? (TICK NEXT TO THOSE THAT APPLY TO YOU)
·         Heart trouble
·         High blood pressure
·         Arthritis or Rheumatism
·         Cancer
·         Emphysema or chronic bronchitis
·         Diabetes
·         A cataract
·         Stroke
·         Broken or fractured bone
·         Chronic nervous or emotional problems
·         Chronic foot trouble (bun‎ions‚ ingrown toenails)
·         Rectal growth or rectal bleeding
·         Parkinson’s disease
·         Other (please describe)
To what extent do you consider yourself to be a religious person? (B)
To what extent do you consider yourself to be part of a religious community? (D)
If so‚ which religious community are you a part of?
To what extent do you have spiritual beliefs? (B)
To what extent do you have strong personal beliefs? (B) 
S1 *Spiritual Connection
S2 *Meaning & Purpose In Life
S3 *Experiences of Awe & Wonder
S4 *Wholeness & Integration
S5 *Spiritual Strength
S6 *Inner Peace
S7 *Hope & Optimsim
S8 *Faith
A.    1 Not at all; 2 A little; 3 A moderate amount; 4 Very much; 5 An extreme amount
B.    1 Not at all; 2 Slightly; 3 Moderately; 4 Very; 5 Extremely
C.    1 Not at all; 2 Slightly; 3 Moderately; 4 Very well; 5 Extremely
D.   1 Not at all; 2 A little; 3 Moderately; 4 Mostly; 5 Completely
E.    1 Very dissatisfied; 2 Dissatisfied; 3 Neither satisfied nor dissatisfied; 4 Satisfied; 5 very satisfied
F.    1 Very unhappy; 2 Unhappy; 3 Neither happy nor unhappy; 4 Happy; 5 Very happy
G.   1 Very poor; 2 Poor; 3 Neither poor nor good; 4 Good; 5 Very good
H.   1 Never; 2 Seldom; 3 Quite often; 4 Very often; 5 Always
 

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Bonomi‚ A.E.‚ Patrick‚ D.L.‚ Bushnell‚ D.M.‚ et al. (2000). Validation of the United States’ version of the World Health Organization Quality of Life (WHOQOL) instrument. J Clin Epidemiol 2000;53:1–12.

WHOQOL Group. (1998). Development of the World Health Organization WHOQOLBREF quality of life assessment. Psychol Med‚ 28:551–558.

McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS

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