Scientific Online Resource System

Scripta Scientifica Salutis Publicae

Conceptual and methodological approaches to quality of life - a public health perspective

Desislava Vankova


Quality of life is a major goal in the context of public health. It is important, both as a needs assessment tool and as an outcome measure in health promotion interventions. QoL has been frequently measured but seldom explicitly defined. The aim of this article is to discuss a wide range of conceptual and methodological issues related to QoL. The classical Being-Belonging-Becoming approach is presented. Further, the methodology for QoL assessment covers a wide range of topics. It involves the taxonomy of QoL definitions, a classification of QoL instruments, and recommendations how to choose the right questionnaire with the relevant psychometric properties. There is a need for more research based on carefully selected measures of QoL chosen as being of particular importance to individuals and to the hypotheses being tested. Measuring health rather than disease is a methodological challenge which has recently received more attention and should be further explored in target-setting exercises at a community level.


quality of life; health; concept; methodology

Full Text


Pais-Ribeiro JL. Quality of life is a primary end-point in clinical settings. Clinical Nutrition. 2004;23:121-130.

Rosenberg R. Health-related quality of life between naturalism and hermeneutics. Social Science & Medicine;1995;41:1411-15.

Wilson W. Correlates and avowed Subjective well-being. Psychological Bulletin. 1967;67.

Andrews FM, Withey SB. Developing Measures of perceived life quality: results from several national surveys. Social Indicators Research. 1974;1:1-26.

Ryff DC. Subjective well-being is everything, or is it? Exploration on the meaning of psychological well-being. Journal of Personality and Social Psychology. 1989;57(6):1069-81.

Katschnig H. How useful is the concept of quality of life in psychiatry? In H Katschnig, H Freeman, N Sartorius. Quality of life in mental disorders, Chichester, England, John Wiley & Sons, 1994, pp. 3-16 in Coelho R, Ramos S, Prata J, Bettencourt P, Ferreira A, Cerqueira-Gomes, Heart Failure and Health Related Quality of Life. Clinical Practice and Epidemiology in Mental Health. 2005;1:19.

Albrecht GL. Subjective health assessment. In C Jenkinson (Ed.). Measuring health and medical outcomes. UCL Press: London; 1994. 7-26.

Wood-Dauphinee S. Assessing quality of life in clinical research from where have we come and where are we going? Journal of Clinical Epidemiology. 1999;52:355-63.

Moons P, Budts W, De Geest S. Critique on the conceptualization of quality of life: A review and evaluation of different conceptual approaches. International Journal of Nursing Studies. 2006;43:891-901.

Farquhar M. Definitions of Quality of Life: a Taxonomy. Journal of Advanced Nursing. 1995;22(3):502.

Felce D, Perry J. Quality of Life: Its Definition and Measurement. Research in Developmental Disabilities. 1995;16(1):51.

Day H, Jankey SG. Lessons From the Literature. Towards a Holistic Model of Quality of Life' in Renwick, Rebecca, Brown, Ivan, and Nagler, Mark (eds) Quality of Life in Health Promotion and Rehabilitation. Conceptual Approaches, Issues and Applications, Thousand Oaks: Sage; 1996.

Rejeski WJ, Mihalko SL. Physical Activity and Quality of Life in Older Adults. Journals of Gerontology: Series A: Biological Sciences & Medical Sciences. 2001;56(11):24.

Schalock RL. Three Decades of Quality of Life', Focus on Autism & Other Developmental Disabilities. 2000;15(2):116-27.

Taillefer MC, Dupuis G, Roberge MA, Lemay S. Health-Related Quality of Life Models: Systematic Review of the Literature'. Social Indicators Research. 2003;64(307)293-323.

Rapley M. Quality of Life Research. A Critical Introduction. London: Sage; 2003. 84.

Raphael D. Defining Quality of Life: Eleven Debates Concerning Its Measurement in Renwick, Rebecca, Brown, Ivan and Nagler, Mark (eds) Quality of Life in Health Promotion and Rehabilitation: Conceptual Approaches, Issues and Applications. Thousand Oaks: Sage; 1996.

Haas BK. A Multidisciplinary Concept Analysis of Quality of Life, Western Journal of Nursing Research. 1999;21(6):728-742.

Armstrong D, Caldwell D. Origins of the Concept of Quality of Life in Health Care: A Rhetorical Solution to a Political Problem. Social Theory and Health. 2004;2(4):361-71.

McHorney CA. Concepts and Measurement of Health Status and Health-Related Quality of Life` in Albrecht, Gary L, Fitzpatrick, Ray and Scrimshaw Susan C (eds) Handbook of Social Studies in Health and Medicine. Thousand Oaks, New Delhi: Sage; 2000.

Michalos AC. Social Indicators Research and Health-Related Quality of Life Research. Social Indicators Research. 2004;65(1):27-72.

Meeberg GA. Quality of Life: a Concept Analysis, Journal of Advanced Nursing. 1993;18(1):32-38.

Haas BK. Clarification and Integration of Similar Quality of Life Concepts, IMAGE: Journal of Nursing Scholarship. 1999;31(3):4.

Coffman DD. Music and Quality of Life in Older Adults. Psychomusicology. 2002;18(1-2):76.

