WHO defines Quality of Life as an individual's perception 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.

1. Health Related Quality of
Life (HRQoL)
VISHWANATH GOUDA
1ST M. PHARM
DEPARTMENT OF PHARMACY PRACTICE,
NGSMIPS, NITTE (DEEMED TO BE UNIVERSITY)

2. Health
 A state of complete physical, mental, and
social well-being not merely the absence of
disease
World health organization. Health statistics and information systems, Introducing the WHOQOL instruments.[cited 19 feb 2018]. Available from
http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

3. Quality of Life
 Quality of life (QOL) is the general well-being of individuals and
societies, outlining negative and positive features of life
 It observes life satisfaction, including everything from
Physical
health Family Education Employment Wealth
Religious
beliefs
Environment
Barcaccia, Barbara. Quality Of Life: Everyone Wants It, But What Is It?"Forbes/ Education.[ updated 2013 Sep 4; cited 2018 Feb 18]. Available from
https://www.forbes.com/sites/iese/2013/09/04/quality-of-life-everyone-wants-it-but-what-is-it/#6029d09c635d

4. QOL
 WHO defines Quality of Life as an individual's
perception 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
World health organization. Health statistics and information systems, Introducing the WHOQOL instruments.[cited 19 feb 2018]. Available from
http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

5. Quality of Life
 QOL has a wide range of contexts, including the fields of
International development,
Healthcare,
Politics and employment.
 It is important not to mix up the concept of QOL with a more recent
growing area of health related QOL (HRQOL).
Bottomley, Andrew (2002). "The Cancer Patient and Quality of Life“. The Oncologist. 7 (2): 120–125.

6. What is health-related quality of life?
 The concept have evolved since the 1980s
 To encompass the aspects of overall quality of life that can be
clearly shown to affect health - either physical or mental at levels of
On the individual level
 Includes physical and mental health perceptions (e.g., Energy level, mood) correlating with
 Health risks and conditions, functional status, social support, and socioeconomic status
 At the community level
 Community-level resources, conditions, policies, and practices that influence a population’s health
perceptions and functional status

7. HRQoL
 Its part of a person’s overall quality of life that “
represents the functional effect of an illness and its
consequent therapy upon a patient, as perceived by
the patient .
Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p132

8. Quality of life and health related quality of life – is
there a difference?
 Quality of life and HRQoL are used interchangeably in the literature but
each has its own meaning.
 QoL is a broader concept which covers all aspects of life
 HRQoL has a focus on the effects of illness and specifically on the impact
treatment may have on QoL
 QoL is therefore broader than HRQoL because it includes evaluation of
non-health related features of life whereas HRQoL is connected to an
individual’s health or disease status
 HRQoL can help us understand the distinction between aspects of life
related to health.
 QoL can help us understand those aspects of life that extend beyond
health such as education and the social environment

9. The importance of HRQoL
 Detect undiagnosed or undetected diseases such as depression
 Over all impact of diseases and their treatment
 Represent a patient’s estimation of his/her own health at a point
 To determine the burden of
 preventable disease,
 injuries, and disabilities,
 Can provide valuable new insights into the relationships between HRQoL and
risk factors.
Centers for disease control and prevention[internet]. Health related quality of life. [updated 2016 May 31; cited 2018 Feb 19]. Available from:
https://www.cdc.gov/hrqol/concept.htm

10. Figure1. Deshpande PR, et al., Patient-reported outcomes: A new era in clinical research. Perspective in clinical research

11. Difference Between Symptoms
And Health Related Quality of
Life
one-dimensional
property
directly related
to disease and
treatment effect
symptoms
multidimensional
indirect relation
HRQoL
Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new era in clinical research. Perspect Clin Res 2011;2(4):137-44

