Reliability and validation of the German WHOQOL-BREF in adults with congenital heart disease.

PURPOSE: Quality of Life (QoL) is a key outcome in adults with congenital heart disease (ACHD). While the WHOQOL-BREF is broadly applied, its psychometric properties have not been systematically assessed in German-speaking ACHD. This study aimed to evaluate the reliability and validity of the German WHOQOL-BREF in this population.

METHODS

Descriptive statistics and item characteristics were calculated. Internal consistency was examined using Cronbach’s α and item-rest correlations. Construct validity was assessed with confirmatory factor analysis (CFA) of the original four-domain model. Known-groups validity was evaluated by comparing QoL scores across NYHA class, arrhythmia, and heart failure status. Associations between WHOQOL-BREF domains and the global items of quality of life and general health were examined using regression models.

RESULTS

A total of 846 ACHD patients participated (mean age = 33.08 ± 12.0 years, 45.3% female); after excluding cases with excessive missing responses, 805 remained for analysis. Internal consistency ranged from acceptable to good (Cronbach’s α = 0.69–0.84). CFA confirmed the four-factor structure with good model fit (CFI = 0.993, RMSEA = 0.036, SRMR = 0.045). Known-groups comparisons showed lower QoL scores in patients with higher symptom burden. Regression analyses demonstrated that psychological and physical domains were the strongest factors of global QoL and health, explaining up to 47.4% and 44.8% of the variance.

CONCLUSION

The German WHOQOL-BREF demonstrates good psychometric properties in ACHD and provides a robust tool for multidimensional QoL assessment, though the social domain shows limitations.