Adequacy of the WHOQoL-BREF to Assess the Quality of Life of Victims of Armed Conflicts

There is a deterioration in the quality of life (QoL) of survivor victims of warlike conflicts. Because there is a need to guarantee the effectiveness of assessment tools for these populations, we studied the adequacy of the World Health Organization Quality of Life Questionnaire (WHOQoL-BREF) to assess the QoL of 1,136 surviving victims of the armed conflict in Colombia. Although this questionnaire has yielded promising results, questions remain about its psychometric suitability for specific populations. We used model modification at the item level, comparisons of models with different factor structures, and dimensionality analysis to address the psychometric problems encountered. Dimensionality analysis using a bifactor model suggests that WHOQoL-BREF total scores might be a more appropriate way of reporting results when model fit adequacy is not reached. Conclusions are offered on the psychometric properties of the WHOQoL-BREF, the evaluation of special populations, and possible strategies to address future questionnaire modifications.