12. HRQoL
Measures
General
Medical
outcome
study short
form
survey
(MOS-SF)
Quality of
well-being
(QWB)
Sickness
impact
profile (SIP)
Dartmouth
COOP
WHOQOL-
100
Disease
specific
Arthritis
impact
measureme
nt
scale(AIMS)
Diabetes
quality of
life(DQOL)
Kidney
disease
quality of
life
Raskati KL. Essential of Pharmacoeconomics. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p134
World health organization. Health statistics and information systems, Introducing the WHOQOL instruments.[cited 19
feb 2018]. Available from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

13. Generic measures
• Aim to cover the complete spectrum of function, disability
and distress of the patient.
• Applicable to variety of populations.
• Measures HRQoL among various general groups.
Revikumar GK. Pharmacoepidemiology and pharmacoeconomic. Hyderabad: Pharma med press; .p282

14. Medical outcome study short Form survey
(MOS-SF)
 Is a multipurpose survey of general or generic health status
 SF-36
 Useful in comparisons of relative burden of different diseases
 Useful in estimating the relative benefits of different treatment.
 The SF-36 assesses health-related quality of life in 8 areas: 1) limitations in
physical activities because of health problems; 2) limitations in social activities
because of physical or emotional problems; 3) limitations in usual role activities
because of physical health problems; 4) bodily pain; 5) general mental health; 6)
limitations in usual role activities because of emotional problems; 7) vitality
(energy and fatigue); and 8) general health perceptions.
 SF-12
Raskati KL. Essential of Pharmacoeconomics. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p135

15. Psychological General Well-Being
Index (PGWBI)
 Used in clinical trials and epidemiological research to provide a general
evaluation of self-perceived psychological health and well-being
 Consists of 22 items
Grossi E, Groth N, Mosconi P, et al. Development and validation of the short version of the Psychological General Well-Being Index (PGWB-S).
Health and Quality of Life Outcomes. 2006;4:88

16. WHOQOL-100
 The structure of the WHOQOL-100 reflects the issues that a group of
scientific experts as well as lay people in each of the field centres felt were
important to quality of life.
 A total of 100 items in the assessment. All items are rated on a five point
scale (1-5)
 WHOQOL includes the six broad domains of quality of life:
 1. Physical Health
 Energy and fatigue
 Pain and discomfort
 Sleep and rest
World health organization. Health statistics and information systems, Introducing the WHOQOL instruments.[cited 19 feb 2018]. Available
from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

17. 2. Psychological
 Bodily image and appearance
 Negative feelings
 Positive feelings
 Self-esteem
 Thinking, learning, memory and concentration
3. Level of Independence
 Mobility
 Activities of daily living
 Dependence on medicinal substances and medical aids
 Work capacity
4. Social Relations
 Personal relationships
 Social support
 Sexual activity
World health organization. Health statistics and information systems, Introducing the WHOQOL instruments.[cited 19 feb 2018]. Available
from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

18. 5. Environment
 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
 Physical environment (pollution/noise/traffic/climate)
 Transport
6. Spirituality/Religion/Personal beliefs
 Religion/Spirituality/Personal beliefs
World health organization. Health statistics and information systems, Introducing the WHOQOL instruments.[cited 19 feb 2018]. Available
from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

19. Disease specific instrument
 Provides greater detail concerning particular outcomes in term of
functioning and well being associated with a disease condition and its
treatment
 It covers specific disease, specific population or specific function.
Revikumar GK. Pharmacoepidemiology and pharmacoeconomic. Hyderabad: Pharma med press;2016 .p284

21. Other types of instruments
 Dimension specific e.g. Physical Activity Index (PAI)
 Region/site specific e.g. Cambridge Pulmonary Hypertension Outcome
Review (CAMPHOR)
 Individualized (instruments in which the respondent is allowed to select
issues, concerns or domains of personal concern that are not
predetermined by the investigator's list of questionnaire items) e.g.
Schedule for the Evaluation of Individual Quality of Life (SEIQoL)
 Utility measures (considered as generic type but with one particular form
of numerical evaluation of healthiness) e.g. Utility measure for major,
unipolar depression (McSad)
 Summary items e.g. questions (regarding limiting enduring illness) in
General Household Survey
Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new era in clinical research. Perspect Clin Res
2011;2(4):137-44

