The WHOQOL-

DISABILITIES module manual

WHOQOL-BREF & DISABILITIES MODULE (PROXY) INSTRUCTIONS
You are being asked to complete this assessment on behalf of someone else (a proxy assessment). This may be
because that person cannot answer the questions (e.g. as a result of illness or disability), or because the views of
another individual who knows the person well are being sought also.

In order to complete a proxy assessment, you must know well the person for whom you are responding. For

worker, a health professional or their advocate (a person formally or legally appointed to help them). You should
answer the questions as you think the person for whom you are responding would answer, using all your
knowledge and experience of that person and their life.

If you do not know the person well enough to answer questions on their behalf, you should not complete the
assessment. (In this case, please return the questionnaire and explain that you are unable to act as a proxy for this
person.) This assessment asks how the person for whom you are responding feels about their quality of life,
health or other areas of their life. It is about them, and their life, rather than about you.

Please keep in mind what is important to the person for whom you are responding; what makes them happy;
their hopes and dreams, and their worries or concerns.

Please answer all the questions. If you are unsure about which answer to give to a question - if it is hard to pick an
answer - please choose the one that seems nearest or most appropriate. This can often be the first thing that comes into
your mind. Some questions include an example to help you think about your answer.

There are no right or wrong answers just answer what you believe is true. Please think about the life of the person in
the last two weeks.
For example, thinking about the last two weeks, a question might ask:

EXAMPLE
Not at all A Little Moderately Mostly Totally

Does he/she get the kind of support that he/she needs from others? 1 2 3 4 5

For example, does he/she get the kind of help he/she needs from other
people?

In this item, the question has an example. You should circle the number that best fits what the person for whom you are
responding would say about the kind of support (or help) they got from others over the last two weeks. So you would
circle the number 3 if the support (or help) the person got met their needs moderately, as follows:

EXAMPLE
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Does he/she get the kind of support that he/she needs from others? 1 2 33 4 5

For example, does he/she get the kind of help he/she needs from
other people?

Alternatively, you would circle number 1 if the person for whom you are responding would say that the support they got
over the last two weeks did not meet his/her needs at all.

Please read each question, think about the feelings of the person for whom you are responding, and circle the number on
the scale for each question that gives the best answer for him/her.
You may find it helpfu
printed on separate cards also. Please think about the life of the person for whom you are responding in the last two
weeks:

The first two questions ask about his/her life and health overall.
 The WHOQOL-
DISABILITIES module manual

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1G Is he/she satisfied with his/her life? 1 2 3 4 5

2G Is he/she satisfied with his/her health? 1 2 3 4 5

The following questions ask about how he/she has felt about certain things, how much he/she has been able to do
certain things, or how satisfied he/she has been about various aspects of his/her life over the last two weeks.

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3 Does (physical) pain stop him/her from doing what he/she needs 1 2 3 4 5
to do?

4 Does he/she need any medical treatment to help him/her in 1 2 3 4 5

his/her daily life?

For example, medicines.

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5 Does he/she enjoy his/her life? 1 2 3 4 5

6 Does he/she feel his/her life has meaning? 1 2 3 4 5

For example, does he/she feel his/her life is important and has a
purpose?

7 Is he/she able to think clearly? 1 2 3 4 5

For example, is he/she able to pay attention, and think carefully

about things?

8 Does he/she feel safe in his/her daily life? 1 2 3 4 5

For example, at home and in the places he/she goes to during

the day.

9 Does he/she feel the local area he/she lives in is healthy? 1 2 3 4 5

For example, thinking about the noise, the traffic, the pollution,
the weather.

10 Does he/she have enough energy for everyday life? 1 2 3 4 5

For example, is he/she able to do things through the day without

feeling tired?

11 Is he/she able to accept the way his/her body looks? 1 2 3 4 5

12 Does he/she have enough money for the things he/she needs? 1 2 3 4 5
 The WHOQOL-
DISABILITIES module manual

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13 Is he/she able to get the information that he/she needs in his/her 1 2 3 4 5

day-to-day life?

For example, is it easy to find out about things he/she needs to

know in his/her daily life?

14 Does he/she get the chance to do leisure activities? 1 2 3 4 5

For example, does he/she get the chance to do things he/she

enjoys in his/her spare time?

15 Is he/she able to get around OK in the house and outside? 1 2 3 4 5

16 Is he/she satisfied with his/her sleep? 1 2 3 4 5

17 Is he/she satisfied with his/her ability to do his/her daily activities? 1 2 3 4 5

For example, looking after himself/herself, washing, dressing,
eating.

18 Is he/she satisfied with his/her ability to work? 1 2 3 4 5

For example, to do his/her job, or his/her daily activities.

