How to Fill Out and Score the WHOQOL-BREF Quality of Life Assessment

To fill out and score the WHOQOL-BREF, answer all 26 items on the 1-to-5 scale based on your experience over the previous two weeks, reverse-score questions 3, 4, and 26, add the item values within each of the four domains, and then transform each raw domain total to a 0–100 scale.¹ The whole process takes about 10 to 15 minutes to complete and a few more minutes to score.²

Before You Start

Download the questionnaire and scoring instructions from the WHO tools page at who.int/tools/whoqol/whoqol-bref.³ For the U.S. English version, WHO points users to the Seattle Quality of Life Group at the University of Washington, which maintains the American English adaptation.⁴

If you plan to use the form in a formal study or clinical program, WHO asks you to complete a brief online permission form through its copyright licensing page first. The form is free for non-commercial use, and WHO does not charge licensing fees for that use.

Every answer should reflect the previous two weeks, not a lifetime average or how you feel today.⁵ Keep that window in mind before you begin.

Filling Out the 26 Items

Self-administration is the recommended approach when the respondent can read and mark answers independently.² For older adults or anyone who has difficulty reading or writing, an interviewer-assisted format works. In that mode, the interviewer reads each question aloud and records the chosen answer without interpreting or paraphrasing.

Every item uses a five-point scale scored from 1 to 5, but the labels differ by question type.² Some items ask about intensity (“not at all” through “an extreme amount”), some about capacity (“not at all” through “completely”), and some about satisfaction (“very dissatisfied” through “very satisfied”). Pick the option that best matches your experience.

Answer every question. There are no right or wrong responses, and no outside verification is involved. If a question feels uncomfortable, choose whichever option comes closest to your experience rather than skipping it. Missing answers directly affect whether a domain score can be computed, and in two of the four domains a single blank invalidates the entire domain.

Which Items Belong to Which Domain

The 26 items split into four scored domains plus two standalone questions. Questions 1 and 2 rate overall quality of life and general health satisfaction and are examined individually, not folded into a domain total.

Physical Health (7 items): questions 3, 4, 10, 15, 16, 17, and 18. Covers energy, sleep, mobility, work and daily tasks, and interference from pain or medical treatment.¹
Psychological Well-Being (6 items): questions 5, 6, 7, 11, 19, and 26. Covers enjoyment and meaning, concentration, body image, self-satisfaction, and negative feelings.¹
Social Relationships (3 items): questions 20, 21, and 22. Covers satisfaction with personal relationships, sexual activity, and support from friends.¹
Environment (8 items): questions 8, 9, 12, 13, 14, 23, 24, and 25. Covers safety, healthiness of surroundings, finances, information and leisure, housing, health services, and transportation.¹

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Reverse-Score Questions 3, 4, and 26

Three items are phrased so that a higher answer means worse quality of life, the opposite of every other item on the form.¹ Before you add anything up, convert the responses to questions 3, 4, and 26 as follows: 1 becomes 5, 2 becomes 4, 3 stays 3, 4 becomes 2, and 5 becomes 1. Skipping this step is the most common scoring error and will distort the Physical Health and Psychological domains.

Add Up Each Domain

Once the three items are reversed, sum the item values within each domain. Physical Health sums seven items and produces a raw score that can range from 7 to 35. Psychological sums six items (range 6 to 30). Social Relationships sums three items (range 3 to 15). Environment sums eight items (range 8 to 40).

Transform Raw Scores to the 0–100 Scale

Convert each raw domain sum to a 0–100 scale with a straightforward calculation: subtract the lowest possible raw score from the actual raw score, divide by the possible raw score range, and multiply by 100.¹ The transformed number is the percentage of the total possible score achieved in that domain. A 0 means the lowest possible quality of life in that area; 100 means the highest. Using the same scale for every domain makes it easy to compare domains or track one domain over time.

Handling Missing Answers

The rules for missing responses are stricter than many users expect, and they vary by domain.¹

For the Physical Health and Environment domains, you can still compute a score if no more than one item is missing. Substitute the respondent’s average across the remaining completed items in that domain for the missing value. If two or more items are missing from either of those domains, do not calculate a domain score.

The Psychological and Social Relationships domains are less forgiving. If any item is missing from either one, the domain score is invalid. Social Relationships is especially vulnerable because it only contains three questions, so a single blank wipes out the whole domain.

Reading the Scores

The WHOQOL-BREF has no fixed clinical cutoffs that label someone as “healthy” or “impaired.” Higher transformed scores consistently indicate better perceived quality of life, and interpretation runs on comparison rather than absolute thresholds.

The most common use is to compare the four domain scores against each other to identify relative strengths and weaknesses. A respondent who scores 85 in Environment but 40 in Social Relationships has a clear imbalance pointing toward a specific area for attention. Comparing scores over time, such as before and after a treatment program, is another core use. Where population norms are available, they let you rank an individual’s score as a percentile against a reference group. Some clinicians treat scores below the 30th percentile in any domain as a signal that further clinical attention is warranted.

Keeping Responses Private

WHOQOL-BREF answers cover finances, sexual satisfaction, and mental health, and they qualify as sensitive health information. In the United States, any healthcare provider, health plan, or clearinghouse that handles these responses electronically is subject to the security and privacy requirements of the Health Insurance Portability and Accountability Act.⁶ That means encrypted storage, limited access, and audit trails. Researchers collecting responses outside a covered healthcare entity typically need institutional review board approval, which brings its own data-handling standards.

1
University of Washington. WHOQOL-BREF Quality of Life Assessment Form
2
Shirley Ryan AbilityLab. WHO Quality of Life-BREF (WHOQOL-BREF)
3
The World Health Organization. WHOQOL-BREF
4
The World Health Organization. The World Health Organization Quality of Life (WHOQOL)
5
Seattle Quality of Life Group. World Health Organization Quality of Life Instruments (WHOQOL-BREF)
6
U.S. Department of Health and Human Services. Summary of the HIPAA Security Rule