22. Domains of health status
 Four essential domains should be included in all HRQoL instruments:
 Physical functioning
 Psychological functioning
 Social functioning
 General health perception
Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p136-138

23. Ideal Properties of HRQoL Instruments
 It should be specific to the concept being measured..
 It should contain optimum number of items.
 It should have easy and specific measurement properties i.e. use of the
scales which is easiest for the intended population to understand.
 It should maintain the confidentiality of the patient.
 It should be reproducible
Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new era in clinical research. Perspect Clin Res
2011;2(4):137-44

24. Factors affecting health related quality
of life
Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new era in clinical research. Perspect Clin Res
2011;2(4):137-44

25. Assessing HRQoL Insruments
Psychometric properties :
 Reliability
 Validity
 Responsiveness
Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p138-140

26. Reliability
 Refer to the consistency of an instrument.
 Does the instrument produce the same score on multiple
administration?
 Test-retest
 Internal consistency
 Interrater reliability
Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p138-140

27. validity
 Refer to the extent to which differences in patient scores reflect the
differences among individuals that the test developer sought to measure
 Purpose: whether the instrument is actually measuring what it is supposed
to be measuring.
 For an instrument to be valid, it must first be reliable
 If researchers do not get reliable results upon readministration, they
cannot assess whether these results actually measure the underlying
concept
 Content validity
 Criterion validity
 Construct validity
Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p138-140

28. Responsiveness
 Refer to its ability to detect changes in health status
 For instance if there is an instrument which is determining the quality of
life of breast cancer patient, then it should be able to predict the quality of
life after the treatment. The quality of life score should be able to predict
the improvement/stability in condition/worsening
Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer Health;2013. p138-140
Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new era in clinical research. Perspect Clin Res
2011;2(4):137-44

29. Uses of HRQoL Measurement
 In medical practice
 Improving the doctor-patient relationship
 Assessing the effectiveness and relative merits of different treatments
 Health services evaluation
 In research
 In policy making
World health organization. The uses of the WHOQOL instruments .[cited 19 feb 2018]. Available from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/index3.html

30. Thank you

31. List of references
1. Raskati KL. Essential of Pharmacoeconomic. 2nd edition. Philadelphia: Wolters Kluwer
Health;2013. p131-140
2. Revikumar GK. Pharmacoepidemiology and pharmacoeconomic. Hyderabad: Pharma med
press;2016 .p279-287
3. Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new
era in clinical research. Perspect Clin Res 2011;2(4):137-44
4. Grossi E, Groth N, Mosconi P, et al. Development and validation of the short version of the
Psychological General Well-Being Index (PGWB-S). Health and Quality of Life Outcomes.
2006;4:88
5. Bottomley, Andrew (2002). "The Cancer Patient and Quality of Life“. The Oncologist. 7 (2):
120–125
6. Deshpande PR, Rajan S, Sudeepthi B L, Abdul Nazir C P. Patient-reported outcomes: A new
era in clinical research. Perspect Clin Res 2011;2(4):137-44
7. World health organization. Health statistics and information systems, Introducing the
WHOQOL instruments.[cited 19 feb 2018]. Available from
http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/

32. 8. World health organization. The uses of the WHOQOL instruments .[cited 19 feb 2018]. Available
from http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/index3.html
9. Centers for disease control and prevention[internet]. Health related quality of life. [updated
2016 May 31; cited 2018 Feb 19]. Available from: https://www.cdc.gov/hrqol/concept.htm
10. World health organization. Health statistics and information systems, Introducing the
WHOQOL instruments.[cited 19 feb 2018]. Available from
http://www.who.int/healthinfo/survey/whoqol-qualityoflife/en/
11. Barcaccia, Barbara. Quality Of Life: Everyone Wants It, But What Is It?"Forbes/ Education.[
updated 2013 Sep 4; cited 2018 Feb 18]. Available from
https://www.forbes.com/sites/iese/2013/09/04/quality-of-life-everyone-wants-it-but-what-is-
it/#6029d09c635d