{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T21:01:12Z","timestamp":1779915672473,"version":"3.53.1"},"reference-count":68,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T00:00:00Z","timestamp":1631145600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>The aim of the present study was to evaluate the quality of life (QoL) of oral submucous fibrosis (OSMF) patients using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. This cross-sectional study was conducted at the Department of Oral and Maxillofacial Surgery, Liaquat University of Medical and Health Sciences (LUMHS), Jamshoro. We used the consecutive sampling technique to recruit patients who were clinically diagnosed with OSMF (n = 112). Data were collected using the WHOQOL-BREF questionnaire, which contains a total of 26 questions. The first two questions, related to overall QoL and overall health status, were evaluated separately. The remaining questions (3\u201326), which represented four domains\u2014physical, psychological, social, and environmental health\u2014were evaluated separately. Patients were asked questions in their native language (Urdu). The relationship between these four domains of life was evaluated with gender, age categories, functional staging, and habit duration using the independent t-test to determine statistical significance. Cronbach\u2019s Alpha was used to assess the reliability of the WHOQOL-BREF domains. The overall QoL of the OSMF patients was considerably poor, and the majority of the patients were unsatisfied with their oral health status. The age variable significantly affected the scores of all domains except for social relationships, whereas habit duration and functional staging of OSMF did not significantly affect the scores of all domains. The domains of the WHOQOL-BREF questionnaire (translated into the Urdu language) showed good reliability, except for social relationships.<\/jats:p>","DOI":"10.3390\/ijerph18189498","type":"journal-article","created":{"date-parts":[[2021,9,9]],"date-time":"2021-09-09T12:20:37Z","timestamp":1631190037000},"page":"9498","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":17,"title":["Assessing the Quality of Life of Oral Submucous Fibrosis Patients: A Cross-Sectional Study Using the WHOQOL-BREF Tool"],"prefix":"10.3390","volume":"18","author":[{"given":"Abdul Bari","family":"Memon","sequence":"first","affiliation":[{"name":"Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneela Atta Ur","family":"Rahman","sequence":"additional","affiliation":[{"name":"Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan"},{"name":"Faculty of Community Medicine and Public Health Sciences, Shaheed Mohtarama Benazir Bhutto Medical University, Larkana 77150, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0174-3549","authenticated-orcid":false,"given":"Kashif Ali","family":"Channar","sequence":"additional","affiliation":[{"name":"Department of Oral and Maxillofacial Surgery, Institute of Dentistry, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5157-7067","authenticated-orcid":false,"given":"Muhammad Sohail","family":"Zafar","sequence":"additional","affiliation":[{"name":"Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah, Al Munawwarah 41311, Saudi Arabia"},{"name":"Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2030-6907","authenticated-orcid":false,"given":"Naresh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Medical Research Centre, Liaquat University of Medical and Health Sciences, Jamshoro 76090, Pakistan"},{"name":"Ishrat Ul Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, Karachi 74200, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,9,9]]},"reference":[{"key":"ref_1","first-page":"399","article-title":"An update on studies on etiological factors, disease progression, and malignant transformation in oral submucous fibrosis","volume":"13","author":"Bari","year":"2017","journal-title":"J. Cancer Res. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Gadbail, A., Dande, R., Sarode, S.C., Gondivkar, S., Belekar, L., Mankar-Gadbail, M., Sarode, G.S., Patil, S., and Yuwanati, M. (2019). Patients with oral submucous fibrosis who visit dental hospitals have nonspecific chief complaints. Transl. Res. Oral Oncol., 24.","DOI":"10.1177\/2057178X19858453"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/j.jobcr.2020.07.005","article-title":"Evaluation of mast cells and burning sensation in various stages of Oral Submucous Fibrosis","volume":"10","author":"Kumar","year":"2020","journal-title":"J. Oral Biol. Craniofacial Res."