Similarities and differences among the Taiwan, China, and Hong-Kong versions of the WHOQOL questionnaire

To facilitate comparison across cultures, the World Health Organization (WHO) has been developing a universal measure of quality of life (QOL) called the WHOQOL Questionnaire. This questionnaire contains 24 facets organized into six broad domains: physical, psychological, level of independence, social relationships, environment, and spirituality/religion/personal beliefs. The standard WHOQOL is designed for cross-cultural comparison. However, to obtain a valid QOL measure that can be applied in diverse populations, cultural adaptation of the WHOQOL has been encouraged. Each culture is permitted to add culture-specific questions, called national items, so that the questionnaire can also reflect cultural attributes. Three Chinese versions of the WHOQOL have been developed for China, Hong Kong, and Taiwan. National items were selected for each version according to the criteria proposed by the WHOQOL Group. The purpose of this paper is to compare the Taiwan version to the China and Hong Kong versions. The questionnaire development process, response scale generation, psychometric properties (reliability and validity), national items, and population means were all examined. Results indicated that not only is cultural adaptation of WHOQOL measures necessary for individual cultures, but also for sub-cultures, as these differences must be considered in order to provide effective health care and treatment.