The Quality of Life Index (QLI) was developed by Ferrans and Powers to measure quality of life in terms of satisfaction with life. Quality of life is defined by Ferrans as "a person's sense of well-being that stems from satisfaction or dissatisfaction with the areas of life that are important to him/her". The QLI measures both satisfaction and importance of various aspects of life. Importance ratings are used to weight the satisfaction responses, so that scores reflect the respondents' satisfaction with the aspects of life they value. Items that are rated as more important have a greater impact on scores than those of lesser importance. The instrument consists of two parts: the first measures satisfaction with various aspects of life and the second measures importance of those same aspects. Scores are calculated for quality of life overall and in four domains: health and functioning, psychological/ spiritual, social and economic, and family.
A number of versions of the QLI have been developed for use with various disorders and the general population, and have been reported in more than 100 published studies. A common set of items forms the basis for all versions, and items pertinent to each disorder have been added to create the illness-specific versions. Scores for all versions range from 0 - 30, which facilitates comparisons of findings across different versions. General population data are available for interpretive purposes.
Abbreviated Name: QLI
Author(s): Carol E. Ferrans and M.J Powers
Purpose: To measure quality of life in terms of satisfaction with life
Type of Instrument: Quality of Life, Satisfaction Mode of Administration:
Time required: 10 minutes
Response Options: Likert scale Scoring: Global score
Scores by dimension Score Direction: Higher scores show better QoL Number of Items: Generic version: 66 Original Language: English
Existing Translations : French, Hungarian, Japanese, Korean, Mandarin Chinese, Norwegian, Polish, Portuguese, Romanian, Russian, Spanish, Swedish, Thai
Copyright: Copyright 1984 and 1998 (USA) by Carol Estwing Ferrans and Marjorie Powers
Contact for information and permission to use:
Carol Estwing Ferrans PhD, RN, FAAN Associate Professor
Department of Medical-Surgical Nursing (M/C 802)
College of Nursing
University of Illinois at Chicago
845 South Damen Avenue, 7th Floor, Room 746
Chicago, Illinois 60612-7350 USA
E-mail: [email protected]
Dimensions covered by the questionnaire :
• Health and Functioning
• Psychological / Spiritual
• Social and Economic
1. Ferrans CE. Development of a Conceptual Model of Quality of Life. Scholarly Inquiry for Nursing Practice: An International Journal 1996;10(3):293-304
Quality of life is a critically important concept for health care that has been developed predominantly in the past three decades. Conceptual clarity is extremely important, because differences in meaning can lead to profound differences in outcomes for research, clinical practice, and allocation of health care resources. This paper describes the development of the Ferrans conceptual model of quality of life. The model was developed based on the adoption of an individualistic ideology, which recognizes that quality of life depends on the unique experience of life for each person. Individuals are the only proper judge of their quality of life, because people differ in what they value. Consistent with this ideology, quality of life was defined in terms of satisfaction with the aspects of life that are important to the individual. The model was developed using qualitative methodology. Factor analysis of patient data was used to cluster related elements into domains of quality of life. The resulting model identifies four domains of quality of life: health and functioning, psychological/spiritual, social and economic, and family. Subsequent cross-cultural work with African Americans and Mexican Americans has provided evidence that the elements of the model appropriately reflect quality of life for segments of the population not sampled in the original work. The Ferrans and Powers Quality of Life Index was developed based on this model.
2. Ferrans CE, Powers MJ. Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 1992; 15: 29-38
The purpose of this study was to examine the psychometric properties of the Quality of Life Index (QLI) (Ferrans & Powers, 1985a). The sample consisted of 349 patients selected randomly from the adult, in-unit hemodialysis patient population of Illinois. Factor analysis was used to examine the underlying factor structure. A four-factors solution best fit the data, indicating that there were four dimensions underlying the QLI: health and functioning, socioeconomic, psychological/spiritual, and family. Factor analysis of the four primary factors revealed one higher order factor, representing quality of life. Construct validity also was supported by the contrasted groups approach. As predicted, it was found that those who had higher incomes had significantly higher quality of life scores on the social and economic subscale. Support for convergent validity was provided by a strong correlation (r = .77) between scores from the QLI and an assessment of life satisfaction. Findings supported the internal consistency reliability of the entire QLI (alpha = .93) and the four subscales (alphas = .87, .82, .90, .77).
