title: Development, reliability and validity of the Chichewa WHOQOL-BREF in adults in Lilongwe, Malawi.
abstract: BACKGROUND
  Quality of life measurement is a useful addition to measurement of health outcomes in evaluation of the benefits of many health and welfare interventions. The WHOQOL-BREF measures quality of life from a broad multi-dimensional perspective but was not used in Malawi. The objective of this study was to translate the WHOQOL-BREF questionnaire into the main local language of Malawi: Chichewa; and to validate it quantitatively with respect to internal consistency, domain structure, and discriminant validity for this context.
  
  
  METHODS
  WHO-mandated guidelines were followed for translation, adaptation, pre-testing (focus groups), piloting (patient interviews) and data coding. Analyses using descriptive statistics, correlation and regression were undertaken to investigate the validity of the WHOQOL-BREF in the ways described above. Additional regression analyses examined the impact of socio-demographic variables on the domain scores.
  
  
  RESULTS
  309 respondents completed the questionnaire (with >98% response rates for all questions except Q21 (sex life)). 259 were sick with a variety of health problems, and 50 were considered healthy. All domains showed adequate internal consistency (Cronbach's alpha > =0.7) with all item scores also most highly correlated with the scores of their assigned domain. All domain scores varied by health problem, and more depressed respondents had significantly lower scores in all domains than those less depressed. Domain scores and their associations with socio-demographic variables are presented and discussed.
  
  
  CONCLUSIONS
  This study demonstrates that the new Chichewa WHOQOL-BREF questionnaire is acceptable and comprehensible to respondents in Malawi. The questionnaire also passed a number of tests of the validity of its psychometric properties. In the pilot population we found that older age was associated with lower Physical domain scores. Conversely, higher levels of educational attainment were found to be associated with higher quality of life in all domains except for Social Relationships. Respondents living as married or single were found to have higher quality of life in the Physical, Psychological and Social domains, and those who were widowed lower Physical quality of life.
authors: Parent and Child Health Initiative (PACHI), Amina House (top floor, Entrance 3), Paul Kagame Road roundabout, P.O. Box 31686, Lilongwe 3, Malawi. t.colbourn@ucl.ac.uk
authors: Tim
authors: T
authors: Colbourn
authors: Gibson
authors: G
authors: Masache
authors: Jolene
authors: J
authors: Skordis-Worrall
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016002:Discriminant Analysis; D004522:Educational Status; D004777:Environment; D005260:Female; D006304:Health Status; D006801:Humans; D007398:Interpersonal Relations; D007802:Language; D008295:Malawi; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011788:Quality of Life; D012044:Regression Analysis; D015203:Reproducibility of Results; D012919:Social Behavior; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D014175:Translating; D055815:Young Adult