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Since publication use of the WHOQOL-Bref has rapidly risen. However, as yet no population norms have been published as a reference point against which researchers can interpret their findings. This study provides preliminary population norms for this purpose. Randomly sampled community residents from two studies were pooled and used to examine the properties of the WHOQOL-Bref by age group, gender and health status. The results showed that general norms for the WHOQOL-Bref domains were 73.5 (SD=18.1) for the Physical health domain, 70.6 (14.0) for Psychological wellbeing, 71.5 (18.2) for Social relationships and 75.1 (13.0) for the Environment domain. In general scores declined slightly by age group. For females scores were stable across the lifespan with an accelerated decline after the age of 60 years. Males exhibited a more consistent and even decline across the lifespan. There were significant differences in WHOQOL-Bref scores when reported by health status, with those in poor health obtaining scores that were up to 50% lower than those in excellent health. Effect sizes between different health status levels are reported. These preliminary norms and effect sizes may be used as reference points for interpreting WHOQOL-Bref scores. They provide additional information to the numerous national studies already reporting on the validity of the WHOQOL-Bref.

Objective: To address the increasing diversity in the linguistic and ethnic backgrounds of medical students at the University of Melbourne, a program was developed to prepare students for the particular challenges in cultural literacy and idiomatic English language proficiency, especially when exploring sensitive areas of patients' personal history. The authors outline the University of Melbourne program and present two case studies. Results: Post hoc confidential survey of students' appraisals of the program is presented. Conclusion: The survey found a high level of acceptance and approval among most students.

Objective: The Assessment of Quality of Life (AQoL) instrument is widely used in Australian health research. To assist researchers interpret and report their work, this paper reports population and health status norms, general minimal important differences (MIDs) and effect sizes. Method: Data from the 1998 South Australian Health Omnibus Survey (n=3,010 population-based respondents) were analysed by gender, age group and health status. Data from four other longitudinal studies were analysed to obtain estimated MIDs. Results: The mean (SD) AQoL utility score was 0.83 (0.20). Gender and age subgroup differences were apparent; the mean scores for women were consistent until their 50s, when scores declined. Greater variability was observed for males whose scores declined more slowly but consistently between 40-80 years. For both genders, those aged 80+ years had the lowest scores. When assessed by health status, those reporting excellent health obtained the highest utility scores; progressive declines were observed with decreasing health status. Effect sizes of 0.13 or greater may reflect important differences between groups. A difference in AQoL scores of 0.06 utility points over time suggests a general MID. Conclusions: AQoL population norms, MIDs and effect sizes can be used as reference points for the interpretation of AQoL data. These findings add to the growing evidence that the AQoL is a robust and sensitive measure that has wide applicability. Implications: The availability of population norms will assist researchers using the AQoL to more easily interpret and report their work.

Abstract Background Multi attribute utility (MAU) instruments are used to include the health related quality of life (HRQoL) in economic evaluations of health programs. Comparative studies suggest different MAU instruments measure related but different constructs. The objective of this paper is to describe the methods employed to achieve content validity in the descriptive system of the Assessment of Quality of Life (AQoL)-6D, MAU instrument. Methods The AQoL program introduced the use of psychometric methods in the construction of health related MAU instruments. To develop the AQoL-6D we selected 112 items from previous research, focus groups and expert judgment and administered them to 316 members of the public and 302 hospital patients. The search for content validity across a broad spectrum of health states required both formative and reflective modelling. We employed Exploratory Factor Analysis and Structural Equation Modelling (SEM) to meet these dual requirements. Results and Discussion The resulting instrument employs 20 items in a multi-tier descriptive system. Latent dimension variables achieve sensitive descriptions of 6 dimensions which, in turn, combine to form a single latent QoL variable. Diagnostic statistics from the SEM analysis are exceptionally good and confirm the hypothesised structure of the model. Conclusions The AQoL-6D descriptive system has good psychometric properties. They imply that the instrument has achieved construct validity and provides a sensitive description of HRQoL. This means that it may be used with confidence for measuring health related quality of life and that it is a suitable basis for modelling utilities for inclusion in the economic evaluation of health programs.

Abstract Background Health related quality of life (HRQoL) in very late life is not well understood. The aim of the present study was to assess HRQoL and health outcomes at four months follow-up in a group of older people awaiting transfer to residential aged care. Methods Secondary analysis of data from a randomized controlled trial conducted in three public hospitals in Adelaide. A total of 320 patients in hospital beds awaiting a residential aged care bed participated. Outcome measurements included HRQoL (Assessment of Quality of Life; AQoL), functional level (Modified Barthel Index), hospital readmission rates, survival, and place of residence at four months follow-up. Results In this frail group the median AQoL was poor at baseline (median 0.02; 95%CI -0.01 – 0.04) and at follow-up (0.05; 95%CI 0.03 – 0.06). On leaving hospital, more than one third of participants who were moving for the first time into nursing home care rated themselves in a state worse than death (AQoL ≤ 0.0). Poor HRQoL at discharge from hospital (AQoL ≤ 0.0) was a significant predictor of mortality (HR 1.7; 95%CI 1.2 – 2.7), but not hospital readmission nor place of residence at four months follow-up. Improved function was a predictor of improved HRQoL among the surviving cohort. Conclusion People making the transition to residential aged care from hospital have very poor HRQoL, but small gains in function seem to be related to improvement. While functional gains are unlikely to change discharge destination in this frail group, they can contribute to improvements in HRQoL. These gains may be of great significance for individuals nearing the end of life and should be taken into account in resource allocation.