3. Ferrans CE. Development of a quality of life index for patients with cancer. Oncology Nursing Forum, 1990;17(3): 15-19
This study developed an instrument to measure the quality of life (QOL) of patients with cancer that would account for individual values, as well as satisfaction. The sample consisted of patients with breast cancer (n = 111) listed in the tumor registry of a major hospital. Ferrans and Power's Quality of Life Index (QLI) was modified based on an extensive review of the oncology literature, which supported content validity. The findings supported the internal consistency reliability of the entire QLI (alpha = 0.95) and of the four subscales: health and functioning, socioeconomic, psychological/spiritual, and family (alphas = 0.90, 0.84, 0.93, and 0.66, respectively). Support for concurrent validity was provided by a strong correlation (r = 0.80) between the QLI and a measure of satisfaction with life. Support for construct validity was provided by significantly higher mean QOL scores for subjects who had less pain, less depression, and were coping better with stress, using the known group technique. The positive results obtained from this assessment and the fact that many patients can complete the QLI independently are important variables to consider when health professionals are selecting instruments for research and practice.
4. Ferrans C, Powers M. Quality of Life Index: Development and psychometric properties.
Advances in Nursing Science, 1985; 8: 15-24
The purpose of the study on which this article is based was to assess the validity and reliability of an instrument designed to measure quality of life. Sixty-four items applicable to both healthy subjects and dialysis patients were tested with graduate students (n = 88); six items relative to dialysis were added, and the instrument was administered to dialysis patients (n = 37). Items were based on literature review, which supported content validity. Correlations between the instrument and an overall satisfaction with life question of 0.75 (graduate students) and 0.65 (dialysis patients) supported criterion-related validity. Support for reliability was provided by test-retest correlations of 0.87 (graduate students) and 0.81 (dialysis patients) and Cronbach's alphas of 0.93 (graduate students) and 0.90 (dialysis patients).
Reliability and Validity of the Ferrans and Powers Quality of Life Index (QLI)
Internal Consistency Reliability. Internal consistency reliability for the QLI (total scale) was supported by Cronbach's alphas ranging from .84 to .98 across 20 studies (Table 1). Cronbach's alphas for the four subscales have been published in 11 studies, which have provided support for internal consistency of the subscales (Table 2). Alphas ranged from .70 to .93 for the health and functioning subscale, from .73 to .89 for the social and economic subscale, and from .80 to .93 for the psychological/spiritual subscale. For the family subscale, alphas were acceptably high in 10 studies, ranging from .63 to .92.
Temporal (Stability) Reliability. For the total scale, support for temporal reliability was provided by test-retest correlations of .87 with a two-week interval and .81 with a one-month interval (Ferrans & Powers, 1985) and by correlations of .78 with a three to four-week interval (Rustoen et al., 1999b). Temporal reliability also was supported by test-retest correlations with a two-week interval for all five scores: overall quality of life (r = .79), health and functioning (r = .72), social and economic (r = .68), psychological/spiritual (r = .76), and family (r = .69) (Dougherty et al., 1998).
Content Validity. Content validity of the QLI was supported by the fact that items were based both on an extensive literature review of issues related to quality of life and on the reports of patients regarding the quality of their lives (Ferrans & Powers, 1985). Support for content validity also was provided by an acceptably high rating using the Content Validity Index (Oleson, 1990).
Construct Validity. Convergent validity of the QLI was supported by strong correlations between the overall (total) QLI score and Campbell, Converse, and Rodgers' (1976) measure of life satisfaction (r = .61, .65, .75, .77, .80, .83, .93) (Bliley & Ferrans, 1993; Ferrans & Powers, 1985; Ferrans & Powers, 1992; Anderson & Ferrans, 1997; Ferrans, 1990).
Further evidence for construct validity was provided by factor analysis. Factor analysis revealed four dimensions underlying the QLI: health and functioning, social and economic, psychological/spiritual, and family. The factor analytic solution explained 91% of the total variance. Factor analysis of the four primary factors revealed one higher order factor, which represented quality of life (Ferrans & Powers, 1992).
Construct validity also was supported using the contrasted groups approach. Subjects were divided into groups on the basis of self-reported levels of pain, depression, and success in coping with stress. Subjects who had less pain, less depression, or who were coping better with stress had significantly higher overall (total) QLI scores (Ferrans, 1990). The contrasted groups approach also was used to assess the construct validity of the social and economic subscale. It was found that those who had higher incomes had significantly higher quality of life scores on the social and economic subscale (Ferrans & Powers, 1992).
Sixteen intervention studies have been published in which QLI scores were found to be sensitive enough to detect a change in quality of life. The QLI scores changed significantly over time, when compared before and after an intervention in all 15 studies (Table 3).