Schalock RL. The Concept of Quality of Life in the Lives of Persons with Mental Retardation. Paper presented at the 15th Annual Meeting of the American Association of Mental Retardation, Washington DC in Renwick Rebecca, Brown Ivan, Quality of Life in Health Promotion and Rehabilitation: Conceptual Approaches, Issues, and Applications. Sage;1996. 7.

Barcaccia B, Esposito G, Matarese M, Bertolaso M, Elvira M, De Marinis MG. Defining Quality of Life: A Wild-Goose Chase? Europe`s Journal of Psychology. 2013;9(1).

Raphael D, Brown I, Renwick R, Rootman Ir. Quality of Life: What are the Implications for Health Promotion? Chapter 2 in Health Promotion and Quality of Life in Canada. Essential Reedings. Ed. By Dennis Raphael. Toronto, Ontario: Canadain Scholar Press Inc; 2010.

Schipper H, Clinch J, Powel V. Definitions and conceptual Issues. In Spilker, B, ed. Quality of Life in Clinical Trials. New York: Raven; 1990.

Bowling A. Measuring Health. Philadelphia: Open University Press & Philadelphia; 1991.

Green L, Kreuter M. Health Promotion Planning. Toronto: Mayfield; 1991.

Schalock R. ed. Quality of Life: Perspectives and Issues. Washington, DC: American Association of Mental Retardation; 1990.

Lawton MP. A multidimensional view of quality of life in frail elders. In Birren J, Lubben I, Rowe J, Deuthman D, eds. The Concept and Measurement of Quality of Life in the Frail Elderly. New York: Academic Press; 1991.

Andrews FM. Introduction. In Andrews FM, ed. Research on the Quality of Life. Ann Arbor, MI: Institute for Social Research; 1986.

Renwick R, Brown I. The Centre for Health Promotion`s Conceptual Approaches to Quality of Life. Being, Belonging, and Becoming. In Renwick R, Brown I, Nagler M. eds. Quality of Life in Health Promotion and Rehabilitation: Conceptual Approaches, Issues, and Applications. Thousand Oaks: Sage; 1996. 75-86.

WHO, WHOQOL-BREF - Instructions, Administration, Scoring and Generic Version of the Assessment WHO. Geneva; 1996. p. 5.

Tashakkori A, Teddlie C. (Eds.). Handbook on mixed methods in the behavioral and social sciences. Thousand Oaks, CA: Sage Publications; 2003.

Teddlie C, Tashakkori A, (Eds.). Foundations of mixed methods research: integrating quantitative and qualitative approaches in the social and behavioral sciences, Thousand Oaks, CA: Sage Publications; 2009.

Vankova D., Micheva, I., Kerekovska A. [Mixed-method approach in medicine]. Social Medicine. 2013;21(2):16-17. Bulgarian.

Creswell JW. Educational research: Planning, conducting, and evaluating quantitative and qualitative approaches to research, Upper Saddle River, NJ: Merrill/Pearson Education; 2002.

Green JC, Caracelli VJ, Graham WF. Toward a conceptual framework for mixed-method evaluation designs. Educational Evaluation and Policy Analysis. 1989;11(3):255-274.

Tashakkori A, Teddlie C. Mixed methodology: Combining qualitative and quantitative approaches. Applied Social Research Methods Series. Thousand Oaks, CA: Sage Publications; 1998.

CDC. Measuring Healthy Days. [monograph]. Atlanta, Georgia; 2000.

Perry J. Measure for Measure: How Do Measures of Quality of Life Compare? British Journal of Learning Disabilities. 1995;23(4).

Fryback DG. Understanding and Comparing Existing Summary Measures of Health and Health-Related Quality of Life: The State of the Art in Workshop Report: To Develop a Research Agenda and Research Resources for Health Status Assessment and Summary Health Measures; 2003.

Mapi [Internet]. [cited 2015]. Available from:

Brooks R. The EuroQol Group after 25 Years. the Netherlands: Springer; 2013.

Kaplan R, Bush J, Berry C. Health Status: Types of Validity and the Index of Wellbeing. Health Services Research. 1976;11:478-507.

Bergner M, Bobbitt RA, Pollard WE, Martin DP, Gilson BS. The sickness impact profile: validation of a health status measure. Med Care. 1976;14(1):57-67.

Hunt S, McEwen J. The Development of a Subjective Health Indicator. Social Health and Illness. 1980;2:231-246.

Hunt SM, McKenna SP, McEwen J, Backett EM, Williams J, Papp E. A quantitative approach to perceived health status: A validation study. Journal of Epidemiology & Community Health. 1980;34(4):281-6.

Coons SJ, Rao S, Keininger DL, et al. A Comparative Review of Generic Quality- of- Life Instruments. Pharmacoeconomics. 2000;17:13-35.

Green L, Kreuter M. Health Promotion planning: An Educational and Environmental Approach. Mountatin View, CA: Mayfield, 1991, p. 48.

Birnbacher D. Quality of Life - Evaluation or Description? Ethical Theory and Moral Practice. 1999;2(1):29.

Heyrman J, Van Hoeck K. Chapter 12: Health outcome measures for older people. In: Hutchinson A, McColl, Christie M, Rccalton C. (Ed) Health Outcome Measures in Primary and Out-Patient Care. United Kingdom: Harwood Academic Publishers; 1996. 167-175.

WHO Regional Office for Europe, 2011. Setting targets for Health 2020. WHO, Denmark.



About The Author

Desislava Vankova
Medical University of Varna, PhD graduate


Font Size