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Shen, Y.-W., Shih, Y.-H., Fuh, L.-J., and Shieh, T.-M. (2020). Oral Submucous Fibrosis: A Review on Biomarkers, Pathogenic Mechanisms, and Treatments. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21197231"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1020","DOI":"10.1111\/odi.12857","article-title":"Development and validation of oral health-related quality of life measure in oral submucous fibrosis","volume":"24","author":"Gondivkar","year":"2018","journal-title":"Oral Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"S157","DOI":"10.4103\/0976-237X.166820","article-title":"Estimation of serum, salivary immunoglobulin G, immunoglobulin A levels and total protein, hemoglobin in smokeless tobacco chewers and oral submucous fibrosis patients","volume":"6","author":"Aswath","year":"2015","journal-title":"Contemp. Clin. Dent."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"406","DOI":"10.1111\/jop.12581","article-title":"Oral submucous fibrosis: An update on current theories of pathogenesis","volume":"46","author":"Arakeri","year":"2017","journal-title":"J. Oral Pathol. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"81","DOI":"10.4103\/0975-962X.135266","article-title":"Serum vitamin c and iron levels in oral submucous fibrosis","volume":"5","author":"Guruprasad","year":"2014","journal-title":"Indian J. Dent."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1016\/j.jfma.2015.05.011","article-title":"High frequencies of vitamin B12 and folic acid deficiencies and gastric parietal cell antibody positivity in oral submucous fibrosis patients","volume":"114","author":"Wang","year":"2015","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1111\/j.1600-0714.2008.00643.x","article-title":"Fingerprinting genomic instability in oral submucous fibrosis","volume":"37","author":"Teh","year":"2008","journal-title":"J. Oral Pathol. Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1016\/j.oraloncology.2005.08.005","article-title":"Oral submucous fibrosis: Review on aetiology and pathogenesis","volume":"42","author":"Tilakaratne","year":"2006","journal-title":"Oral Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"757","DOI":"10.1016\/j.oraloncology.2005.01.007","article-title":"Cell-mediated immunity and head and neck cancer: With special emphasis on betel quid chewing habit","volume":"41","author":"Chang","year":"2005","journal-title":"Oral Oncol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1111\/j.1834-7819.1996.tb03136.x","article-title":"Oral submucous fibrosis. A review","volume":"41","author":"Cox","year":"1996","journal-title":"Aust. Dent. J."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Ili\u0107, I., \u0160ipeti\u0107, S., Gruji\u010di\u0107, J., Ma\u010du\u017ei\u0107, I.\u017d., Koci\u0107, S., and Ili\u0107, M. (2019). Psychometric Properties of the World Health Organization\u2019s Quality of Life (WHOQOL-BREF) Questionnaire in Medical Students. Medicina, 55.","DOI":"10.3390\/medicina55120772"},{"key":"ref_15","first-page":"646","article-title":"Interaction of collagen-related genes and susceptibility to betel quid-induced oral submucous fibrosis","volume":"11","author":"Chiu","year":"2002","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Shih, Y.-H., Wang, T.-H., Shieh, T.-M., and Tseng, Y.-H. (2019). Oral Submucous Fibrosis: A Review on Etiopathogenesis, Diagnosis, and Therapy. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20122940"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1016\/j.oooo.2015.01.025","article-title":"Quality of life in patients with oral potentially malignant disorders: A systematic review","volume":"119","author":"Tadakamadla","year":"2015","journal-title":"Oral Surg. Oral Med. Oral Pathol. Oral Radiol."},{"key":"ref_18","unstructured":"Spilker, B. (1996). The world health organisation quality of life (WHOQOL) assessment instrument. Quality of Life and Pharmaeconomics in Clinical Trials, Lippincott-Raven Publishers. [2nd ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"938","DOI":"10.1136\/jech.2006.056028","article-title":"Antonovsky\u2019s sense of coherence scale and its relation with quality of life: A systematic review","volume":"61","author":"Eriksson","year":"2007","journal-title":"J. Epidemiol. Community Heath"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Fayers, P.M., and Machin, D. (2007). 