Table 2. Internal Consistency Reliability of the Per runs anil Powers Quality of Life Index (QLI): Subcalcs
Population Health & Social & Psychological'' Family Study
Functioning Economic Spiritual Subseale
Sub scale Sub sc ale Subscalc
Ureast cancel' survivors Melanoma patients Newly diagnosed patients
Angina pectoris (stable) Angioplasty and bypass Angioplasty and bypass Arrythmias (lile-threatening) Cardiac rehabilitation
F.nd-Stage Renal Disease Hemodialysis patients
Other Illness Groups Chronic fatigue syndrome Stroke survivors HIV+
Tnhlo 3. Intervention Studies Demonstrating Sensitivity to Change
L Aurora, R., Chou, T., Jain, D., Nesto, EL, et al. (1998). Results of the multicenter enhanced external counterpulsation (MUST-EECP) outcomes study: quality of life benefits sustained six months after treatment. Circulation, 98(17, Suppll), 1-350.
2. Brooks, N. (2000), Quality of life and the high-dependency unit. Intensive Critical Care Nursing, 16(1), 1832.
3. Riley, A.V. & Ferrans, C. (1993). Quality of life alter angioplasty. Heart & Lung. 22(3), 193-199.
4. Dougherty, C., Dew hurst, T., Niehol, P., & Sped, us, J. (1998). Comparison of three quality of life instruments in stable angina pectoris: Seattle Angina Questionnaire, Short Form Health Survey (SF-36), and Quality of Life Index - Cardiac Version III. Journal ol Clinical Epidemiology, 51(7), 569-575.
5. Fans, J.& Stotts, N. (1990). The effect of percutaneous transluminal coronary angioplasty on quality of life. I'rogress in Cardiovascular Nursing, 5(4), 132-140.
6. Fazio, M, Glaspy, J. (1991). The impact of granulocyte colony-stimulating factor on quality of llie in patients with severe chronic neutropenia. Oncology Nursing Forum. 1 S(S). 1411-1414.
7. Grady, K., Jalowiec, A., Hetfleisch, M. (1993). A comparison of life satisfaction before and after heart transplantation. Journal of Heart and Lung transplantation, 12, S66.
H. Hathaway, D., Haitwig, M., Milstcad, J., Elmer, D., Evans, S., Gaber, A. (1994). A prospective study of changes in quality of life reported by diabetic recipients of kidney-only and pan ereas-kidney allografts. Journal of Transplant Coordination, 4,12-17.
9. Hathaway, D., Haitwig, M, Milstcad, J., Elmer, D., Evans, S., Gaber, A. (1994). Improvement in quality of life reported by diabetic recipients of kidney-only and pan ereas-kidney allografts. Transplantation R-oceedings, 26(2), 512-514.
10. Hathaway, D., Haitwig, M, Winsctt, R., Gaber, A. (1992). Quality of life 6-12 months after renal transplant. ANNA Journal, 19(2), 152.
11. Ilixon, M. (1992). Perceived quality of life before and after percutaneous balloon valvuloplasty. Heart and Lung, 21(3), 290.
12. Jenkins, L., Ellenbogcn, K., Kay, N., Guidici, M., et al. (1996). Quality of life post-ablation/ pacemaker implantation in patients with symptomatic atrial fibrillation. Circulation, 94(8 Suppl I), 1-581.
13. Jenkins, L-, Steinberg. J., Kutalek, S_, Cook, J., el al. (1997). Quality of life in patients enrolled in the antiarrhythmics versus implantable defibrillators (AVID) trial. Circulation, (Supp I), 1-439.
14. Johnson, C-, Wicks, MK., Milstcad, J., Hartwig, M., and Hathaway, D. (1998). Racial and gender differences in quality of life following kidney transplantation. Image: Journal of Nursing Scholarship. 30(2). 125-130.
15. Kolz, N. (1939). Self-perceived quality of life following cardiac surgery. Heart & Lung. 18(3'l. 304.
16. LoBiondio-Wood, G., Williams, L., Wood, R.. Shaw, B. (1997). Impact (if liver transplantation on quality of life: a longitudinal pcrspcctivc. Applied Nursing Research. lOf 1). 27-32.
PUBLICATIONS REPORTING RELIABILIT Y AND VALIDITY INFORMAT ION FOR FERRANS AND POWERS QUALITY OF LIFE INDEX (QLI)
Anderson, J. & Fcrrans, C. (1997). The quality of life of persons with chronic fatigue syndrome. Journal of Nervous and Menial Disease. 186(6), 359-367.
Blilcy, AV., & Fcrrans, C. (1993). Quality of life after angioplasty. Heart & Lung. 22(3). 193-199.
Carroll, D., Hamilton, G., & McGovem, B. (1999). Changes in health status and quality of life and the impact of uncertainty in patients who survive life-threatening arrhythmias. Heart & Lung, 28(4), 251-260.