19 Is he/she satisfied with himself/herself as a person? 1 2 3 4 5

For example, with the kind of person he/she is, in what he/she
does, how he/she spends his/her time, his/her friendships, his/her
achievements.

20 Is he/she satisfied with his/her personal relationships? 1 2 3 4 5

For example, how he/she gets along with the people in his/her life,
his/her friends, his/her family, the people he/she lives with.

21 Is he/she satisfied with his/her sex life, or his/her relationship with 1 2 3 4 5

his/her partner?

For example, his/her husband/wife, boyfriend/girlfriend.

22 Is he/she satisfied with the support he/she gets from his/her 1 2 3 4 5

friends?

23 Is he/she satisfied with what his/her home is like? 1 2 3 4 5

For example, thinking about his/her home and the place he/she
lives in.

24 Is he/she satisfied with his/her access to health services? 1 2 3 4 5

For example, is it easy to see the doctors, nurses or other staff
who look after him/her when he/she is unwell?

25 Is he/she satisfied with the transport he/she can use? 1 2 3 4 5

For example, how he/she gets to the places he/she goes to (e.g.
by bus, car, taxi etc.).

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26 Does he/she feel very unhappy, sad, worried or depressed? 1 2 3 4 5

 The WHOQOL-
DISABILITIES module manual
DISABILITIES MODULE

The next question asks about his/her disability overall.

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27G Does he/she feel that his/her disability has a negative (bad) 1 2 3 4 5
effect on his/her day-to-day life?

The following questions ask about how he/she has felt about certain things, how much certain things have applied to
him/her, and how satisfied he/she has been about various parts of his/her life over the last two weeks

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28 Does he/she feel that some people treat him/her unfairly? 1 2 3 4 5

29 Does he/she feel that he/she needs someone to stand up for 1 2 3 4 5

him/her when he/she has problems?

30 Does he/she worry about what might happen to him/her in the 1 2 3 4 5

future?

For example, thinking about not being able to look after

him/herself, or being a burden to others in the future.

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31 Does he/she feel in control of his/her life? 1 2 3 4 5

For example, does he/she feel in charge of his/her life?

32 Does he/she make his/her own choices about his/her day-to-day 1 2 3 4 5

life?

For example, where to go, what to do, what to eat.

33 Does he/she get to make the big decisions in his/her life? 1 2 3 4 5

For example, like deciding where to live, or who to live with, how
to spend his/her money.

34 Is he/she satisfied with his/her ability to communicate with other 1 2 3 4 5

people?

For example, how he/she says things or gets his/her point

across, the way he/she understands others, by words or signs.

35 Does he/she feel that other people accept him/her? 1 2 3 4 5

36 Does he/she feel that other people respect him/her? 1 2 3 4 5

 The WHOQOL-
DISABILITIES module manual
For example, does he/she feel that others value him/her as a
person and listen to what he/she has to say?

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37 Is he/she satisfied with his/her chances to be involved in social 1 2 3 4 5

activities?

For example, meeting friends, going out for a meal, going to a party

etc.

38 Is he/she satisfied with his/her chances to be involved in local 1 2 3 4 5

activities?

For example, being part of what is happening in his/her local

area or neighbourhood.

39 Does he/she feel that his/her dreams, hopes and wishes will 1 2 3 4 5
happen?

For example, does he/she feel he/she will get the chance to do
the things he/she wants, or get the things he/she wishes for, in
his/her life?

Do you have any comments about the questionnaire?

 The WHOQOL-
DISABILITIES module manual
ABOUT YOU
Finally, we would like to ask you to answer a few general questions about yourself. Please answer by putting a cross
like this X in the box beside the correct answer OR write in the space provided.

Gender Male Female

Age (in years) Date of Birth

(dd / mm / yy)

Education: What is the highest level of education you received?

None at all
Primary school
Secondary school / High school
College / University
Other (please tell us what

Your relationship to the person for whom you have responded:

Partner
Parent
Sibling
Other family member (please specify relationship
Friend
Paid Carer / Staff
Professional
Other (please tell us what

How long have you known the person? years / months)

How much contact do you have with the person?

Monthly Fortnightly Weekly Daily 24 hours

How well do you think you know the person?

Not very well A Little Quite well Well Very well

Your view of the Quality of Life of the person for whom you have responded:
How do you think his/her quality of life compares with that of other people who live in the
same local area?

Much worse A bit worse About the same A bit better Much better

How do you think his/her quality of life compares with that of other people with similar disabilities?
Much worse A bit worse About the same A bit better Much better

Overall, how easy or difficult did you find it to answer quality of life questions on his/her behalf?

Very difficult Difficult Neither easy Easy Very easy

nor difficult