5 Multi-item scales. Quality of Life: The Assessment, Analysis and Interpretation of Patient-Reported Outcomes, John Wiley & Sons, Ltd. [2nd ed.].","DOI":"10.1002\/9780470024522"},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"(1998). The Whoqol Group Development of the World Health Organization WHOQOL-BREF Quality of Life Assessment. Psychol. Med., 28, 551\u2013558.","DOI":"10.1017\/S0033291798006667"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2555","DOI":"10.1590\/S0102-311X2007001100003","article-title":"Measuring the impact of oral health problems on hildren\u2019s quality of life: Conceptual and methodological issues","volume":"23","author":"Tesch","year":"2007","journal-title":"Cad. Saude Publica"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1590\/S0102-311X2007000700023","article-title":"The impact of oral health on daily performance of municipal waste disposal workers in Porto Alegre, Rio Grande do, Sul State, Brazil","volume":"23","author":"Gomes","year":"2007","journal-title":"Cad. Saude Publica"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.socscimed.2003.12.021","article-title":"Self-rated oral health as an independent predictor of self-rated general health, self-esteem and life satisfaction","volume":"59","author":"Benyamini","year":"2004","journal-title":"Soc. Sci. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1123","DOI":"10.1007\/s11136-011-9845-3","article-title":"Quality of life in Brazil: Normative values for the WHOQOL-bref in a southern general population sample","volume":"20","author":"Cruz","year":"2011","journal-title":"Qual. Life Res."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1007\/s00038-010-0174-z","article-title":"Quality of life among an Iranian general population sample using the World Health Organization\u2019s quality of life instrument (WHOQOL-BREF)","volume":"56","author":"Nedjat","year":"2010","journal-title":"Int. J. Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1023\/A:1018782831217","article-title":"Development of the Fear of Pain Questionnaire-III","volume":"21","author":"McNeil","year":"1998","journal-title":"J. Behav. Med."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1023\/A:1013867826835","article-title":"The WHO quality of life assessment instrument (WHOQOL-Bref): The importance of its items for cross-cultural research","volume":"10","author":"Saxena","year":"2001","journal-title":"Qual. Life Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s11205-005-5552-1","article-title":"Interpreting the WHOQOL-Br\u00e8f: Preliminary Population Norms and Effect Sizes","volume":"77","author":"Hawthorne","year":"2006","journal-title":"Soc. Indic. Res."},{"key":"ref_30","unstructured":"World Health Organization (1996). WHOQOL-BREF: Introduction, Administration, Scoring and Generic Version of the Assessment: Field Trial Version, December 1996, World Health Organization."},{"key":"ref_31","first-page":"129","article-title":"Psychometric properties of the Urdu version of the World Health Organization\u2019s quality of life questionnaire (WHOQOL-BREF)","volume":"31","author":"Raza","year":"2017","journal-title":"Med. J. Islam. Repub. Iran"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1186\/s40064-015-1477-6","article-title":"Influence of burnout and sleep difficulties on the quality of life among medical students","volume":"4","author":"Pagnin","year":"2015","journal-title":"SpringerPlus"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Zhang, Y., Qu, B., Lun, S., Wang, D., Guo, Y., and Liu, J. (2012). Quality of Life of Medical Students in China: A Study Using the WHOQOL-BREF. PLoS ONE, 7.","DOI":"10.1371\/journal.pone.0049714"},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Suliman, N.M., Johannessen, A.C., Ali, R.W., Salman, H., and \u00c5str\u00f8m, A.N. (2012). Influence of oral mucosal lesions and oral symptoms on oral health related quality of life in dermatological patients: A cross sectional study in Sudan. BMC Oral Health, 12.","DOI":"10.1186\/1472-6831-12-19"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1007\/s12663-018-1114-3","article-title":"Impact of Oral Submucous Fibrosis on Quality of Life: A Cross-Sectional Study","volume":"18","author":"Chaudhry","year":"2019","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s12663-019-01190-4","article-title":"Impact of Oral Submucous Fibrosis on Quality of Life: A Multifactorial Assessment","volume":"19","author":"Chaudhry","year":"2020","journal-title":"J. Maxillofac. Oral Surg."},{"key":"ref_37","unstructured":"The World Health Organization Quality of Life Group (1996). The World Health Organization Quality of Life Assessment (WHOQOL-BREF): Introduction, Administration, Scoring and Generic Version of the Assessment, Programme on Mental Health."