Cowan, M., Young-Graham, K.„ & Cochrane, B. (1992). Comparison of a theory of quality of life between myocardial infarction and malignant melanoma: A pilot study. Progress in Cardiovascular Nursing, 7(1), 18-28.
Delunas, L. & Potempa, K. (1999), Adaptation after treatment for heart disease: Preliminary examination within a stress appraisal contcxt. Heart & Lung, 28(3), 186-194.
Deshotels, A., PlanchoeL N., Deeh, '¿., Pre vos 1, S. (1995). Gender differences in perceptions of quality of life in cardiac rehabilitation patients. Journal of Cardiopulmonary Rehabilitation, 15(2), 143-148.
Dougherty, C., Dew hurst, T., Nicho!, P., & Spertus, J. (1998). Comparison of three quality aflife instruments in stable angina pectoris: Seattle Angina Questionna ire. Short Form Health Survey (SF-36), and Quality of Life Index - Cardiac Version III. Journal of Clinical Epidemiology. 51(7). 569-575.
Fazio, M., Glaspy, J. (1991). Hie impact of granulocyte colony-stimulating factor on quality of lfie in patients with severe chronic neutropenia. Oncology Nursing Forum. 18(8). 1411-1414.
Ferraris, C. (1990). Development of a quality of life index for patients with cancer. Oncology Nursing Forum, 17(3) suppl, 15-19.
Fcrrans, C. & Powers, M. (1985). Quality of Life Index: Development and psychometric properties. Advances in Nursing Science. 8, 15-24.
Feirans, C, & Powers, M. (1992). Psychometric assessment of the Quality of Life Index. Research in Nursing and Health, 15,29-38.
Ilicks, F.r Larson, J., & Feirans, C. (1992). Quality7 of life after liver transplantation. Research in Nursing and Health,15,111-119.
Hughes, K. K. (1993). Psychosocial and functional status of breast cancer patients. Cancer Nursing. 16(31. 222-229.
Kim S, & Rew, L, (1994). lithnie identity, role integration, quality of life, and depression in Korean-American women. Archives ol'Psychiatric Nursing, 8(6), 348-356.
King, R.( 1996). Quality oflife after stroke. Stroke. 27(9). 1468-1472.
LoRiondio-Wood, G., Williams, L., Wood, R., Shaw, B. (1997). Impact of liver transplantation on quality of life: a longitudinal perspective. Applied Nursing Research, 10( 1 ), 27-32.
Me Hors, M.P., Riley, T., Erlen, J, ( 1997). HTV, self-transcendence, and quality of life. Journal of the Association of Nurses in AIDS Care, 8(2), 59-69.
Nesbitt, B. & Hcidrich, S. (2000). Sense of coherence and illness appraisal in older women's quality of life. Research in Nursing and Health, 23, 25-34.
Nunes, J., Raymond, S., Nicholas, P., Leuner, J., Webster, A (1995). Social support, quality of lite, immune function, and health in persons living with HIV. Journal of Holistic Nursing. 13(2), 1 74-198.
Oleson, M. (1990). Content validity of the Quality of Life Index. Applied Nursing Research. 3(3). 126-127.
Papadantonaki, A, Stotts, N., & Paul, S. (1994). Comparison of quality of life before and after coronary artery bypass surgery and pcrcutancous transluminal angioplasty. Heart and Lung, 23(1), 45-52.
Rustoen, T., Moum, T., Wiklund, I., 1 lan est ad, B. (1999a). Quality of" life in newly diagnosed cancel patients. Journal of Advanced Njgsjng. 2'J(2), 490-498.
Rustoen,'!., Wieklund, L, Hanestad, B., Burckhardt, C. (1999b). Validity and reliability of the Norwegian-version of the Fei rans and Powers Quality of Life Index. Scandinavian Journal of Caring Science, 13, 90-101.
Skaggs, B. &. Yates, B. (1999). Quality of" hie comparisons alter coronary angioplasty and coronary artery bypass grail surgery. IlearL and Lung. 28 (6). 409-418.
Smith, C. (1994), A model of caregiving effectiveness for technologically dependent adults residing at home. Advances in Nursing Science, 17(2), 27-40.
Stuifbcrgcn, A. (1995). Health-promoting behaviors and quality of life among individuals with multiple sclcrosis. Scholarly Inquiry for Nursing Practice; An International Journal. 9( 1). 31-50.
Ferrans and Powers QUALITY OF LIFE INDEX' CARDIAC VERSION - IV
PART 1. For each of the following, please choose the answer that best describes how satisfied vou are with that area of your life. Please mark your answer by circling the number. There are no right or wrong answers.
HOW SATISFIED ARE YOU WITH:
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