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1111\/j.1365-2842.1995.tb00084.x","article-title":"Angle of mouth opening measurement: Reliability of a technique for temporomandibular joint mobility assessment","volume":"22","author":"Dijkstra","year":"1995","journal-title":"J. Oral Rehabil."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"200","DOI":"10.1016\/j.oraloncology.2011.10.011","article-title":"Proposed clinical classification for oral submucous fibrosis","volume":"48","author":"More","year":"2012","journal-title":"Oral Oncol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"2494","DOI":"10.1016\/j.joms.2012.05.013","article-title":"Quality of Life Outcomes After Third Molar Removal in Subjects with Minor Symptoms of Pericoronitis","volume":"70","author":"Bradshaw","year":"2012","journal-title":"J. Oral Maxillofac. Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1241","DOI":"10.1007\/s11136-011-0022-5","article-title":"The internal responsiveness of the Oral Health Impact Profile-14 to detect differences in clinical parameters related to surgical third molar removal","volume":"21","author":"Kieffer","year":"2012","journal-title":"Qual. Life Res."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Jaro\u0144, A., Preuss, O., Konkol, B., and Trybek, G. (2021). Quality of Life of Patients after Kinesio Tape Applications Following Impacted Mandibular Third Molar Surgeries. J. Clin. Med., 10.","DOI":"10.3390\/jcm10102197"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1023\/B:QURE.0000018486.91360.00","article-title":"The World Health Organization\u2019s WHOQOL-BREF quality of life assessment: Psychometric properties and results of the international field trial. A Report from the WHOQOL Group","volume":"13","author":"Skevington","year":"2004","journal-title":"Qual. Life Res."},{"key":"ref_44","first-page":"35","article-title":"The Factor Structure of the Adapted WHO Quality of Life BREF questionnaire in a sample of adolescents in Nigeria","volume":"6","author":"Akpa","year":"2018","journal-title":"Arch. Basic Appl. Med."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Baiano, M., Salvo, P., Righetti, P., Cereser, L., Baldissera, E., Camponogara, I., and Balestrieri, M. (2014). Exploring health-related quality of life in eating disorders by a cross-sectional study and a comprehensive review. BMC Psychiatry, 14.","DOI":"10.1186\/1471-244X-14-165"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1007\/s11136-004-4694-y","article-title":"Reliability and validity of the WHOQOL BREF in a sample of Brazilian outpatients with major depression","volume":"14","author":"Berlim","year":"2005","journal-title":"Qual. Life Res."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"1","DOI":"10.4103\/2231-0762.115700","article-title":"Oral health related quality of life","volume":"3","author":"Bennadi","year":"2013","journal-title":"J. Int Soc. Prev. Community Dent."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1186\/s12955-016-0502-y","article-title":"A comparison of health state utility values associated with oral potentially malignant disorders and oral cancer in Sri Lanka assessed using the EQ-5D-3 L and the EORTC-8D","volume":"14","author":"Kularatna","year":"2016","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1111\/jop.12620","article-title":"Impact of oral potentially malignant disorders on quality of life","volume":"47","author":"Tadakamadla","year":"2017","journal-title":"J. Oral Pathol. Med."},{"key":"ref_50","first-page":"43","article-title":"Validation of Nepalese Oral Health Impact Profile14 and Assessment of Its Impact in Patients with Oral Submucous Fibrosis in Nepal","volume":"13","author":"Rimal","year":"2015","journal-title":"J. Nepal Health Res. Counc."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.ijporl.2017.03.029","article-title":"Paediatric oral submucous fibrosis\u2014The neglected pre-malignancy of childhood","volume":"97","author":"Chitguppi","year":"2017","journal-title":"Int. J. Pediatr. Otorhinolaryngol."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1111\/j.1600-0714.1990.tb00804.x","article-title":"A case-control study of oral submucous fibrosis with special reference to the etiologic role of areca nut","volume":"19","author":"Sinor","year":"1990","journal-title":"J. Oral Pathol. Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"124","DOI":"10.4103\/0972-1363.195085","article-title":"Oral submucous fibrosis: A demographic study","volume":"28","author":"Kumar","year":"2016","journal-title":"J. Indian Acad. Oral Med. Radiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1111\/j.1600-0714.2006.00485.x","article-title":"Oral submucous fibrosis: Study of 1000 cases from central India","volume":"36","author":"Hazarey","year":"2006","journal-title":"J. Oral Pathol. Med."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"27","DOI":"10.4103\/0975-8844.113690","article-title":"Impact of oral diseases on quality of life insubjects attending out-patient department of a dental hospital, India","volume":"5","author":"Sahmadhavi","year":"2013","journal-title":"J. Orofac. Sci."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"e573","DOI":"10.4317\/medoral.14.e573","article-title":"Correlation between oral health-related quality of life (OHQoL) and oral disorders in a Turkish patient population","volume":"14","author":"Caglayan","year":"2009","journal-title":"Medicina Oral Patolog\u00eda Oral Cirugia Bucal"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"S296","DOI":"10.4103\/0019-5545.161496","article-title":"Female sexuality","volume":"57","author":"Rao","year":"2015","journal-title":"Indian J. Psychiatry"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"1086","DOI":"10.3389\/fpsyg.2018.01086","article-title":"Comparing Prescriptive and Descriptive Gender Stereotypes About Children, Adults, and the Elderly","volume":"9","author":"Koenig","year":"2018","journal-title":"Front. Psychol."},{"key":"ref_59","first-page":"985","article-title":"Oral submucous fibrosis: Etiology, pathogenesis, and future research","volume":"72","author":"Rajendran","year":"1994","journal-title":"Bull. World Health Organ."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1111\/j.1600-0714.1995.tb01156.x","article-title":"Etiology of oral submucous fibrosis with special reference to the role of areca nut chewing","volume":"24","author":"Murti","year":"1995","journal-title":"J. Oral Pathol. Med."},{"key":"ref_61","first-page":"317","article-title":"A comparative clinicopathological study of oral submucous fibrosis in habitualchewers of pan masala and betel quid","volume":"34","author":"Babu","year":"1996","journal-title":"Clin. Toxicol."},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Tadakamadla, J., Kumar, S., Lalloo, R., and Johnson, N.W. (2017). Qualitative analysis of the impact of Oral Potentially Malignant Disorders on daily life activities. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0175531"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12955-018-1065-x","article-title":"Assessing the quality of life among Pakistani general population and their associated factors by using the World Health Organization\u2019s quality of life instrument (WHOQOL-BREF): A population based cross-sectional study","volume":"17","author":"Lodhi","year":"2019","journal-title":"Health Qual. Life Outcomes"},{"key":"ref_64","first-page":"130","article-title":"Psychometric properties of WHOQOL-BREF in clinical and health Greek populations: Incorporating new culture-relevant items","volume":"23","author":"Triantafillou","year":"2012","journal-title":"Psychiatriki."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1007\/s11136-011-9926-3","article-title":"The WHO quality of life (WHOQOL) questionnaire: Spanish development and validation studies","volume":"21","year":"2012","journal-title":"Qual. Life Res."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1007\/s00296-011-2352-6","article-title":"Factors influencing quality of life (QOL) for Korean patients with rheumatoid arthritis (RA)","volume":"33","author":"Cho","year":"2012","journal-title":"Rheumatol. Int."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1007\/s11336-008-9101-0","article-title":"On the Use, the Misuse, and the Very Limited Usefulness of Cronbach\u2019s Alpha","volume":"74","author":"Sijtsma","year":"2008","journal-title":"Psychometrika"},{"key":"ref_68","unstructured":"Paul, K. (2000). The Handbook of Psychological Testing, Routledge."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9498\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T06:59:16Z","timestamp":1760165956000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/18\/18\/9498"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,9,9]]},"references-count":68,"journal-issue":{"issue":"18","published-online":{"date-parts":[[2021,9]]}},"alternative-id":["ijerph18189498"],"URL":"https:\/\/doi.org\/10.3390\/ijerph18189498","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,9,9]]}}}